Benign paroxysmal positional vertigo (BPPV) is an inner ear condition. It can cause a person to experience a spinning sensation with any head movement. It is not a serious condition, but it can certainly feel scary, disorienting, or lead to falls. Symptoms usually resolve on their own in a few days, but for some people it may take several weeks. There is a simple in-office procedure a doctor can perform that can help to alleviate your symptoms.

What Is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is an inner ear disorder that causes a person to experience a spinning sensation anytime they move their head. It is one of the most common causes of vertigo. Tilting your head backward or sitting up in bed may lead to an episode of feeling like the room is spinning. Dizziness can range from mild to severe and symptoms can last for several seconds or up to a minute.

BPPV is not a serious condition, and it usually resolves in a few days. However, some people may experience symptoms for several weeks. If it takes longer than six weeks, contact your healthcare provider. A simple in-office procedure can usually alleviate symptoms.

Although BPPV is not a serious medical condition, it can feel frightening and disorienting to suddenly have a sensation that the room is spinning. It is a dangerous condition for people over 65 to experience as it increases your risk of falling. Falling is the leading cause of fractures in people over 65. BPPV is most common among people over 50, but it can affect people at any age. It is rare in children.

What Causes BPPV?

BPPV, or the sensation of vertigo, is usually triggered when you move your head. Often, people notice this when tilting their head backward or sitting up in bed. The vertigo happens when calcium carbonate particles (otoconia) move into the inner ear structures that control balance and become trapped. Otoconia can loosen due to aging, injury, or infection. When you turn your head, the otoconia roll around and push against hair-like structures (cilia). Cilia are what transmits information about balance to your brain. BPPV has also been associated with migraines.

In some cases, BPPV can be a symptom of another inner ear condition, including:

• Vestibular neuritis
• Labyrinthitis
• Acoustic neuroma

Benign Paroxysmal Positional Vertigo Symptoms

Vertigo is the main symptom of BPPV. The sensation can range from mild to severe and last for several seconds up to one minute. BPPV usually only affects one ear at a time, but sometimes both ears can be affected.

Other symptoms include:

• Dizziness
• Lightheadedness
• Balance issues
• Nausea or vomiting
• Vision problems (blurred vision)
• Rapid, involuntary eye movements (nystagmus)

How Long Does BPPV Last?

The sensation of vertigo usually only lasts for several seconds up to a minute. Episodes can occur for a few days or up to six weeks. If symptoms persist beyond six weeks, consult with your healthcare provider. A simple in-office procedure can help to alleviate symptoms.

Benign Paroxysmal Positional Vertigo Diagnosis

Your doctor will conduct a physical exam and take a thorough medical history. To determine a BPPV diagnosis, your doctor will assess for the rapid eye movement, known as nystagmus. Your doctor may ask you to lie in certain positions, with your head slightly off the table. Changing your head positions will allow your doctor to see if you have an ability to control your eye movement. Your doctor will also check for dizziness related to your head or eye movement. If the dizziness lasts for a minute or less, this may indicate BPPV.

Additionally, your doctor may recommend further testing to assess your symptoms or rule out other causes, including:

• Electronystagmography (ENG)
• Videonystagmography (VNG)
• MRI

BPPV Treatment Options

Often, BPPV symptoms resolve on their own. But it is possible that symptoms may return at some point. If episodes are recurring, treatment usually consists of physical therapy. There are certain exercises, known as a canalith repositioning procedure and an Epley maneuver, that help to shift the otoconia out of the semicircular canals and back into their proper location in the utricle. A physical therapist or your healthcare provider can help take you through these exercises.

If exercises do not work to relieve BPPV, your doctor may recommend surgery. Additionally, your doctor may recommend motion sickness medication. Make sure not to take these medications for a prolonged period.

Treatment options may include:

• Canalith repositioning procedures
• Epley maneuver
• Vestibular rehabilitation therapy
• Surgery (in rare cases)
• Motion sickness medications

What are Benign Paroxysmal Positional Vertigo Exercises?

The physical therapy exercises, known as a canalith repositioning procedure, involve a series of movements that change the position of your head and body. Usually, one round of exercises can resolve your symptoms. There is also a technique known as the Epley maneuver, which is an exercise that your physical therapist or audiologist can perform in their office. Additional exercises may be needed if symptoms persist.

Steps of the Epley Maneuver (for right ear BPPV):

1. Sit on a bed and turn your head 45 degrees to the right.
2. Lie back quickly with your head slightly hanging off the edge, still turned to the right. Hold for 30 seconds.
3. Turn your head 90 degrees to the left, without raising it. Hold for 30 seconds.
4. Turn your head and body another 90 degrees to the left so you're lying on your side. Hold for 30 seconds.
5. Sit up slowly.

Note: Your provider will guide you through these steps and modify them based on which ear is affected.

How to Prevent BPPV

There is no way to prevent BPPV, but it is possible to manage the condition with repositioning exercises. You can reduce the risk of trauma-related BPPV by wearing a helmet when biking or playing other contact sports.

Helpful prevention tips:

• Avoid sleeping with your head completely flat.
• Rise slowly from bed in the morning.
• Wear protective headgear when biking or during contact sports.
• Do repositioning exercises if advised by your doctor.

When to Talk to Your Doctor

If you experience an episode of vertigo that lasts for several seconds or up to a minute when you move your head, contact your healthcare provider. They can show you exercises to help reduce or alleviate symptoms. To reach a Baptist Health audiologist, please call 1.844.679.6835.

FAQs

What Triggers Benign Paroxysmal Positional Vertigo?

BPPV is usually triggered by moving your head. Tilting your head backward or sitting up in bed are common triggers for BPPV.

Additional triggers may include:

• Inner ear diseases
• High-intensity aerobics
• Long periods with your head in the same position (e.g., dentist, hair salon, bed rest)

What Vitamin Deficiency Causes Benign Paroxysmal Positional Vertigo?

Research has shown that a deficiency in vitamin D can cause BPPV.

How Common is BPPV?

BPPV is the most common form of vertigo and is considered the most common inner ear infection.