Benign Paroxysmal Positional Vertigo (BPPV)

What is benign paroxysmal positional vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder. With BPPV, changes in your head position — such as tipping your head backward or sitting up in bed — lead to sudden vertigo (a feeling that the room is spinning).

BPPV isn’t a sign of a serious problem, and it usually disappears on its own within a few days of the first episode. (It could take several weeks for some people.) However, the symptoms of BPPV can be very frightening and may be dangerous, especially in adults over the age of 65. The unsteadiness of BPPV can lead to falls, which are a leading cause of fractures.

Who does benign paroxysmal positional vertigo affect?

BPPV can affect people of all ages, but it’s most common in adults over the age of 50. About half of all people in this age range experience at least one episode of BPPV in their lifetime.

BPPV can affect children, but it’s rare.

How common is BPPV?

Benign paroxysmal positional vertigo is the most common inner ear disorder. In fact, approximately 20% of people who are evaluated for dizziness are diagnosed with BPPV.

Is BPPV permanent?

BPPV usually goes away on its own. However, until it’s successfully treated, it can come back. In some cases, months — or even years — go by before another episode occurs.

What are the symptoms of benign paroxysmal positional vertigo?

Vertigo is the main symptom of BPPV. This vertigo sensation can range from mild to severe and may last seconds, or up to 1 minute. It may be accompanied by other benign paroxysmal positional vertigo symptoms, including:

• Dizziness.
• Lightheadedness.
• Balance problems.
• Nausea and vomiting.
• Blurred vision.
• Nystagmus (rapid, involuntary eye movements).

While BPPV usually only affects one ear at a time, it can potentially affect both ears.

What triggers BPPV?

BPPV is almost always triggered by a change in your head’s position. Some people may notice symptoms when lying down or sitting up in bed. Others might notice symptoms when they tilt their head back or to the side. These symptoms often worsen with age due to normal wear and tear of the inner ear structures.

In some instances, BPPV may be a symptom of another inner ear condition, such as:

• Labyrinthitis.
• Vestibular neuritis.
• Acoustic neuroma.

Additionally, BPPV may accompany migraines, or it may develop after a traumatic event — such as a fall, accident or sports injury.

Why do changes in head position cause BPPV?

BPPV develops when calcium carbonate particles (otoconia) move into your semicircular canals (inner ear structures that control balance) and become trapped. Normally, the otoconia are part of your utricle, a vestibular organ next to your semicircular canals.

In your utricle, the otoconia may become loose due to injury, infection or age. As your head position changes, the otoconia roll around and push on tiny hair-like structures (cilia) within your semicircular canals. Those cilia help transmit information about balance to your brain. Vertigo develops when the cilia are stimulated by the rolling otoconia.

How is benign paroxysmal positional vertigo diagnosed?

Your healthcare provider can diagnose BPPV during an office visit. They’ll perform a physical examination and ask questions about your symptoms and medical history.

What is the fastest way to cure BPPV?

The most effective benign paroxysmal positional vertigo treatments involve physical therapy exercises. The goal of these exercises is to move the calcium carbonate particles out of your semicircular canals and back into your utricle. Here, the particles resorb more easily and don’t cause uncomfortable symptoms.

You can also take motion sickness medications to relieve your symptoms. However, you shouldn’t take these medications long term.

Benign paroxysmal positional vertigo exercises: How do they work?

BPPV exercises — sometimes called canalith repositioning procedures — typically take about 15 minutes to complete. Particle repositioning involves a series of physical movements that change the position of your head and body. These actions shift the otoconia out of your semicircular canals and back into their proper location in your utricle.

A single particle repositioning procedure is effective in treating about 80% to 90% of cases of BPPV. Additional BPPV exercises may be needed if symptoms continue.

Your healthcare provider can perform this maneuver during an office visit. They can also demonstrate how to do these exercises at home to ease your BPPV symptoms.

In the meantime, here are some step-by-step instructions to try:

• Step 1: Start by sitting up on a bed or table. Turn your head 45 degrees toward the affected ear.
• Step 2: Quickly lie back, keeping your head turned toward the affected ear as you lie back with your head slightly over the edge of the bed or table. Wait about a minute or until you stop having symptoms.
• Step 3: Without raising your head, turn your head quickly in the opposite direction so that your “good” ear is parallel with — but slightly over the edge of — the table or bed. Wait about a minute or until you stop having symptoms.
• Step 4: Roll onto your side. Continue to turn your head another 90 degrees in the same direction as step 3 so that your nose is now facing the floor. Wait about a minute.
• Step 5: Keeping your chin tucked in toward your shoulder, sit up in the direction your body is facing. Follow any post-particle repositioning instructions given to you by your healthcare provider.

Can BPPV go away on its own?

Yes. In many cases, BPPV goes away on its own eventually. But it can come back. If it does, your healthcare provider can tell you how to manage your symptoms when they occur.

How can I reduce my risk for BPPV?

You can’t prevent BPPV, but you can manage it with particle repositioning exercises. To reduce your risk of trauma-related BPPV, be sure to wear a helmet when biking, playing contact sports or participating in other similar activities.

What can I expect if I have benign paroxysmal positional vertigo?

The good news is that BPPV doesn’t indicate a serious health problem. Even so, dealing with your symptoms can be scary and frustrating. Your healthcare provider can teach you how to do BPPV exercises at home so you can manage your symptoms at the first sign of trouble.

How long does BPPV last?

In most cases, a BPPV episode lasts 1 to 2 minutes. Your symptoms may be mild, or they may be so severe that you throw up. You might even lose your balance when you try to stand or walk.

When should I see my healthcare provider?

If you’ve experienced a BPPV episode, schedule an appointment with your healthcare provider. They can demonstrate physical therapy exercises to reduce your symptoms.

If you have dizziness combined with a severe headache, chest pain or an irregular heartbeat, call 911 right away.

A note from Cleveland Clinic

Benign paroxysmal positional vertigo isn’t life-threatening, but it can have a significant negative impact on your quality of life. If you’ve experienced sudden episodes of dizziness, vertigo, balance problems or other symptoms related to BPPV, call your healthcare provider. In most cases, physical therapy exercises and home treatments can keep your symptoms at bay.

Benign Paroxysmal Positional Vertigo (BPPV): Glossary of Terms

• Semicircular canals: These structures act like a gyroscope, with canals positioned in three dimensions: upward, downward, and horizontal. Together, the canals send signals to your brain about the rotation/positioning of your head (for example, when you bend over or spin around.)
• Cupula: Detects the flow of fluid within your semicircular canals. The flow of fluid gives your body a sense of motion.
• Utricle: An organ located in your inner ear that helps control balance. Your utricle contains hair cells, which are covered with otoconia. The otoconia sway with gravity, sending signals to your brain about the position of your head and body (upright, tilted, etc.).
• Otoconia: The tiny calcium crystal particles that become dislodged from within your utricle (where they can dissolve) and move into your semicircular canals (where they can’t dissolve).
• Cochlea: The “snail-shell” sense organ of your inner ear that translates sound into nerve impulses that are sent to your brain.