Benign Paroxysmal Positional Vertigo (BPPV) (2022)

Condition Basics

What is benign paroxysmal positional vertigo (BPPV)?

Vertigo is the feeling that you are spinning or the world is spinning around you. Benign paroxysmal positional vertigo is a balance problem that causes brief vertigo spells that come and go.

For many people, BPPV goes away by itself in a few weeks, but treatment can help. It can come back again.

BPPV isn't a sign of a serious health problem.

What causes it?

BPPV is caused by a problem in the inner ear. Tiny calcium "stones" inside your inner ear help you keep your balance. When you have BPPV, these stones move into the semicircular canal in your inner ear where they can cause a feeling of spinning.

What are the symptoms?

The main symptom of BPPV is a feeling that you are spinning or tilting when you are not. It can happen when you move your head in a certain way, like rolling over in bed. You may find it hard to walk or stand without losing your balance.

How is it diagnosed?

BPPV is diagnosed with a physical exam. Your doctor will ask questions about your symptoms and past health. You may have a Dix-Hallpike test. In this test, your doctor watches your eyes while turning your head and helping you lie back.

How is BPPV treated?

BPPV may go away in a few weeks by itself. If treatment is needed, it usually involves your doctor moving your head in different directions.

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  • Vertigo: Balance Exercises
(Video) MUSC: Benign Paroxysmal Positional Vertigo (BPPV)

Cause

Benign Paroxysmal Positional Vertigo (BPPV) (1)

Benign paroxysmal positional vertigo (BPPV) is caused by a problem in the inner ear. Tiny calcium "stones" inside your inner ear canals help you keep your balance. Normally, when you move a certain way—such as when you stand up or turn your head—these stones move around. Sometimes these stones move into an area of your inner ear called the semicircular canal. When you move your head in certain ways, the stones in your semicircular canal move. Sensors in the semicircular canal are triggered by the stones, which causes a feeling of spinning.

What Increases Your Risk

Scientists think you're more likely to develop benign paroxysmal positional vertigo (BPPV) if you have one of these conditions:

  • You are an older adult.
  • You have a head injury.
  • You have an inflammation of the inner ear or of the nerve that connects the inner ear to the brain, a condition called vestibular neuritis.
  • You have ear surgery.

If you've had one episode of vertigo caused by BPPV, you are likely to have more.

Symptoms

The main symptom of BPPV is the feeling that you or your surroundings are spinning, whirling, or tilting. This sensation is called vertigo. It usually lasts a minute or two.

It's important to understand the difference between vertigo and dizziness. People often use those two terms as if they meant the same thing. But they are different symptoms, and they may point to different problems.

  • Vertigo is the feeling that you are spinning or the world is spinning around you. It happens when your body's balance sensory systems disagree about what kind of movement they sense. You may find it hard to walk or stand. You may even lose your balance and fall. If your vertigo is bad enough, you may also have nausea and vomiting.
  • Dizziness isn't a feeling that you are spinning. It is a woozy or unsteady feeling.

Learn more

  • Dizziness: Lightheadedness and Vertigo

What Happens

Benign paroxysmal positional vertigo (BPPV) causes a whirling, spinning sensation even though you are not moving. If the vertigo is bad, it may also cause nausea or vomiting. The vertigo attacks happen when you move your head in a certain way, such as tilting it back or up or down, or by rolling over in bed. It usually lasts less than a minute. Moving your head to the same position again may trigger another episode of vertigo.

BPPV often goes away without treatment. Until it does, or is successfully treated, it can repeatedly cause vertigo with a particular head movement. Sometimes it will stop for a period of months or years and then suddenly come back.

(Video) What Is Benign Paroxysmal Positional Vertigo?

When to Call a Doctor

Call 911 or other emergency services immediately if you have vertigo (a spinning sensation) and:

  • You passed out (lost consciousness).
  • You have symptoms of a stroke, such as:
    • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
    • Sudden vision changes.
    • Sudden trouble speaking.
    • Sudden confusion or trouble understanding simple statements.
    • Sudden problems with walking or balance.
    • A sudden, severe headache that is different from past headaches.
  • You have chest pain.
  • You have a headache, especially if you also have a stiff neck and fever.
  • You have sudden hearing loss.
  • You have numbness or tingling anywhere on your body, and it doesn't go away.
  • You have vomiting that doesn't stop.
  • You had a recent head injury.

