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Home > Wellness > Health Library > 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 caused by a problem in the inner ear. It usually causes brief vertigo spells that come and go.
For some people, BPPV goes away by itself in a few weeks. But it can come back again.
BPPV is not a sign of a serious health problem.
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 the semicircular canal move. Sensors in the semicircular canal are triggered by the stones, which causes a feeling of dizziness.
The main symptom is a feeling that you are spinning or tilting when you are not. This can happen when you move your head in a certain way, like rolling over in bed, turning your head quickly, bending over, or tipping your head back.
BPPV usually lasts a minute or two. It can be mild, or it can be bad enough to make you feel sick to your stomach and vomit. You may even find it hard to stand or walk without losing your balance.
Your doctor can usually tell that you have BPPV by asking you questions about your vertigo and doing a physical exam. You may have a test where your doctor watches your eyes while turning your head and helping you lie back. This is called the Dix-Hallpike test.
There are other things that can cause vertigo, so if your doctor doesn't think you have BPPV, you may have other tests too.
Your doctor can usually do one of two procedures in the office that works for most cases of BPPV. These procedures are called the Epley maneuver and the Semont maneuver. If you don't want treatment or if treatment doesn't work, BPPV usually goes away by itself within a few weeks. Over time, your brain will likely get used to the confusing signals it gets from your inner ear. Either way, you can do some simple exercises that train your brain to get used to the confusing vertigo signals.
Medicine may help with severe nausea and vomiting.
Be extra careful so that you don't hurt yourself or someone else if you have a sudden attack of vertigo.
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The main symptom of benign paroxysmal positional vertigo (BPPV) is the feeling that you or your surroundings are spinning, whirling, or tilting. This sensation is called vertigo.
It is 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.
To find out whether your vertigo is caused by BPPV, your doctor will want to find out what causes it, how bad it is, and how long it lasts. With BPPV:
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.
Scientists think you're more likely to develop benign paroxysmal positional vertigo (BPPV) if you have one of these conditions:
If you've had one episode of vertigo caused by BPPV, you are likely to have more.
Call 911 or other emergency services immediately if you have vertigo (a spinning sensation) and:
Call your doctor now or seek immediate care if:
Call your doctor to schedule an appointment if:
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.
Benign paroxysmal positional vertigo (BPPV) is diagnosed with a physical exam and your medical history. But diagnosing the cause of the spinning, whirling sensation of vertigo can be difficult. Several diseases, the side effects of medicines, and head injuries can also cause vertigo.
A Dix-Hallpike test may be done to help your doctor find out the cause of your vertigo. During this test, he or she will carefully observe any involuntary eye movements. 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. The Dix-Hallpike test also can help your doctor find out which ear is affected.
If your symptoms or the results of your exam make your doctor think you don't have BPPV, other tests may be done:
Benign paroxysmal positional vertigo (BPPV) may go away in a few weeks by itself. If treatment is needed, it usually consists of head exercises (Epley and Semont maneuvers). These exercises will move the particles out of the semicircular canals of your inner ear to a place where they will not cause vertigo.
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. Compensation occurs most quickly if you continue normal head movements, even though doing so causes the whirling sensation of vertigo. A Brandt-Daroff exercise may also be done to speed the compensation process.
Medicines called vestibular suppressants (such as antihistamines, sedatives, or scopolamine) may be tried if your symptoms are severe.
Antiemetic medicines may also be used to reduce nausea and vomiting that can occur with vertigo.
In rare cases, surgery may be used to treat BPPV.
In most cases, benign paroxysmal positional vertigo (BPPV) cannot be prevented. But some cases may result from head injuries. Wearing a helmet when bicycling, motorcycling, playing baseball, or doing other sports activities can protect you from a head injury and BPPV.
You can reduce the whirling or spinning sensation of vertigo when you have benign paroxysmal positional vertigo (BPPV) by taking these steps:
You can also help yourself by doing balance exercises and taking safety precautions.
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.
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.
Medicines to reduce the whirling sensation of vertigo are called vestibular suppressants. They include:
Antiemetic medicines, such as promethazine (Promethegan), may be used if you have severe nausea or vomiting.
Medicines that calm the inner ear (vestibular suppressants) may also slow down the brain's ability to adjust to the abnormal balance signals triggered by the particles in the inner ear. They should be taken only to control severe symptoms.
Ear surgery is an option for treating benign paroxysmal positional vertigo (BPPV) only in severe cases when other treatments have not worked.
Exercises are used to treat benign paroxysmal positional vertigo (BPPV). These exercises help the particles in the semicircular canals of your inner ear move around, so that they don't cause vertigo. Although the exercises usually stop the vertigo for months or years, the problem may return and cause your symptoms to come back.
Exercises that may be used to treat BPPV include:
These exercises can get rid of BPPV symptoms. The Epley and Semont maneuvers usually are more comfortable than the Brandt-Daroff exercise, and they work faster—in one or two treatments rather than being repeated several times a day for weeks. So these maneuvers have become the first line of treatment.footnote 1
Fife TD, et al. (2008). Practice parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 70(22): 2067–2074.
Other Works Consulted
Hillier SL, McDonnell M (2011). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews (2).
Hilton M, Pinder D (2004). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
Johnson J, Lalwani AK (2012). Vestibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 729–738. New York: McGraw-Hill.
Kerber KA (2011). Episodic vertigo. In ET Bope et al., eds., Conn's Current Therapy 2011, pp. 210–213. Philadelphia: Saunders.
Von Brevern M, et al. (2006). Short-term efficacy of Epley's manoeuvre: A double-blind randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry, 77(8): 980–982.
Walker MF, Daroff RB (2015). Dizziness and vertigo. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 19th ed., vol. 1, pp. 148–151. New York: McGraw-Hill Education.
Current as of:
December 2, 2020
Author: Healthwise StaffMedical Review: Anne C. Poinier MD - Internal MedicineKathleen Romito MD - Family MedicineE. Gregory Thompson MD - Internal Medicine
Current as of: December 2, 2020
Author: Healthwise Staff
Medical Review:Anne C. Poinier MD - Internal Medicine & Kathleen Romito MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine
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