Vertigo is the feeling that you are spinning or the
world is spinning around you. Benign paroxysmal positional vertigo is caused by
a problem in the
inner ear. It usually causes brief vertigo spells that come and go.
For some people, BPPV goes away by itself in a few weeks. But it can come
BPPV is not a sign of a serious health
Benign paroxysmal positional
vertigo (BPPV) is caused by a problem in the inner ear. Tiny calcium "stones"
inside your inner ear canals help you keep your balance. Normally, when you
move a certain way, such as when you stand up or turn your head, these stones
move around. But things like infection or inflammation can stop the stones from
moving as they should. This sends a false message to your brain and causes the vertigo.
The main symptom is a
feeling that you are spinning or tilting when you are not. This can happen when
you move your head in a certain way, like rolling over in bed, turning your
head quickly, bending over, or tipping your head back.
usually lasts a minute or two. It can be mild, or it can be bad enough to make
you feel sick to your stomach and vomit. You may even find it hard to stand or
walk without losing your balance.
Your doctor can usually tell that you have BPPV by asking you questions about your vertigo and doing a physical exam. You may have a test where your doctor watches your eyes while turning your head and helping you lie back. This is called
the Dix-Hallpike test.
There are other things that can cause
vertigo, so if your doctor doesn't think you have BPPV, you may have other tests too.
Your doctor can usually do one of two procedures in the office that works for most cases of BPPV. These procedures are called the Epley maneuver and the Semont maneuver. If you don't want treatment or if treatment doesn't work, BPPV usually goes away by
itself within a few weeks. Over time, your brain will likely get used to the
confusing signals it gets from your inner ear. Either way, you can do some simple
exercises that train your brain to get used to
the confusing vertigo signals.
Medicine can help with severe
nausea and vomiting caused by your vertigo. But using this kind of medicine
can also make BPPV take longer to go away. Only you know whether you feel sick
enough that it is worth it to take medicine (and possibly have vertigo
Be extra careful so that you don't hurt yourself or
someone else if you have a sudden attack of vertigo.
Learning about benign paroxysmal positional vertigo (BPPV):
Living with BPPV:
Health Tools help you make wise health decisions or take action to improve your health.
Benign paroxysmal positional vertigo
(BPPV) is caused by a problem in the inner ear. Tiny calcium "stones" inside
your inner ear canals help you keep your balance. Normally, when you move a
certain way, such as when you stand up or turn your head, these stones move
around. But things like infection or inflammation can stop the stones from
moving as they should. This sends a false message to your brain and causes the vertigo.
The main symptom of
benign paroxysmal positional vertigo (BPPV) is the
feeling that you or your surroundings are spinning, whirling, or tilting. This
sensation is called vertigo.
It is important to understand the
difference between vertigo and dizziness. People often
use those two terms as if they meant the same thing. But they are different
symptoms, and they may point to different problems.
To find out whether your vertigo is caused by BPPV, your
doctor will want to find out what causes it, how bad it is, and how long it
lasts. With BPPV:
Benign paroxysmal positional vertigo (BPPV) causes a
whirling, spinning sensation even though you are not moving. If the vertigo is
bad, it may also cause nausea or vomiting. The vertigo attacks happen when you
move your head in a certain way, such as tilting it back or up or down, or by
rolling over in bed. It usually lasts less than a minute. Moving your head to
the same position again may trigger another episode of vertigo.
BPPV often goes away without treatment. Until it does, or is successfully
treated, it can repeatedly cause vertigo with a particular head movement.
Sometimes it will stop for a period of months or years and then suddenly come
Scientists think you're more
likely to develop
benign paroxysmal positional vertigo (BPPV) if you
have one of these conditions:
If you've had one episode of vertigo caused by BPPV, you
are likely to have more.
or other emergency services immediately if you have
vertigo (a spinning sensation) and:
Call your doctor now or seek immediate care
Call your doctor to schedule an appointment if:
If your symptoms suggest
benign paroxysmal positional vertigo (BPPV), watchful
waiting may be appropriate. Over time BPPV may go away on its own. But treatment with a simple procedure in your doctor's office (either the Epley or Semont maneuver) can usually stop your vertigo right away. Talk to your doctor. If your vertigo
interferes with your normal daily activities or causes nausea and vomiting, you
may need treatment.
The following health professionals are able to diagnose
and treat BPPV and the causes of vertigo:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Benign paroxysmal positional vertigo (BPPV) is diagnosed with a physical exam and your
medical history. But diagnosing the cause of the
spinning, whirling sensation of
vertigo can be difficult. Several diseases, the side
effects of medicines, and head injuries can also cause vertigo.
