Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder. With BPPV, changes in your head position, like tipping your head back, cause vertigo. You feel like your environment is spinning around you.

BPPV can affect anyone, but it’s most common in adults aged 50 and older. About half of the people in this age range have at least one episode of BPPV in their lifetime.

This disorder isn’t serious. But it can be scary when your world starts to whirl around you. And some people may get hurt if they fall to the ground during an episode.

Symptoms of benign paroxysmal positional vertigo

Vertigo is the main symptom. It may be mild or severe and last up to a minute. You may have other symptoms, like:

• Dizziness
• Lightheadedness
• Balance issues
• Nausea and vomiting
• Blurred vision
• Fast eye movement that you can’t control (nystagmus)

You may have BPPV symptoms when you lie down or sit up from lying down. Tilting your head back or to the side may cause it.

Benign paroxysmal positional vertigo causes

This disorder happens when small calcium carbonate crystals (otoconia) move around in your inner ear. The crystals move from your utricle to your semicircular canals. Some people call the crystals ear rocks or ear stones.

Your utricle is a chamber that detects horizontal motion, like when you’re in a moving car. Your semicircular canals are fluid-filled tubes inside your inner ear. The tubes contain an area with cilia. These tiny hair-like structures detect motion.

Your cilia tell your brain when they detect motion. This happens when fluid moves in the semicircular canals. Your brain also gets movement information from your eyes and body. When you move your head, you set off a chain reaction that leads to BPPV:

1. Loose crystals start to roll around in your semicircular canals, which makes the fluid move. This causes your brain to detect motion. The loose crystals may start moving when you roll over in bed or tip your head back.
2. Your brain compares the information about movement with the input from your eyes and body.
3. Mixed messages from your ears, eyes and body trigger the vertigo sensation.

Several things may cause crystals to end up where they don’t belong, including:

• Age: The crystals may get loose and move if age causes normal wear and tear on your inner ear structures.
• Head injury: Being hit on your head or falling on it can send the crystals into the canals.
• Infections: Labyrinthitis and vestibular neuritis can loosen them.
• Migraine: You may have BPPV if you have migraines.
• Tumor: Acoustic neuroma, a noncancerous tumor in your ear, may affect your utricle, so the crystals move.

Crystals in the canals may also move around if you hold your head back or to the side for a long time.

Complications of benign paroxysmal positional vertigo

Without treatment, BPPV episodes can happen again. The on-and-off episodes can be upsetting and affect your quality of life.

How doctors diagnose BPPV

A healthcare provider will ask about your symptoms. They’ll do position change tests, like the Dix-Hallpike maneuver test. With the tests, your provider gently moves your head in different directions. If you have BPPV, the movements will cause vertigo and nystagmus.

How is benign paroxysmal positional vertigo treated?

The most common treatment is a canalith repositioning procedure, like the Epley maneuver, which moves the crystals back where they belong.

You may have this treatment in your provider’s office. They’ll show you how to do the treatment on your own. Your provider may prescribe motion sickness medication if BPPV causes nausea and vomiting.

Often, a single treatment session treats BPPV. But some people may need several sessions.

Some people may benefit from vestibular rehabilitation therapy (VRT). This treatment may help with balance issues and dizziness that benign paroxysmal vertigo may cause.

When should I see my healthcare provider?

Contact a provider if you have sudden vertigo and symptoms like feeling lightheaded or nauseated. Many things can cause BPPV symptoms. Talking to a provider is the first step toward finding the cause.

What can I expect if I have BPPV?

Treatment often eases BPPV symptoms. But the condition can come back. If it does, you may need more treatment.

Will BPPV go away on its own?

Yes, it can. Your inner ear fluid can break down the crystals so they dissolve. That’s a slow process. If you have BPPV, you may have episodes for several weeks until the crystals dissolve.