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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 contributes to your sense of balance. The vestibular organs are inside the innermost part of your ear. They include the utricle, saccule, and three semicircular canals. When your head moves, these small organs send this information to the brain.

The utricle contains small calcium crystals. These aid in the perception of motion. Sometimes, these crystals detach from the utricle and land in one of the semicircular canals. When this happens, the canals may send the wrong signals to the brain, especially when the crystals move. This confuses the brain and leads to the symptoms of BPPV.

The condition is called “benign” because it is not life-threatening. It does not get worse with time. “Paroxysmal” refers to the fact 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. However, people of any age can get it. It is one of the most common disorders of the vestibular system.

What causes benign paroxysmal positional vertigo?

Anything that dislodges the crystals from the utricle can cause BPPV. Prior head injury is a major cause. Other times, BPPV may result from other problems with the vestibular system. These can include Meniere disease or vestibular neuritis. Ear surgery is a less common cause. Most of the time, 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 unknown. You may have a higher risk of developing BPPV if you have any of these:

  • Migraine
  • Giant cell arteritis
  • High blood pressure
  • High cholesterol or other blood lipids
  • History of stroke
  • Head injury

It’s not clear whether treating these conditions might lessen your risk for BPPV.

What are the symptoms of benign paroxysmal positional vertigo?

The most common symptoms of BPPV include:

  • A feeling of spinning (vertigo)
  • Lightheadedness
  • Difficulty with balance
  • Nausea and vomiting

Specific types of movement can bring on symptoms. Symptoms then usually 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 commonly, 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 episode.

Unlike some other causes of vertigo, BPPV does not cause neurological symptoms. These include severe headache, speech difficulties, or loss of limb movement. It also does not cause hearing problems.

The symptoms of BPPV may seem like those of other health conditions. Always see your doctor for a diagnosis.

How is benign paroxysmal positional vertigo diagnosed?

BPPV may be diagnosed and treated by your primary healthcare provider or an ear, nose, and throat doctor (otolaryngologist). Or it may be diagnosed and treated by a neurologist. The healthcare provider will ask about your medical 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 healthcare 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. A test called an electronystagmograph might help. This test shows if your vertigo is due to another sort of problem with your vestibular system. An imaging test, such as an MRI, can help rule out nervous system problems as a cause.

How is benign paroxysmal positional vertigo treated?

Your provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

First, your healthcare provider may attempt to move the calcium crystals out of your semicircular canals. This may be done with a series of certain head and neck movements. This usually takes around 15 minutes. Your healthcare provider may tell you to do certain movements at home. This treatment is often successful. Some people may still have vertigo with head movement for a few weeks.

Medicines are not usually given for BPPV. This is because most of them do not 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. In many cases, however, it does come back. If you are still having symptoms from BPPV, your healthcare provider may tell you how to avoid symptoms. For example:

  • Using 2 pillows in bed to elevate your head
  • Not sleeping on your affected side
  • Rising slowly out of bed
  • Not looking up
  • Not bending over to pick things up
  • 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

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 previous vestibular disorders can cause BPPV, but many times the cause is unknown.
  • Symptoms of BPPV typically come on with head movement. The vertigo lasts only a short while, but it may come back multiple times.
  • Your BPPV very likely will respond to treatment with physical maneuvers. In rare cases, however, some people with severe BPPV that doesn’t go away may need surgery.
  • As you are recovering from BPPV, you may need to avoid certain head movements to help prevent your symptoms from coming back.

Next steps

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.

Saint Luke's Ear Nose & Throat Specialists

The Saint Luke’s Ear Nose and Throat Specialists are here to help adults and children with sinusitis, hearing issues, thyroid disorders, throat issues, and other conditions. All of our physicians are board certified in otolaryngology, a specialty for patients with disorders of the ear, nose, throat, sinus, head, and neck.