Dix-Hallpike test may be done to help your doctor find
out the cause of your vertigo. During this test, he or she will carefully
observe any involuntary eye movements. This will help your doctor know whether
the cause of your vertigo is inside your brain, your inner ear, or the nerve
connected to your inner ear. The Dix-Hallpike test also can help your doctor
find out which ear is affected.
If your symptoms or the results of your exam make your doctor think you don't have BPPV, other tests may be done:
Benign paroxysmal positional vertigo (BPPV) may go away in a few weeks by itself. If
treatment is needed, it usually consists of head exercises (Epley and Semont maneuvers). These exercises will move the particles out of the
semicircular canals of your
inner ear to a place where they will not cause vertigo.
Over time, your brain may react less and less to the confusing signals
triggered by the particles in the inner ear. This is called
compensation. Compensation occurs most quickly if you
continue normal head movements, even though doing so causes the whirling
Brandt-Daroff exercise may also be done to speed the
vestibular suppressants (such as
scopolamine) may be tried if your
symptoms are severe. But using medicines to control vertigo often extends the
time needed for compensation to occur.
may also be used to reduce nausea and vomiting that can occur with
In rare cases, surgery may be used to treat BPPV.
In most cases,
benign paroxysmal positional vertigo (BPPV) cannot be
prevented. But some cases may result from head injuries. Wearing a helmet
when bicycling, motorcycling, playing baseball, or doing other sports
activities can protect you from a head injury and BPPV.
You can reduce the whirling or spinning
vertigo when you have
benign paroxysmal positional vertigo (BPPV) by taking
You can also help yourself by doing balance exercises and
taking safety precautions.
Staying as active as
possible usually helps the brain adjust more quickly. But that can be hard to
do when moving is what causes your vertigo. Bed rest may help, but it usually
increases the time it takes for the brain to adjust.
Medicines do not cure
benign paroxysmal positional vertigo (BPPV). But they
may be used to control severe symptoms, such as the whirling, spinning
vertigo and the nausea and vomiting that may
Medicines to reduce the whirling sensation of vertigo are
called vestibular suppressants. They include:
Antiemetic medicines, such as promethazine (Promethegan), may be used if you have severe nausea or
Medicines that calm the inner
ear (vestibular suppressants) may also slow down the brain's ability to adjust
to the abnormal balance signals triggered by the particles in the inner ear.
They should be taken only to control severe symptoms.
Ear surgery is an option for treating
benign paroxysmal positional vertigo (BPPV) only in
severe cases when other treatments have not worked.
Exercises are used to treat
benign paroxysmal positional vertigo (BPPV). These
exercises help the particles in the semicircular canals of your
inner ear move around, so that they don't cause vertigo. Although the
exercises usually stop the vertigo for months or years, the problem may return
and cause your symptoms to come back.
Exercises that may be used to treat BPPV include:
These exercises can get rid of
BPPV symptoms. The Epley and Semont maneuvers usually are more
comfortable than the Brandt-Daroff exercise, and they work faster—in one or two
treatments rather than being repeated several times a day for weeks. So these
maneuvers have become the first line of treatment.1
The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders.
The American Hearing Research Foundation helps pay for
research into hearing and balance disorders and also helps to educate the
public about these disorders. On their website you can find general
information on many common ear disorders, including descriptions, causes,
diagnoses, and treatments. References are also included as a source for further
information. The American Hearing Research Foundation also publishes a
newsletter, available by subscription, as well as a number of pamphlets on a
variety of topics.
The National Institute on Deafness and Other
Communication Disorders, part of the U.S. National Institutes of Health,
advances research in all aspects of human communication and helps people who
have communication disorders. The website has information about hearing,
balance, smell, taste, voice, speech, and language.
This organization provides information and support for
people with dizziness, balance disorders, and related hearing problems. A
quarterly newsletter, fact sheets, booklets, videotapes, a list of other
members in your area, and information about centers and doctors specializing in
balance disorders are all available to members.
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.
Other Works Consulted
Hillier SL, McDonnell M (2011). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews (2).
Hilton M, Pinder D (2004). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
Johnson J, Lalwani AK (2012). Vestibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 729–738. New
Kerber KA (2011). Episodic vertigo. In ET Bope et al., eds., Conn's Current Therapy 2011, pp. 210–213. Philadelphia: Saunders.
Von Brevern M, et al. (2006). Short-term efficacy of Epley's manoeuvre: A double-blind randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry, 77(8): 980–982.
Walker MF, Daroff RB (2012). Dizziness and vertigo. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1, pp. 178–181. New York: McGraw-Hill.
December 19, 2012
Anne C. Poinier, MD - Internal Medicine
& E. Gregory Thompson, MD - Internal Medicine
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