Benign positional vertigo

  • Definition
    • 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.

  • Alternative Names
    • Vertigo - positional; Benign paroxysmal positional vertigo; BPPV: dizziness- positional

  • Causes
    • 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 a small piece of bone-like calcium 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 for developing BPPV may increase if you have:

      • Family members with BPPV
      • Had a prior head injury (even a slight bump to the head)
      • Had an inner ear infection called labyrinthitis
  • Symptoms
    • 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
      • Nausea and vomiting
      • Hearing loss
      • Vision problems, 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 positions can trigger the spinning feeling:

      • Rolling over in bed
      • Tilting your head up to look at something
  • Exams and Tests
    • 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 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 rule out other causes. These may include:

  • Treatment
    • Your provider will teach you how to do a procedure called Epley's maneuver. It can move the small piece of calcium that is floating inside your inner ear. This treatment works best to cure BPPV. 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 care for yourself at home. To keep your symptoms from getting worse, avoid the positions that trigger it.

  • Outlook (Prognosis)
    • BPPV is uncomfortable, but it can usually be treated with Epley's maneuver. It may come back again without warning.

  • Possible Complications
    • People with severe vertigo may get dehydrated due to frequent vomiting.

  • When to Contact a Medical Professional
    • Call your provider if:

      • You develop vertigo
      • Treatment for vertigo doesn't work

      Get medical help right away if you also have symptoms such as:

      • Weakness
      • Slurred speech
      • Vision problems

      These may be signs of a more serious condition.

  • Prevention
    • Avoid head positions that trigger positional vertigo.

  • References
    • Bhattacharyya N, Baugh RF, Orvidas L, et al, American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: Benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139(5 Suppl 4):S47-S81. PMID: 18973840

      Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 165.

      Kim JS, Zee DS. Clinical practice: benign paroxysmal positional vertigo. NEJM. 2014;370:1138-1147. PMID: 24645946