Benign Paroxysmal Positional Vertigo (BPPV)
Brief spinning dizziness triggered by head movements
Quick Facts
- Type: Inner ear (vestibular) disorder
- Cause: Displaced inner ear crystals
- Trigger: Changes in head position
- Treatment: Repositioning maneuvers
Overview
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, the false sensation that you or your surroundings are spinning. It happens when tiny calcium crystals that normally sit in one part of the inner ear become dislodged and move into the fluid-filled balance canals. When you move your head, these loose crystals disturb the fluid and send confusing signals to the brain, triggering a brief, intense spinning sensation.
BPPV is described as benign because it is not life-threatening, paroxysmal because it comes in sudden short bursts, and positional because it is set off by changes in head position. It is usually very treatable with simple repositioning maneuvers, though it can recur.
Symptoms
The hallmark of BPPV is short episodes of vertigo brought on by specific head movements. Symptoms include:
- A sudden spinning sensation, usually lasting less than a minute
- Dizziness triggered by movements such as rolling over in bed, lying down, sitting up, or tilting the head back
- A feeling of imbalance between episodes
- Nausea, and sometimes vomiting, with the spinning
- Brief, jerking eye movements during an episode
BPPV does not cause hearing loss, ringing in the ears, or ongoing dizziness on its own. Seek urgent care if dizziness comes with severe headache, weakness, numbness, trouble speaking, double vision, or fainting, which can suggest a more serious cause.
Causes
BPPV is caused by displaced inner ear crystals (otoliths) entering the balance canals. Often there is no clear reason, but recognized triggers include:
- Aging: The most common situation, as the inner ear changes with age.
- Head injury: A blow to the head can dislodge the crystals.
- Prolonged bed rest or head position: Such as after illness or dental or surgical procedures.
- Inner ear disorders: That disturb the balance system.
Risk Factors
- Older age, with BPPV most common after 50
- Previous head injury
- A prior episode of BPPV, which can recur
- Other inner ear conditions
- Being female, as it is somewhat more common in women
Diagnosis
A clinician can usually diagnose BPPV from the history and a simple bedside test.
- Positional testing: The Dix-Hallpike maneuver involves quickly moving the head and body into specific positions to bring on the vertigo and observe the characteristic eye movements.
- Medical history: Focusing on what triggers the dizziness and how long it lasts.
- Additional tests: Hearing tests or imaging are usually not needed but may be done if the picture is unclear or another cause is suspected.
Treatment
BPPV often responds quickly to repositioning treatments that guide the crystals back to where they belong.
- Canalith repositioning (Epley maneuver): A series of head and body movements performed by a clinician, and sometimes taught for home use, to move the crystals out of the balance canal. This is the main treatment.
- Home exercises: Certain exercises may be recommended to help symptoms settle.
- Symptom relief: Medications for nausea may be used briefly, but they do not cure BPPV.
- Watchful waiting: BPPV sometimes resolves on its own over weeks.
Most people improve substantially after one or a few repositioning sessions, though BPPV can return and be re-treated.
Prevention
BPPV cannot always be prevented, but you can reduce the impact of episodes and lower the risk of injury:
- Move slowly when changing position, especially getting out of bed
- Sit down right away if you feel a spinning episode start
- Learn recommended repositioning exercises if you have recurrent BPPV
- Protect your head from injury
- Make your home safer to prevent falls during episodes
When to See a Doctor
See a clinician if you have repeated episodes of brief spinning dizziness with position changes, so the diagnosis can be confirmed and treated. Seek urgent or emergency care if dizziness is accompanied by a severe or sudden headache, weakness or numbness, trouble speaking or seeing, difficulty walking, fainting, or new hearing loss, as these can indicate a more serious problem such as a stroke.
Frequently Asked Questions
What triggers BPPV episodes?
Episodes are triggered by changes in head position, such as rolling over in bed, lying down, sitting up quickly, or tilting your head back. The movement disturbs displaced inner ear crystals, causing a brief, intense spinning sensation.
How long does BPPV vertigo last?
Each episode of spinning is usually brief, often lasting less than a minute, although you may feel off-balance or queasy for a while afterward. The condition itself can persist or recur until it is treated or settles.
How is BPPV treated?
The main treatment is a canalith repositioning maneuver, such as the Epley maneuver, in which a clinician guides your head and body through a series of positions to move the crystals out of the balance canal. Most people improve after one or a few sessions.
Is BPPV dangerous?
BPPV itself is not dangerous, which is why it is called benign. The main risk is falling or injury during an episode. However, if dizziness comes with severe headache, weakness, trouble speaking, or fainting, seek urgent care to rule out a more serious cause.
Does BPPV cause hearing loss?
No. BPPV affects only the balance part of the inner ear and does not cause hearing loss or ringing in the ears. If you have dizziness along with hearing changes, see a clinician, as another inner ear condition may be involved.
References
- National Institute on Deafness and Other Communication Disorders (NIDCD). Balance Disorders.
- Mayo Clinic. Benign paroxysmal positional vertigo (BPPV).
- MedlinePlus, U.S. National Library of Medicine. Benign positional vertigo.
- American Academy of Otolaryngology-Head and Neck Surgery. Dizziness and Motion Sickness.