Vertigo - positional; Benign paroxysmal positional vertigo; BPPV; Dizziness - positional
Benign positional vertigo is the most common type of vertigo. Vertigo is the feeling that you are spinning or that everything is spinning around you. It may occur when you move your head in a certain position.
Benign positional vertigo is also called benign paroxysmal positional vertigo (BPPV). It is caused by a problem in the inner ear.
The inner ear has fluid-filled tubes called semicircular canals. When you move, the fluid moves inside these tubes. The canals are very sensitive to any movement of the fluid. The sensation of the fluid moving in the tube tells your brain the position of your body. This helps you keep your balance.
BPPV occurs when small pieces of bone-like calcium (called canaliths) breaks free and floats inside the tube. This sends confusing messages to your brain about your body's position.
BPPV has no major risk factors. But, your risk of developing BPPV may increase if you have:
BPPV symptoms include any of the following:
The spinning sensation:
Certain positions can trigger the spinning feeling:
Your health care provider will do a physical exam and ask about your medical history.
To diagnose BPPV, your provider may perform a test called the Dix-Hallpike maneuver.
If this test doesn't show a clear result, you may be asked to do other tests.
You may have brain and nervous system (neurological) tests to rule out other causes. These may include:
Your provider may perform a procedure called the (Epley maneuver). It is a series of head movements to reposition the canaliths in your inner ear. The procedure may need to be repeated if symptoms come back, but this treatment works best to cure BPPV.
Your provider may teach you other repositioning exercises that you can do at home, but may take longer than the Epley maneuver to work. Other exercises, such as balance therapy, may help some people.
Some medicines can help relieve spinning sensations:
But, these medicines often do not work well for treating vertigo.
Follow instructions on how to take care for yourself at home. To keep your symptoms from getting worse, avoid the positions that trigger it.
BPPV is uncomfortable, but it can usually be treated with the Epley maneuver. It may come back again without warning.
People with severe vertigo may get dehydrated due to frequent vomiting.
Call your provider if:
Get medical help right away if you also have symptoms such as:
These may be signs of a more serious condition.
Avoid head positions that trigger positional vertigo.
Baloh RW, Jen JC. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 400.
Bhattacharyya N, Gubbels SP, Schwartz SR, et al; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3_Suppl):S1-S47. PMID: 28248609 pubmed.ncbi.nlm.nih.gov/28248609/.
Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 167.BACK TO TOP
Review Date: 7/26/2021
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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