Call your doctor now or seek immediate care if:

  • You have an attack of vertigo that is different from those you've had before or from what your doctor told you to expect.
  • You need medicine to control nausea and vomiting caused by severe vertigo.

Call your doctor to schedule an appointment if:

  • This is the first time you've had an attack of vertigo.
  • You have a low-pitched roaring, ringing, or hissing sound in your ear, especially if you haven't had it before. This is called tinnitus.
  • You have frequent or severe episodes of vertigo that interfere with your activities.

Watchful waiting

Watchful waiting is a wait-and-see approach. It may be okay to try it if your symptoms suggest BPPV. Over time, BPPV may go away on its own. But treatment with a simple procedure in your doctor's office (either the Epley or Semont maneuver) can usually stop your vertigo right away. Talk to your doctor. If your vertigo interferes with your normal daily activities or causes nausea and vomiting, you may need treatment.

Exams and Tests

BPPV is diagnosed with a physical exam. Your doctor will ask questions about your symptoms and past health.

A Dix-Hallpike test may be done to help your doctor find out the cause of your vertigo. During this test, the doctor watches your eyes while turning your head and helping you lie back. This will help your doctor know whether the cause of your vertigo is inside your brain, your inner ear, or the nerve connected to your inner ear. This test also can help your doctor find out which ear is affected.

Treatment Overview

BPPV may go away in a few weeks by itself. If treatment is needed, it usually involves your doctor moving your head in different directions. Examples are Epley and Semont maneuvers. These movements will move the particles out of the semicircular canals of your inner ear.

Over time, your brain may react less and less to the confusing signals triggered by the particles in the inner ear. This is called compensation. It occurs fastest if you keep doing normal head movements, even if those movements cause the whirling feeling of vertigo.

A Brandt-Daroff exercise may also be done. It can speed the compensation process.

Medicines called vestibular suppressants may be tried if your symptoms are severe. These medicines include antihistamines, sedatives, and scopolamine.

Antiemetic medicines may also be used. They reduce the nausea and vomiting that can occur with vertigo.

(Video) Treating BPPV: The Epley Manuever - Boys Town National Research Hospital

In rare cases, surgery may be used to treat BPPV.

Learn more

  • Brandt-Daroff Exercise for Vertigo
  • Epley and Semont Maneuvers for Vertigo

Watch

  • Reducing the feeling of vertigo

Self-Care

You can reduce the whirling or spinning sensation of vertigo when you have benign paroxysmal positional vertigo (BPPV) by taking these steps.

  • Use two or more pillows at night.
  • Avoid sleeping on your side with the ear that's causing the problem facing down.
  • Get up slowly in the morning and sit on the edge of the bed for a moment before standing.
  • Avoid leaning over to pick things up or tipping your head far back to look up.
  • Be careful about reclining, such as when you are in the dentist's chair or having your hair washed at a hair salon.
  • Be careful about playing sports that require you to turn your head, lean over, or lie flat on your back.
  • Try doing certain exercises.
    • Brandt-Daroff exercises can be done at home to help your brain get used to the abnormal balance signals triggered by the particles in the inner ear.
    • Balance exercises for vertigo may help. Try standing with your feet together, arms down, and slowly moving your head from side to side. This may help you keep your balance and improve symptoms of vertigo.
  • Take precautions to stay safe.

    For example, try adding grab bars near the bathtub and toilet and keeping walking paths clear. This may prevent accidents and injuries.

Staying as active as possible usually helps the brain adjust more quickly. But that can be hard to do when moving is what causes your vertigo. Bed rest may help, but it usually increases the time it takes for the brain to adjust.

Brandt-Daroff exercise

  • If your doctor suggests that you do Brandt-Daroff exercises:
    • Sit on the edge of a bed or sofa. Quickly lie down on the side that causes the worst vertigo. Lie on your side with your ear down.
    • Stay in this position for at least 30 seconds or until the vertigo goes away.
    • Sit up. If this causes vertigo, wait for it to stop.
    • Repeat the procedure on the other side.
    • Repeat this 10 times. Do these exercises 2 times a day until the vertigo is gone.

