Vertigo (BPPV)

Benign paroxysmal positional vertigo, usually shortened to BPPV, is an inner ear problem and the most common cause of vertigo, the sensation that you or your surroundings are spinning. The inner ear contains fluid-filled tubes called semicircular canals that sense movement and help with balance.

In BPPV, tiny crystals of calcium that normally sit in another part of the inner ear become dislodged and move into one of these canals. When you change the position of your head, the loose crystals shift and send confusing signals to the brain, producing a brief but often intense spinning sensation. The name reflects that it is benign (not dangerous), paroxysmal (comes in sudden short bursts), and positional (triggered by position).

The hallmark of BPPV is short episodes of vertigo, usually lasting less than a minute, brought on by changes in head position. Common triggers include lying down, sitting up, rolling over in bed, tipping the head back to look up, or bending forward.

Alongside the spinning, people may feel unsteady, lightheaded or nauseous, and the unsteadiness can linger for a while after the spinning settles. Importantly, BPPV does not cause hearing loss or ringing in the ears, which helps distinguish it from some other inner ear conditions.

Often no clear reason is found for why the crystals become dislodged, and BPPV can simply develop on its own. It becomes more common with age. In some cases it follows a head injury, a period of lying in bed, or another inner ear disorder.

Because the trigger is mechanical, the loose crystals moving within a canal, BPPV tends to respond well to treatments that guide the crystals back to where they belong.

BPPV is usually diagnosed from the history of brief, position-triggered vertigo together with a simple bedside test. The most common is the Dix-Hallpike manoeuvre, in which a clinician carefully moves your head and body into specific positions while watching your eyes.

If BPPV is present, these positions briefly reproduce the vertigo and cause a characteristic eye movement called nystagmus, which confirms the diagnosis and shows which ear and canal are affected. Most people do not need scans, although further tests may be arranged if the picture is unusual or other causes are suspected.

The main treatment is a repositioning manoeuvre, a specific sequence of head and body movements that guides the displaced crystals out of the affected canal so they stop triggering vertigo. The Epley manoeuvre is the best known and is often very effective, sometimes after a single session. A trained clinician usually performs it, and some people are taught exercises to continue at home.

Medicines are generally not the main treatment, but short-term medication may occasionally be used to ease severe nausea or spinning. Until symptoms settle, it can help to move the head gently, get up slowly, and take care with activities where a sudden bout of vertigo could be dangerous.

BPPV itself is not dangerous, but some causes of vertigo are. Seek emergency care if vertigo or dizziness comes with sudden severe headache, weakness or numbness of the face, arm or leg, slurred speech, double vision, difficulty walking, or sudden hearing loss.

These features can point to a problem in the brain or nerves rather than the inner ear and need urgent assessment. If you are unsure whether your symptoms fit straightforward BPPV, it is safest to be checked.

BPPV cannot reliably be prevented, but it usually responds well to treatment and frequently improves within a short time, sometimes settling on its own as the crystals reabsorb. Repositioning manoeuvres often resolve symptoms quickly.

BPPV can return in some people, occasionally months or years later. If it does, the same repositioning treatment can be repeated, and recurring cases can be reviewed by an ear, nose and throat or balance specialist. The overall outlook is reassuring, as the condition is benign and treatable.