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Benign Positional Paroxysmal Vertigo (BPPV)

Overview

Benign positional paroxysmal vertigo (BPPV) refers to brief intermittent attacks of rotatory vertigo, which is a sudden spinning sensation. It is precipitated by a rapid change in head position, such as turning in bed, looking up, or bending forward. Among the inner ear balance organs, the posterior semicircular canal is affected the most, followed by the anterior semicircular canal.

People with BPPV usually experience:

  • Vertigo (spinning sensation) on turning the head, while sitting up or lying down, and looking up or bending down
  • Nausea or vomiting when severe
  • Imbalance
  • Bried and intermittent episodes
  • Relieved by resting in one position

BPPV is caused by movements of canalith (calcium crystals in the inner ear) in endolymph (fluid in the inner ear). These crystals interfere with normal balance signals, leading to vertigo. Certain factors increase the likelihood of developing BPPV:

  • Age: Most common in people aged >50 years, but can occur any time
  • Gender: BPPV is common in women
  • Vitamin D deficiency
  • Head trauma
  • Other disorders, including:
    • Labyrinthitis
    • Vestibular neuronitis
    • Meniere disease
    • Migraine
    • Inner ear surgery
  • Other conditions, including:
    • Hypertension
    • Diabetes mellitus
    • Hyperlipidaemia
    • Osteoporosis
    • Non-apnoea sleep disorders

Doctors diagnose BPPV mainly through:

  • Clinical examination: Using the head impulse test or Dix Hallpike manoeuvre, where specific head positions are used to trigger vertigo and eye movements.
  • MRI brain: to detect unusual features or to rule out other causes.

BPPV can often be effectively treated with:

  • Repositing manoeuvres: Such as Epley’s manoeuvre, Semont’s manoeuvre, or Brandt–Daroff exercises that help move displaced crystals back to their normal position.
  • Regular vestibular rehabilitation exercises to improve balance and reduce dizziness.
  • Medicines for symptomatic treatment of nausea or severe vertigo.

Seek medical advice if you experience:

  • Repeated or severe episodes of spinning sensation.
  • Imbalance that interferes with daily activities.
  • Vertigo associated with hearing loss, double vision, weakness, or slurred speech

While BPPV cannot always be prevented, you can lower risk and recurrence by:

  • Avoiding sudden or jerky head movements.
  • Treating vitamin D deficiency.
  • Managing underlying medical conditions such as diabetes, hypertension, or osteoporosis.

For diagnosis and treatment of BPPV, consult a Neurologist (specialist in brain and balance disorders) or an ENT specialist (if inner ear disease is suspected).

Disclaimer:

The information in this Health Library is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any questions about a medical condition or before starting any treatment. Use of this site and its content does not establish a doctor–patient relationship. In case of a medical emergency, call your local emergency number or visit the nearest emergency facility immediately.