Overview

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.

Benign paroxysmal positional vertigo causes brief episodes of mild to intense dizziness. Benign paroxysmal positional vertigo is usually triggered by specific changes in the position of your head. This might occur when you tip your head up or down, when you lie down, or when you turn over or sit up in bed.

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

Symptoms

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • A loss of balance or unsteadiness
  • Nausea
  • Vomiting

The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of benign paroxysmal positional vertigo can disappear for some time and then recur.

Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Some people also feel out of balance when standing or walking.

Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo.

When to see a doctor

Generally, see your doctor if you experience any unexplained dizziness or vertigo that recurs periodically for more than one week.

Seek emergency care

Although it's uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:

  • A new, different or severe headache
  • A fever
  • Double vision or loss of vision
  • Hearing loss
  • Trouble speaking
  • Leg or arm weakness
  • Loss of consciousness
  • Falling or difficulty walking
  • Numbness or tingling

The signs and symptoms listed above may signal a more serious problem.

Causes

Often, there's no known cause for BPPV. This is called idiopathic BPPV.

When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back, such as in a dentist chair. BPPV also has been associated with migraines.

The ear's role

Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.

Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head's position related to gravity. These otolith organs contain crystals that make you sensitive to gravity.

For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you're lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to, which is what makes you feel dizzy.

Risk factors

Benign paroxysmal positional vertigo occurs most often in people age 50 and older, but can occur at any age. Benign paroxysmal positional vertigo is also more common in women than in men. A head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.

Complications

Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. The dizziness of BPPV can make you unsteady, which may put you at greater risk of falling.

May 28, 2015
References
  1. Kim JS, et al. Benign paroxysmal positional vertigo. New England Journal of Medicine. 2014;370:1138.
  2. Hilton MP, et al. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews. http://www.cochrane.org/CD003162/ENT_the-epley-manoeuvre-for-benign-paroxysmal-positional-vertigo-bppv. Accessed May 4, 2015.
  3. Furman JM. Pathophysiology, etiology, and differential diagnosis of vertigo. http://www.uptodate.com/home. Accessed May 4, 2015.
  4. Barton JJS. Benign paroxysmal positional vertigo. http://www.uptodate.com/home. Accessed May 4, 2015.
  5. Lalwani AK. Vestibular disorders. In: Current Diagnosis & Treatment in Otolaryngology--Head & Neck Surgery. 3rd ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com. Accessed May 4, 2015.

Benign paroxysmal positional vertigo (BPPV)