- Benign paroxysmal positional vertigo (BPPV) is the most common cause of short, sudden episodes of spinning dizziness (vertigo).
- These episodes usually last less than a minute and are often triggered by specific head movements, such as turning in bed, lying down, sitting up quickly, or looking up.
- Vertigo is a false spinning sensation, as if either you or the environment around you is rotating. Most people describe it as feeling like being on a carousel. Less commonly, the sensation may feel like spinning in other directions.
What Causes BPPV?
BPPV occurs when tiny particles inside the inner ear’s semi-circular canals move abnormally. These particles interfere with the inner ear’s ability to communicate balance information to the brain, leading to vertigo. The condition is not dangerous, but it can be very distressing.
Common Signs and Symptoms
- Sudden spinning dizziness lasting less than a minute
- Triggered by rapid head movements (e.g., rolling in bed, bending the head backwards, or looking up/down)
- A feeling of swaying, falling, or general imbalance
- Nausea or vomiting during more intense episodes
- Involuntary eye movements (nystagmus), usually with a rotary or spinning pattern
- Symptoms often improve when focusing on a fixed point
Diagnosis
BPPV can usually be confirmed with simple bedside tests that reproduce symptoms and reveal characteristic nystagmus. These tests also help identify which semi-circular canal is affected.
Treatment
The primary treatment is repositioning manoeuvres (such as the Epley, Semont, or Lempert manoeuvres illustrated below), which guide displaced inner ear particles back to their normal position. These manoeuvres provide fast and reliable relief in most cases, particularly when specific tests, like the Dix-Hallpike test, confirm BPPV.
- Medication is generally not effective in treating BPPV.
- If symptoms persist, vestibular rehabilitation therapy (specialised balance exercises) may be recommended.
Causes of Recurrent or Persistent Symptoms
Sometimes vertigo continues or returns due to other contributing factors, such as:
- Age-related decline in the balance system, neck, or vision
- Previous head or whiplash injuries
- Vestibular migraine or Ménière’s disease
- Neurological conditions affecting balance (e.g., Parkinson’s disease)
- Psychological factors such as stress, anxiety, or depression
- Lifestyle factors, including poor sleep, lack of exercise, or an unbalanced diet
In these cases, vertigo may be multifactorial, requiring a broader evaluation and tailored vestibular rehabilitation.
Prognosis
- Pure BPPV is usually short-lived and highly treatable, often resolving with one or two manoeuvres.
- If one or two different manoeuvres performed by an expert do not provide relief, other possible causes should be considered.
- Persistent or complex vertigo often involves multiple contributing factors and may require longer-term vestibular rehabilitation.
Read more
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