Benign Paroxysmal Positional Vertigo (BPPV) is a disorder in which changing your head position with respect to gravity leads to sudden vertigo—a feeling that the room is spinning around. The vertigo can vary in its intensity from mild to severe, usually lasts for less than one minute, and may be accompanied by other symptoms including dizziness, lightheadedness, a sense of imbalance, nausea, and vomiting.
BPPV is not a sign of a serious problem, and it usually disappears on its own within six weeks after its initial onset. However, the symptoms of BPPV can be very disturbing and may be dangerous, especially in older individuals, because the unsteadiness associated with BPPV can lead to falls. About half of all people over age 65 experience an episode of BPPV at some time, and falls in older individuals are a leading cause of fractures.
What causes BPPV?
Benign paroxysmal positional vertigo develops when calcium carbonate crystals, which are known as otoconia, shift into and become trapped within the semicircular canals (one of the vestibular organs of the inner ear). The otoconia make up part of the structure of the utricle, a vestibular organ adjacent to the semicircular canals. In the utricle, the otoconia may be loosened as a result of injury, infection, or age, and they land in a sac (the utriculus), where they are naturally dissolved. However, otoconia in the semicircular canals will not dissolve. As a person’s head position changes with respect to gravity, the otoconia begin to roll around and push on the tiny hairs which line the semicircular canals. Those hairs act as sensors to give the brain information about balance. Vertigo develops when the hairs are stimulated by the rolling otoconia.
Movements that can trigger an episode of BPPV include rolling over or sitting up in bed, bending the head forward to look down, or tipping the head backward. In most people, only a single ear is affected by BPPV, although both ears may be involved on occasion.
Vertigo Diagnosis and Vertigo Treatment
With advances in medical technology, BPPV can be easily diagnosed and treated. The diagnosis can usually be made in the office based on history and physical examination. Treatment of benign paroxysmal positional vertigo involves a short, simple, in-office procedure known as the particle repositioning maneuver.
The particle repositioning procedure takes about 15 minutes to complete and involves a series of physical maneuvers that change the position of the head and body in order to shift the otoconia out of the semicircular canals and back into their proper location in the utriculus. The maneuvers are done while the patient is on a vertigo treatment table. They are very easy to perform, although patients should wear comfortable clothing that will allow them to move freely. Without treatment, the symptoms of BPPV may increase and then diminish over time until they resolve on their own, usually within six weeks. While the occurrence and severity of BPPV may be lessened during that time by paying careful attention to head position and with use of some medications, such as anti-motion sickness drugs to control nausea, it is usually best to attempt the particle repositioning procedure, which is a very safe and rapid way to relieve symptoms and to minimize the chance for falls. Medications should not be used long term.
What if the vertigo procedure doesn’t work?
The particle repositioning procedure is effective as a vertigo treatment about 80 to 90 percent of BPPV cases. Additional exercise or repositioning maneuvers may be needed if symptoms persist.
Can BPPV recur? What should I do?
A new episode of BPPV can develop after successful treatment—on average there is a 15 percent per year rate of recurrence. However, it may be possible to treat the recurrent BPPV at home by performing a series of movements at the time a episode occurs and by following those movements with the post-procedure instructions used after the original treatment. BPPV patients will receive information on ways to handle recurrences on their own, or they can work with a physical therapist or primary care physician to develop a plan.
In general, if you wake up with positional vertigo, slowly move into the good-ear-down position and wait for a minute. Next, slowly move into a facedown position and slide to the foot of the bed. Keep your head down until you reach the end of the bed and are kneeling or standing on the floor. Slowly bring your head backward into and upright position. Hold on to the bed at all times. Follow the post-particle repositioning maneuver instructions you have been given previously.
An alternate method is to sit toward the foot of the bed, leaving enough room to lie back with your head resting comfortably at the end of the bed and slightly extended. Be careful not to overextend your neck, as this may aggravate existing neck problems. If your symptoms are severe, you may need assistance to complete the following maneuver:
- Step 1: Turn your head toward your affected ear and lie back quickly. HOLD 1-2 min.
- Step 2: Keeping your head back against the bed, turn it toward the good ear. HOLD
- Step 3: Roll onto your side with your good ear down. Your nose should be turned toward the floor. HOLD
- Step 4: Sit up quickly, swinging your feet from the bed to the floor at the side of the bed so your feet touch the floor, keeping your chin tucked in toward your shoulder. You should be sitting on the side of your bed so your feet touch the floor, with your chin still tucked in. HOLD
- Step 5: Bring your head slowly upright.
If this maneuver does not help, it may be repeated one time.