Staying safe

Many people have the spinning sensation of BPPV. The loss of balance it causes puts you at risk for falling.

Be extra careful so that you don't hurt yourself or someone else if you have a sudden attack of vertigo. You can reduce your risk of injury by taking personal precautions and making your home environment safe.

  • Do not drive or cycle if you have vertigo. (This depends on what kind of movement triggers vertigo for you.)
  • At home, keep floors and walkways free of clutter so you don't trip.
  • Avoid heights.
  • Don't use tools or machines that could be dangerous if you suddenly get dizzy or lose your balance.

Learn more

  • Brandt-Daroff Exercise for Vertigo
  • Vertigo: Balance Exercises
  • Vertigo: Staying Safe When You Have Balance Problems

Watch

  • Vertigo: Head Movements That Help
(Video) Maneuvers to Diagnosis and Treat Benign Paroxysmal Positional Vertigo | NEJM

Medicines

Medicines do not cure benign paroxysmal positional vertigo (BPPV). But they may be used to control severe symptoms, such as the whirling, spinning sensation of vertigo and the nausea and vomiting that may occur.

Medicine choices

Medicines to reduce the whirling sensation of vertigo are called vestibular suppressants. They include:

  • Antihistamines, such as meclizine (Antivert).
  • Scopolamine (Transderm-Scop).
  • Sedatives, such as clonazepam (Klonopin).

Antiemetic medicines, such as promethazine (Promethegan), may be used if you have severe nausea or vomiting.

Related Information

  • Dizziness: Lightheadedness and Vertigo
  • Labyrinthitis
  • Ménière's Disease

Credits

Current as of: May 4, 2022

Author: Healthwise Staff
Medical Review:
Anne C. Poinier MD - Internal Medicine
Kathleen Romito MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine

Current as of: May 4, 2022

Author: Healthwise Staff

(Video) Causes and Treatment for Benign paroxysmal positional vertigo (BPPV) with Gregory Whitman, M.D.

Medical Review:Anne C. Poinier MD - Internal Medicine & Kathleen Romito MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine

FAQs

Does BPPV ever go away completely? ›

BPPV may recur even after successful therapy. Although there's no cure, the condition can be managed with physical therapy and home treatments.

What is the root cause of BPPV? ›

BPPV occurs when tiny calcium crystals called otoconia come loose from their normal location on the utricle, a sensory organ in the inner ear. If the crystals become detached, they can flow freely in the fluid-filled spaces of the inner ear, including the semicircular canals (SCC) that sense the rotation of the head.

What is a positive BPPV test? ›

A positive test is indicated by torsional and upbeating nystagmus. • If the patient feels dizzy but there is no nystagmus this is NOT a positive test. • If the patient feels dizzy when returning to upright position only this is suggestive of orthostatic intolerance.

What is the fastest way to cure BPPV? ›

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.

Is BPPV a serious condition? ›

Although BPPV can be bothersome, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for BPPV during a doctor's office visit.

Can anxiety and stress cause BPPV? ›

After 9 years of following the participants, the researchers found that people with anxiety disorders were 2.17 times more likely to develop benign paroxysmal positional vertigo (BPPV), the most common type of vertigo, than people without anxiety disorders.

Should I be worried about BPPV? ›

Many of our patients who need a chiropractor for vertigo in Seneca, SC feel a bit intimidated by their BPPV condition. This is mostly, because it sounds like a very troublesome disorder. In truth, it's not life-threatening as you can resolve it or reduce symptoms by practicing some management techniques.

Can BPPV trigger a stroke? ›

A recent population cohort study reported that benign paroxysmal positional vertigo (BPPV) was a risk factor for ischemic stroke.

What should you not do with BPPV? ›

These are head movements that correct the inner ear problem that causes BPPV. After you go home: For the rest of the day, do not bend over. For several days after treatment, do not sleep on the side that triggers symptoms.

What infection causes BPPV? ›

Labyrinthitis is an inner infection that results in the inflammation of the vestibular labyrinth found in our inner ear. This infection may also include inflammation of other structures in the inner ear, which in turn may provide false information to our brain.

