Conditions
BPPV is one of the most common causes of vertigo. It causes brief, intense spells of spinning that are set off by specific head movements, such as rolling over in bed, looking up, or bending down. The cause is mechanical: small crystals that are loose in the inner ear where they do not belong.
This page covers what BPPV is, how it is diagnosed, how it is usually treated, and where our care fits.
New vertigo should be checked by a medical provider. If vertigo comes with a sudden, severe headache, double vision, numbness or weakness, trouble speaking, or confusion, or if you think it could be an emergency, call 911 or go to the nearest emergency department.
The inner ear has sensors that detect gravity and movement, and three looped canals that sense rotation. Tiny calcium crystals normally sit in one of the sensors. In BPPV, some of these crystals break loose and drift into a canal. When you move your head, they shift in the fluid and send a false spinning signal to the brain, which does not match what the other ear, your eyes, and your body are reporting. The result can be intense vertigo, jerking eye movements called nystagmus, and nausea.
Possible reasons the crystals come loose include age-related changes, a head injury, and inner ear problems. Sometimes no cause is found.
Brief, intense spinning, usually lasting under a minute
Vertigo set off by rolling over, looking up, bending down, or tipping the head
Jerking eye movements (nystagmus) during an attack
Nausea, or unsteadiness between spells
Symptoms that repeat with the same head movement
The 2017 clinical practice guideline from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) says posterior canal BPPV is diagnosed with the Dix-Hallpike test, in which a clinician moves you from sitting to lying with your head turned, looking for vertigo and a particular pattern of eye movement. If history suggests BPPV but this test is negative or shows a different pattern, a supine roll test checks the other canals (AAO-HNSF guideline summary, March 2017).
The guideline advises against imaging or extra vestibular testing for people who meet the criteria for BPPV, unless other signs or symptoms do not fit BPPV.
The same guideline recommends a canalith repositioning procedure for posterior canal BPPV, such as the Epley maneuver. This is a sequence of head and body movements that moves the loose crystals out of the canal. It says clinicians should not routinely treat BPPV with antihistamines or benzodiazepines, that observation or vestibular rehabilitation may be offered, and that people should be reassessed within a month, with persistent symptoms checked for unresolved BPPV or another cause (AAO-HNSF guideline summary, March 2017).
Because the right maneuver depends on which ear and which canal is involved, we suggest having a trained clinician do the maneuver rather than trying it alone.
Sometimes dizziness continues after BPPV is treated, or the picture turns out to be more than BPPV. Balance problems often overlap. Our Vertigo & Balance page covers the other common causes, and our Vestibular Rehabilitation page describes exercise-based care for the balance system. Our care is meant to be complementary to your medical care.
A short, intense spinning feeling when you move your head in a certain way, often when rolling over in bed or looking up. It usually lasts under a minute.
The guideline notes that observation is one option, so some cases may settle without a procedure. Ask your clinician about your case.
A series of head and body positions used to move loose crystals out of the canal. It is the type of procedure the guideline recommends for posterior canal BPPV.
A head injury is one possible cause. See our Concussion & Brain Injury page.
It can for some people. Talk with your clinician about what to do if it does.
Vestibular migraine episodes last longer, from minutes to days, and may come with migraine features. See our Vestibular Migraine page.
See our Vertigo Treatment in Smyrna, GA, Marietta, and Atlanta pages.
Next steps
If spinning spells are disrupting your days, we would be glad to help you understand what is going on.