Overview:

Symptoms of Positional Vertigo

The primary symptom of BPPV is vertigo, which is a spinning sensation or a feeling of being off balance.

Other common symptoms include:
  • Brief episodes of dizziness lasting for a few seconds to a few minutes
  • Nausea and vomiting during severe episodes
  • Loss of balance and unsteadiness
  • Blurred vision or nystagmus (involuntary eye movements)
  • Lightheadedness or faintness
  • Sensation of being pulled to one direction1

BPPV can sometimes cause related consequences, such as tinnitus (ringing or buzzing in the ears).

The symptoms may last up to a minute and usually subside once the crystals have settled back down into position.

Can Positional Vertigo Come and Go?

Unfortunately, even after treatment, positional vertigo may re-occur weeks or even years later, if another crystal dislodges into your semicircular canals.

If you have BPPV, anytime there is a change in the position of the head, the crystals can move and trigger an attack of vertigo and dizziness.

These include common daily movements like:
  • Moving from lying down to sitting up in bed
  • Rolling over in bed
  • Looking upwards
  • Bending forwards to pick something up
Symptoms may be more frequent at times, if the otoconia do not find their way back into the utricle. This can be disturbing and fear-inducing since you might feel fine one day, but then the symptoms return again the next day.

What is the Cause of Benign Paroxysmal Positional Vertigo?

The exact cause of BPPV is often unknown, but it can occur as a result of:
  • Aging
  • Head trauma
  • Inner ear infections
  • Medical conditions affecting the inner ear, such as Ménière's disease
It may even develop spontaneously without an identifiable cause, in some cases.1

What Can I Do for Benign Paroxysmal Positional Vertigo?

Step 1: Diagnosis
The first step is to visit your healthcare provider for an accurate diagnosis. 

You will likely be referred to an Otolaryngologist or Ear, Nose and Throat specialist.

Diagnosing BPPV involves a thorough medical history review and a physical examination, which may include specific tests like, the Dix-Hallpike manoeuvre or the Roll test.

To perform these tests the specialist will move you quickly from a seated to lying down position on a bed, holding your head at a 45º angle.

The aim of these tests is to trigger the movement of dislodged otoconia within the semicircular canals to reproduce the characteristic symptoms of BPPV.

If you have BPPV you will likely experience vertigo or dizziness for a few seconds when your head is moved from one position to the next. The doctor will observe any nystagmus (or jerking movements of the eyes) caused by the changing head position, to confirm the diagnosis.
Step 2: Treatment
If the result is positive on the Dix-Hallpike test for BPPV, the doctor will likely move straight into treating it with the Epley manoeuvre (described below), while you are lying back.2

How Do You Fix Benign Paroxysmal Positional Vertigo?

Positional vertigo can be successfully treated without medicines, surgery or special equipment, using the Epley manoeuvre.2

The Epley manoeuvre is a series of head and body movements performed by a healthcare professional. It helps to guide the otoconia out of the affected semicircular canal, repositioning them back into the utricle where they no longer cause symptoms.

While lying back after the Dix-Hallpike assessment, the doctor will:
  1. Turn your head to the other side and hold for 30 seconds
  2. Then ask you to roll onto the side, while turning your head to face the floor - holding for 30 seconds
  3. Then have you swing your legs off the side of the bed to sit back up, while holding your head facing downwards for 30 seconds

Symptoms usually resolve after the manoeuvre has been performed, but sometimes it can take a few tries before the procedure works. In these cases, your doctor may prescribe some of these movements for you to repeat at home.

In some cases, medications may be prescribed to alleviate associated symptoms such as nausea and dizziness.2

What Should You Do After Treatment for Positional Vertigo?

For the remainder of the day after the Epley manoeuvre treatment, it is best to avoid:
  • Tilting your head back
  • Bending far forward (for example, to put on shoes) 

Also avoid sleeping on the affected side for several days. It can help to prop yourself up on several pillows overnight.

Does Benign Paroxysmal Positional Vertigo Ever Go Away?

BPPV can be successfully managed and often resolves spontaneously over time, particularly in cases without an underlying cause.

The repositioning manoeuvres and treatments mentioned above have a high success rate in providing relief.

However as mentioned before, it is possible for BPPV to recur, especially in individuals who are prone to developing otoconia displacement.

Tips for Managing Positional Vertigo at Home

  1. It is important to stay active and perform exercises that promote balance, and your healthcare provider might prescribe some vestibular rehabilitation exercises for you to do at home.
  2. Caution should be used during self-treatment as your dizziness and nausea may get worse during the movement. It is therefore strongly recommended that you have someone with you while you are performing the exercises for safety and reassurance.
  3. The most effective exercise for you will depend upon which ear is affected, and more specifically, which semicircular canal is affected. Your healthcare provider will diagnose this and recommend which exercises to perform.

Here are some examples of at home vestibular rehab exercises:

The Home Epley Manoeuvre


This is very similar to the Epley manoeuvre your healthcare provider will have performed at the time of treatment.

If the problem is in your Right ear:
  1. Start sitting up in bed with your head turned 45º to the Right
  2. Lie back quickly, keeping your head in that position, so that your shoulders are on your pillow and your head is reclined off the edge of it
  3. Wait for 30 seconds
  4. Turn your head to look 45º to the Left in that reclined position
  5. Wait another 30 seconds
  6. Sit up on the Left side

Start facing the Left if the problem is in your Left ear.3

Brandt-Daroff Exercises

 
  1. Start sitting upright on the edge of your bed
  2. Move into a side-lying position with your nose turned upward at 45º
  3. Hold that position until the dizziness subsides and then repeat to the other side
  4. Repeat this movement several times, twice a day.

Summary

The symptoms of BPPV can be very disturbing since their onset may be quite sudden and they may cause people to lose their balance or even fall out of bed.

Thankfully the cause is benign as a result of calcium carbonate crystals moving around the semicircular canals.

It is crucial to consult with a healthcare provider for an accurate diagnosis and appropriate treatment plan. Treatment is non-invasive and symptoms usually subside quickly afterwards.

References:

  1. De Stefano A, Dispenza F, Suarez H, Perez-Fernandez N, Manrique-Huarte R, Ban JH, et al.(2014). A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. Auris Nasus Larynx. 41:31–6. 10.1016/j.anl.2013.07.007
  2. Benign Paroxysmal Positional Vertigo (BPPV). Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-positional-vertigo-bppv, on 15 May 2023.
  3. Fife TD, et al. (2008). Practice parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 70(22): 2067–2074.
  4. Home Epley Maneuver. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/home-epley-maneuver, on 15 May 2023.
The information contained in this article is for educational and informational purposes only. You should not use the information as a substitute for, nor should it replace, professional medical advice. If you have any questions about your health, you should always consult with a physician or other health-care professional.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is a disorder of the inner ear that arises when small calcium carbonate crystals called otoconia become dislodged from the their normal position in the utricle.1

The utricle is a sensory organ at the base of each semicircular canal within the inner ear. There are three semicircular canals and they are responsible for sensing rotational movement. They play a crucial role in our ability to maintain our balance.

When the crystals dislodge, they migrate into the fluid-filled semicircular canals.This interferes with the normal fluid movement, leading to false signals being sent to the brain, resulting in dizziness and vertigo.