Can you be sick with BPPV? ›

Benign paroxysmal positional vertigo (BPPV)

It is often accompanied by nausea, although vomiting is rare. You may also experience your eyes briefly moving uncontrollably (nystagmus).

Can BPPV cause memory loss? ›

The most common inner ear condition that causes vertigo, BPPV, can cause vertigo memory problems in patients of all ages. The good news is that if BPPV is the cause of the cognitive impairment, then the cognitive symptoms often clear up instantly as soon as the BPPV is resolved.

What vitamin helps BPPV? ›

“Our study suggests that for people with benign paroxysmal positional vertigo, taking a supplement of vitamin D and calcium is a simple, low-risk way to prevent vertigo from recurring,” said Ji-Soo Kim, M.D., Ph. D., of Seoul National University College of Medicine in Korea.

How should I sleep with BPPV? ›

Most commonly, people with BPPV learn to sleep propped up on pillows and avoid sleeping on the involved side to prevent feelings of vertigo when lying down.

Does bed rest help BPPV? ›

Bed rest for extended periods of time can cause calcium particles already dislodged by infection or even a blow to the head to shift into the inner ear. Sitting or standing quickly (motion sickness) after long periods of rest can trigger episodes of vertigo. Sleeping, on its own, is not a cause of BPPV.

Can I drive with BPPV? ›

The DVLA recommends that you should stop driving if you have sudden, unexpected, and disabling attacks of dizziness. You should tell your employer if BPPV could pose a risk to yourself or others in your job. For example, if you use ladders, operate heavy machinery, or drive.

Can BPPV be disability? ›

Conclusions. Patients diagnosed with posterior canal BPPV in primary care perceive their condition as a disability according to DHI-S scores, with higher levels of disability reported by women and patients with subjective BPPV.

Does BPPV increase with age? ›

BPPV is the most common cause of vertigo in older adults, with most cases being idiopathic. Although BPPV occurs in all age groups, its prevalence increases with age.

Can BPPV start suddenly? ›

The onset of an episode of BPPV is usually sudden following changes in head position. Often, ordinary movements such as turning over on one's side, lying down, looking up, stooping or bending over can cause an episode. The severity of the disorder can vary greatly from one person to another.

Can you drive with vertigo? ›

Driving with Dizziness is Against the Law

If you are dizzy at all or recovering from a vertigo attack, then driving should be avoided.

Is vertigo physical or mental? ›

It can also be caused by conditions affecting the balance structures in the inner ear, including infections and Meniere's disease. However, there isn't always a physical cause for vertigo. Sometimes it seems to be linked to our emotions instead.

Should I go to work with vertigo? ›

Vertigo is a disorder that affects equilibrium. Symptoms include a loss of balance with nausea and vomiting. Employees diagnosed with vertigo can return to work safely; however, they may need workplace restrictions and accommodation as symptoms may persist for months.

Does BPPV cause dementia? ›

The adjusted OR of dementia for BPPV was 1.14 (95% CI = 1.03–1.26, p = 0.009). In subgroup analyses according to age and sex, males had higher ORs of dementia for BPPV. BPPV increases the risk of dementia in the 60 years of age or older population.

Does BPPV affect blood pressure? ›

Messina et al18 found that 55.8% of patients with BPPV had hypertension. They also analyzed the recurrence of disease among patients with BPPV and found that 64.5% of patient with hypertension had recurrence that was found to be significant.

Can a brain tumor cause BPPV? ›

BPPV is a common medical problem and can co-exist with other medical conditions including serious pathologies such as brain tumors.

What is the best medication for BPPV? ›

Common practice by ED physicians is to rule out serious medical causes for their symptoms. It is presently common for ED physicians to treat these patients mainly with benzodiazepines, antihistamines, and anticholinergic medications, especially if the history and physical is consistent with BPPV.

Does BPPV get worse over time? ›

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.

What are the after effects of BPPV? ›

7 However, up to two-thirds of patients may perceive a prolonged and handicapping instability, lightheadedness and malaise also known as “residual dizziness.”8 This residual symptomatology after the resolution of BPPV is variably described among patients. Some patients also complain of nausea and vomiting.

