Benign paroxysmal positional vertigo

What is BPPV?

BPPV is one of the most common forms of vertigo. Vertigo is a feeling of movement when the body is not actually moving. This often feels like the room is spinning, causing you to feel dizzy.

Though BPPV can be very unpleasant, the condition is called ‘benign’ as it does not cause serious harm. BPPV occurs when small crystals in your ear become dislodged and settle in the fluid-filled semicircular canals of the inner ear. These canals are part of your balance system. When a crystal is moving within these canals, it causes the feeling of dizziness.

Symptoms

BPPV causes feelings of dizziness or imbalance. It can last seconds or a couple of minutes at a time and may be accompanied by nausea and sometimes vomiting. Symptoms are brought on by changes in head position, such as rolling over in bed, getting out of bed, lifting your head to look up or bending down.

BPPV does not cause ringing in your ears (tinnitus) or hearing loss. If you have these symptoms, please tell your treating doctor.

Causes

Causes of BPPV can be:

• spontaneous – no cause, with the risk increasing with age
• trauma; for example, after a knock to the head or concussion
• recent inner ear infection.

Diagnosis

To obtain a diagnosis, a health professional, such as a doctor or physiotherapist, will ask you to describe your symptoms in detail. The treating health professional will also perform some tests which involve moving your head in certain positions while examining your eyes. These tests may bring on your symptoms and can feel uncomfortable. However, it is important to work out a diagnosis and find out which ear is causing the problem so you can have the best treatment.

Sometimes the results may not be clear, especially if you have been given medication for your symptoms.

Treatment

BPPV can be treated with exercises that involve moving your head in certain positions to return the dislodged crystal back to the correct position in the inner ear.

It is important to seek treatment, even though BPPV may get better without treatment in some people. The most common exercises your health professional might use are called the “epley manoeuvre” or the “BBQ roll”.

The choice of exercise will depend on what type of BPPV you have. Sometimes it takes more than one session to treat BPPV, so you may be referred to a specialist doctor or physiotherapist for further treatment.

Following treatment

You may experience mild dizziness or feel a bit ‘off’ for up to a week after the BPPV episode.

For some people, BPPV can re-occur again after a period of time. You don't need to limit your activities or movements, as these won't change the risk of BPPV occurring again.

If your symptoms do not resolve or they re-occur, follow up with your doctor or a physiotherapist who treats BPPV. Take note of what causes your symptoms, as this will be helpful for your health professional.

Important considerations

Falls

BPPV can make you feel unsteady and off balance. This increases the risk of falling over while you have symptoms. Take sensible precautions, such as walk with others; hold onto rails when using stairs; and avoid activities that challenge your balance, such as climbing ladders or walking on uneven surfaces.

If you feel unsafe, contact your doctor or physiotherapist for more advice. You are encouraged to return to your everyday activities once you feel safe.

Driving

Driving is not recommended until your dizziness has resolved.

Sleeping

After treatment for BPPV, you may sleep in any position that is comfortable. It may feel natural to avoid positions that aggravate your symptoms, such as lying completely flat, or on a particular side. After your symptoms have resolved, you should be able to return to sleeping in your normal positions.

Medication

Short-term use of a prescribed anti-nausea medication can be helpful to control nausea and vomiting due to BPPV. Remember, these medications treat the symptoms but do not treat the cause. You should stop using them as your symptoms get better, as long-term use can cause more problems.

Normal activities

You can return to work, school, sport or other activities as symptoms resolve and you feel safe to do so. Bed rest or inactivity will not speed up your recovery.