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Key Features:

Benign: Not dangerous

Paroxysmal: Rapid onset that eases and then returns

Positional: Triggered by head movement

Vertigo: Spinning sensation

What Is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness, often presenting as brief episodes of vertigo or a spinning sensation triggered by changes in head position.

The vestibular system, located in your inner ear, helps control balance and movement. It consists of:

  • Otoconia (tiny calcium carbonate crystals)
  • Three fluid-filled semi-circular canals (anterior, posterior, horizontal)
  • Nerves (vestibular and cochlear)

BPPV occurs when these crystals become dislodged and fall into one or more of the semi-circular canals. This movement stimulates the vestibular nerve, which sends a mismatched signal to the brain, leading to abnormal eye movements (nystagmus) and the sensation of spinning (vertigo).

These episodes can be very distressing however the spinning usually eases within 1 minute. Beyond this period, your balance will continue to be affected which increases your risk of falling. This is why it is important to get it treated as soon as possible.

Signs and symptoms

The primary symptom of BPPV is short episodes of spinning, typically lasting less than one minute. These episodes are usually triggered by specific movements, such as:

  • Rolling over in bed
  • Looking up
  • Bending over (e.g., loading the dishwasher, gardening)
  • Getting in or out of bed

Other associated symptoms include:

  • Headaches
  • Nausea or vomiting
  • A sense of imbalance or unsteadiness
  • Brain fog

Causes

In most cases (50-70%), the exact cause of BPPV is unknown (idiopathic). Other possible causes include:

  • Ear surgery, migraines, or Meniere’s disease
  • Viral infections such as labyrinthitis or vestibular neuritis (15%)
  • Head trauma (7-17%)

Management and treatment

BPPV is typically managed through canal repositioning manoeuvres, which involve moving the head and body in specific sequences to shift the dislodged crystals out of the affected canal.

Your physiotherapist may also prescribe balance and gaze stability exercises to help restore normal function once the crystals have been repositioned.

Why Treatment is Important:

BPPV can significantly impact your daily life, with many people limiting their head movements or avoiding activities that could trigger vertigo. Research shows:

  • 69% of people with BPPV restrict their head movements.
  • 24% stop driving.
  • 18% avoid leaving home.
  • 37% take time off work.

While BPPV may reoccur, it can usually be treated effectively with physiotherapy. If symptoms return, it is important to see your physiotherapist for further treatment.

Reference

  • Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2022 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470308/