How much vitamin D should you take for BPPV? ›

Patients with recurrent BPPV had lower Vitamin D serum than other patients. They recommended that serum Vitamin D should be above 30 ng/ml with safe sun exposure for up to 30 min per day to decrease recurrence of BPPV43.

Can I treat BPPV myself? ›

The home Epley maneuver is a type of exercise help that helps to treat the symptoms of benign paroxysmal positional vertigo (BPPV). You can do this exercise at home. BPPV is caused by a problem in your inner ear. Your semicircular canals are found inside your ear.

What deficiency causes vertigo? ›

Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency.

Can BPPV wake you up? ›

Symptoms. A patient with BPPV frequently will awake with vertigo. This occurs when rolling over in bed or sitting up, or looking up on a shelf. It may wake the person from sleep by turning over while asleep.

Does walking help with BPPV? ›

Walking is a simple but powerful exercise for vertigo. It can help improve your balance. Walking with greater balance will allow you to function better on your own, which in turn may lead to improved self-confidence. As you walk, you will also be working your muscles.

Why wont my BPPV go away? ›

One theory as to why symptoms persist, even though BPPV is cleared, is that the brain was making adjustments to try to deal with the problem while BPPV was present. Now that BPPV is no longer present, the adjustments are no longer appropriate and the brain needs time to "reset" back to normal.

How long does it usually take for BPPV to go away? ›

In about half of all people who have BPPV, the symptoms go away after only 1 to 3 months. So treatment isn't always needed. If the dizzy spells don't go away on their own or are very difficult for the person to cope with, repositioning maneuvers can help.

What are the chances of BPPV coming back? ›

Though patients can commonly be treated effectively with the Epley maneuver, the recurrence rate for BPPV is high. Since its symptoms are not very pleasant, patients who suffer from vertigo do not like to hear that there is a 10 to 18% chance of another attack within the next year.

How long does it take to feel normal after vertigo? ›

For several weeks afterward, it is common to feel a little bit off balance. Typically, after three to four weeks the balance returns to normal.

How do you stop BPPV from coming back? ›

“Our study suggests that for people with benign paroxysmal positional vertigo, taking a supplement of vitamin D and calcium is a simple, low-risk way to prevent vertigo from recurring,” said Ji-Soo Kim, MD, PhD, of Seoul National University College of Medicine in Korea.

Is bed rest good for BPPV? ›

Bed rest for extended periods of time can cause calcium particles already dislodged by infection or even a blow to the head to shift into the inner ear. Sitting or standing quickly (motion sickness) after long periods of rest can trigger episodes of vertigo. Sleeping, on its own, is not a cause of BPPV.

Does BPPV make you tired? ›

Moderate fatigue is quite common during an attack of BPPV. It seems to be a genuine symptom of the entity that might worsen patients' distress. For severe or persistent fatigue treatment with fatigue relieving drugs such as amantadine, methylphenidate or modafinil could be tried in the future.

Why are some people more prone to BPPV? ›

Known factors associated with a higher prevalence of BPPV include age, female sex, history of head trauma, other inner ear disease including Meniere's disease and vestibular neuritis, osteoporosis, and migraines [3, 15, 21, 31, 33].

How long does it take for ear crystals to dissolve? ›

The results demonstrated that normal endolymph can dissolve otoconia very rapidly (in about 20 hours).

Can I drive with vertigo? ›

Vertigo could also affect your ability to drive. You should avoid driving if you've recently had episodes of vertigo and there's a chance you may have another episode while you're driving.

Videos

1. Wellstar OrthoSport: Testing for BPPV (Benign Paroxysmal Positional Vertigo)
(Wellstar Health System)
2. Vertigo Treatment - Epley Maneuver - American Academy of Neurology
(AANChannel)
3. Maneuvers to Diagnosis and Treat Benign Paroxysmal Positional Vertigo | NEJM
(NEJM Group)
4. Causes and Treatment for Benign paroxysmal positional vertigo (BPPV) with Gregory Whitman, M.D.
(Hoag Health)
5. Top 3 Signs Your Vertigo is BPPV (Benign Paroxysmal Positional Vertigo)
(Bob & Brad)
6. Benign Paroxysmal Positional Vertigo (BPPV) | Overview
(Catalyst University)

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