Benign paroxysmal positional vertigo (BPPV)

Published by Bupa's Health Information Team, November 2010.

This factsheet is for people who have benign paroxysmal positional vertigo (BPPV), or who would like information about it.

BPPV is the most common cause of vertigo. Vertigo is the sensation that you, or things around you are moving, even when you're not. In BPPV, you get vertigo when you move your head in certain directions.

About benign paroxysmal positional vertigo

Your ear is made up of three parts: the outer ear, the middle ear and the inner ear. The inner ear consists of a system of fluid-filled tubes (the labyrinth). This is made up of the cochlea, which senses sound, the vestibule and semicircular canals, which sense the movement of your head.

The semicircular canals are responsible for sensing movement. When you move your head, fluid moves around the semicircular canals, bending tiny hairs that line the canal walls. This triggers nerve messages to be sent to your brain, giving your brain information about the change in position or movement of your head.

In BPPV, tiny particles from the vestibule in your inner ear become dislodged and enter the semicircular canals. These particles prolong the movement of the hair cells in the semicircular canals, so that signals continue to be sent to your brain indicating movement, even when your head is still. This gives the sensation of vertigo. In BPPV, the vertigo you experience is described as rotational (as if you're spinning).

Symptoms of benign paroxysmal positional vertigo

Attacks of vertigo in BPPV last for less than one minute (usually only a few seconds) and are almost always caused by the following head movements:

• moving your head to one side - for example, when turning in bed
• tilting your head backwards to look up - for example, when hanging up washing on a washing line or taking something from the top shelf
• bending over - for example, to tie your shoe laces

It's common to feel sick during an attack of vertigo in BPPV. You may be sick or feel light headed, although this is rare.

Generally, the attacks will stop or improve after a few weeks or months. However in some cases, they can persist for longer.

If you have BPPV, you may also get involuntary movements of your eye (nystagmus), although only your GP may notice this.

Although not necessarily a result of BPPV, if you have these symptoms, you should visit your GP.

Causes of benign paroxysmal positional vertigo

The particles that cause BPPV are thought to come from the vestibule in your inner ear, where they have come loose - and lodge in one of your semicircular canals. There are a number of reasons why this may happen, including:

• head injury
• ear surgery
• ear infection
• ageing

However, there is often no obvious reason why you have developed the condition.

Diagnosis of benign paroxysmal positional vertigo

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will look into your ear using an instrument called an otoscope, to check whether your symptoms are due to an infection in your outer or middle ear.

You will need to have a test called the Hallpike manoeuvre to confirm whether you have BPPV. This involves your GP moving your head into different positions, while you lie on a couch/bed, to see if this sets off your vertigo or eye movements.

Your GP may do this test, or you may be referred to a doctor specialising in balance disorders, such as an audiovestibular or audiological physician, a neurologist, or an ear, nose and throat (ENT) consultant.

Treatment of benign paroxysmal positional vertigo

BPPV can stop by itself or improve after a few weeks or months, as the particles disappear or move out of your semicircular canals. However, in some rare cases, it can persist for years.

Medicines aren't usually helpful for the treatment of BPPV. However, physical therapies have been found to be very effective at stopping the vertigo.

Physical therapy

Your GP will usually refer you to a specialist, such as a neurologist, an audiovestibular or audiological physician, an ENT consultant or a physiotherapist for treatment.

The physical techniques designed for BPPV work by moving the particles in your semicircular canals back into a position where they will no longer cause vertigo.

The techniques may include the following.

• The Epley manoeuvre. This involves moving your head through a precise sequence of four positions, designed to force the particles out of the semicircular canal where they have lodged, into the adjoining area of your inner ear.
• The Semont manoeuvre. In this procedure, you move quickly from lying on one side to the other.
• The Brandt-Daroff exercises. Your doctor usually suggests these if other types of exercises haven't helped with your vertigo. You will be shown how to do them at home. They involve a precise sequence of moving from a sitting position to specific lying positions and need to be repeated several times a day for two to three weeks.

Although these manoeuvres can be effective in stopping your vertigo, it's possible that your BPPV may come back. However, your doctor or physiotherapist may teach you how to do these techniques yourself, so that you can do them at home if your BPPV keeps coming back.

If you have recurrent BPPV, your GP may refer you to an ENT surgeon. He or she may be able to do another procedure to help improve your symptoms. Your surgeon will be able to give you more information about this.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.