Benign Paroxysmal Positional Vertigo
What is benign paroxysmal positional vertigo?
Benign paroxysmal positional vertigo (BPPV) is a disease of the vestibular system of your inner ear. When you change your head position, it causes vertigo. Vertigo is a feeling that the room is spinning around you.
Your vestibular system helps sense
motion and changes in space. It adds to your sense of balance. The vestibular organs are
inside the innermost part of your ear. They include the utricle, saccule, and 3
semicircular canals. When your head moves, these small organs send this information to
The utricle contains small calcium
crystals. These help you to sense motion. Sometimes these crystals detach from the
utricle and land in one of the semicircular canals. Then the canals may send the wrong
signals to the brain, especially when the crystals move. This confuses the brain and
leads to BPPV symptoms.
The condition is called benign
because it is not life-threatening. It does not get worse with time. Paroxysmal means
that the vertigo comes and goes. Positional just means that symptoms come from a change
in head position.
BPPV is fairly common, especially
in women. Older adults have it more often. But people of any age can get it. It is one
of the most common vestibular disorders.
What causes benign paroxysmal positional vertigo?
Anything that dislodges the
crystals from the utricle can cause BPPV. Having a past head injury is a major cause.
Other times, BPPV may result from other problems with the vestibular system. These can
include Ménière disease or vestibular neuritis. Ear surgery is a less common cause. In
most cases, no one knows exactly what causes BPPV.
Who is at risk for benign paroxysmal positional vertigo?
People with certain health
conditions may have a higher risk for BPPV. But many times the cause is not known. You
may have a higher risk of developing BPPV if you have any of these:
It’s not clear if treating these
conditions might reduce your risk for BPPV.
What are the symptoms of benign paroxysmal positional vertigo?
The most common BPPV symptoms
Certain types of movement can bring
on symptoms. Symptoms then often last a minute or less. Common triggers are rolling over
in bed or looking up while standing. These symptoms can vary in how often they happen
and how severe they are. In some people, these symptoms are so severe that they disrupt
personal and work life.
Very often, the symptoms go away
and then come back weeks or months later. Without treatment, symptoms might continue for
a few weeks before going away. In a small number of people, the symptoms never come back
after the first time.
Unlike some other causes of
vertigo, BPPV doesn't cause nervous system symptoms such as severe headache, speech
problems, or loss of limb movement. It also doesn't cause hearing problems.
The symptoms of BPPV may seem like
those of other health conditions. Always see your healthcare provider for a
How is benign paroxysmal positional vertigo diagnosed?
BPPV may be diagnosed and treated
by your primary healthcare provider. Or by an ear, nose, and throat doctor
(otolaryngologist). Or it may be diagnosed and treated by a neurologist. The provider
will ask about your health history. You may also have a physical exam. This may include
hearing and balance tests. It will also include an exam of the nervous and
cardiovascular systems. Problems with these systems can also cause vertigo.
As part of the exam, your
healthcare provider may have you do certain movements. These will include moving your
head and body in certain ways. If you have BPPV, this test can bring on vertigo. It can
also bring on quick, involuntary eye movements (nystagmus). Your provider can also use
this test to find which semicircular canal is most likely affected.
If your healthcare provider is
still not sure about the diagnosis, you may need other tests such as:
ENG (electronystagmography). This test uses
electrodes to test your eye movements in response to stimuli that may cause your
VNG (videonystagmography). This test is similar
to an ENG but it uses cameras instead. Your eyes are a part of your sense of
balance. So ENG and VNG tests may help find the cause of your vertigo.
Imaging tests. Tests such as an MRI can help
rule out nervous system problems as a cause.
How is benign paroxysmal positional vertigo treated?
Treatment will depend on your symptoms, age, and general health. It
will also depend on how severe the condition is.
First your healthcare provider may
try to move the calcium crystals out of your semicircular canals. This may be done with
a series of certain head and neck movements. This often takes about 15 minutes. Your
provider may tell you to do certain movements at home. This treatment often works. Some
people may still have vertigo with head movement for a few weeks.
Special physical therapy may also
be part of your treatment.
Medicines are not often given for
BPPV. This is because most of them don't help. In some cases, short-term use of motion
sickness medicines may help to ease nausea.
If these other treatments fail, in
rare cases your healthcare provider may advise surgery. One option is called posterior
canal plugging. It blocks the movement of calcium crystals in the posterior semicircular
canal. The surgery can work well. But in rare cases, it can cause some hearing loss.
Your healthcare provider may also
advise a watch-and-wait approach to your BPPV before trying surgery. BPPV does often go
away on its own over time. But in many cases it does come back. If you are still having
symptoms from BPPV, your healthcare provider may tell you how to prevent symptoms. For
Using 2 pillows in bed to raise your
Not sleeping on your affected
Rising slowly out of bed
Not looking up
Not bending over to pick things
Not doing exercises that use head
rotation, such as swimming laps
Even if you stop having symptoms,
your healthcare provider may suggest that you follow similar instructions, at least for
a few weeks. This may help prevent your symptoms from coming back.
Key points about benign paroxysmal positional vertigo
BPPV is a disease that affects the
vestibular system of the inner ear. With changes of head position, it causes sudden
vertigo and related symptoms.
Head injury and past vestibular disorders can cause BPPV. But
many times the cause is not known.
Symptoms typically happen with head
movement. The vertigo lasts only a short while, but it may come back many times.
BPPV often responds to treatment with
physical movements. But in rare cases some people with severe BPPV may need
As you are recovering from BPPV, you
may need to not make certain head movements to help prevent your symptoms from coming
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
Online Medical Reviewer:
Ashutosh Kacker MD
Online Medical Reviewer:
Daphne Pierce-Smith RN MSN CCRC
Online Medical Reviewer:
Ronald Karlin MD
Date Last Reviewed:
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