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) break free and float 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:
Family members with BPPV
A history of a head injury (even a slight bump to the head)
A history of an inner ear infection called
BPPV symptoms include any of the following:
Feeling like you are spinning or moving
Feeling like the world is spinning around you
Loss of balance
Hearing loss
, such as a feeling that things are jumping or moving
The spinning sensation:
Is usually triggered by moving your head
Often starts suddenly
Lasts a few seconds to minutes
Certain movements can trigger the spinning feeling:
Rolling over in bed
Tilting your head up to look at something
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.
Your provider holds your head in a certain position. Then you are asked to lie quickly backward over a table.
As you do this, your provider will look for abnormal eye movements (called
) and ask if you feel like you are spinning.
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 check for other causes. These may include:
(ENG)
scan
scan
Magnetic resonance angiography
(MRA) of the head
Warming and cooling the inner ear with water or air to test eye movements (
)
Your provider may perform a procedure called the
. 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 refer you to vestibular rehabilitation or 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:
Antihistamines
Anticholinergics
Sedative-hypnotics
But, these medicines often do not work well for treating vertigo.
Follow instructions on how to take
. 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.
Contact your provider if:
You develop vertigo.
Treatment for vertigo doesn't work.
Get medical help right away if you also have symptoms such as:
Vision problems
These may be signs of a more serious condition.
Avoid head positions that trigger positional vertigo.
Vertigo - positional; Benign paroxysmal positional vertigo; BPPV; Dizziness - positional
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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.
Updated 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 C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.