BPPV (benign paroxysmal positional vertigo) is an inner ear condition that can cause brief episodes of spinning vertigo, dizziness, and feeling unsteady. It often happens with simple movements like getting out of bed, turning over in bed, or quickly looking up.
BPPV occurs when tiny calcium carbonate crystals shift out of place inside the inner ear’s fluid-filled semicircular canals. This makes the inner ear overly sensitive to changes in head position and can trigger dizziness or vertigo.
Treatment is typically guided by a primary care provider or an otolaryngologist (ENT). Options may include specific repositioning maneuvers, medicines to ease symptoms in selected cases, or surgery in rare situations.
Main symptoms
The main symptoms of benign paroxysmal positional vertigo (BPPV) include:
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Dizziness when lying down, getting up, or turning over in bed;
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Spinning vertigo, with a sensation that the surroundings are moving;
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Intense dizziness when moving the head, such as tilting it backward, to the side, or downward;
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Loss of balance;
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Nausea and vomiting;
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Involuntary eye movements, called nystagmus.
Dizziness is usually short-lived and lasts less than 1 minute. In some cases, episodes can recur over weeks or months, which may disrupt daily life and make routine tasks harder.
Confirming a diagnosis
Benign paroxysmal positional vertigo is diagnosed by an otolaryngologist (ENT) or a primary care provider based on symptoms and health history.
To confirm BPPV, the clinician usually performs an in-office test that brings on symptoms, called the Dix-Hallpike maneuver. According to the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF), the Dix-Hallpike maneuver is the recommended positional test to diagnose posterior canal BPPV when it provokes vertigo with characteristic nystagmus.
In some situations, imaging or other tests may be ordered to rule out conditions with similar symptoms, such as Ménière’s disease, labyrinthitis, or stroke. Examples include a CT scan, MRI, electronystagmography, or electrocochleography.
Possible causes
Benign paroxysmal positional vertigo (BPPV) is caused by calcium carbonate crystals, also called otoconia, moving into areas of the inner ear where they do not belong, including the semicircular canals.
These crystals help the inner ear sense head position and movement in relation to gravity, such as looking up or down, turning side to side, and moving between lying down, sitting, and standing. When the crystals shift, the inner ear can misread head movements, leading to dizziness and vertigo.
Certain factors may increase the risk of BPPV, including older age (it is more common in older adults), head injury, labyrinthitis, migraine, prior inner ear surgery, and Ménière’s disease.
Treatment options
Treatment for BPPV is usually guided by a clinician experienced in vestibular disorders (such as a primary care provider, ENT, audiologist, or physical therapist) and typically involves specific maneuvers to move the displaced inner ear crystals back into place.
A common option is the Epley maneuver, which is performed in the clinic and is often enough to relieve symptoms and resolve vertigo right away. Your clinician may repeat the maneuver or use other repositioning maneuvers at follow up if symptoms persist.
Based on the AAO-HNSF clinical practice guideline, canalith repositioning procedures (such as the Epley maneuver) are recommended as first-line treatment for BPPV, and routine use of vestibular suppressant medications is discouraged.
Still, in certain cases, a clinician may prescribe medication to help relieve vertigo, such as meclizine, or anti-nausea medicines to help with nausea and vomiting, such as ondansetron or metoclopramide.
In some cases, especially when maneuvers and symptom-relief medicines do not improve BPPV, surgery may be recommended to block the affected semicircular canal.