What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign Paroxysmal Positional Vertigo (BPPV): Causes & Treatment

Benign Paroxysmal Positional Vertigo (BPPV) is a balance disorder that is the most common cause of vertigo or dizziness in adults. This type of vertigo is characterized by a sudden, brief sensation of spinning or feeling that the room is spinning, usually occurring when changing head position in specific ways [2]. For example, you may feel it when lying down, sitting up, rolling over in bed, or tilting your head up or down.

To understand BPPV, it is important to know that the inner ear contains a complex system known as the vestibular system, which is responsible for sending signals to the brain about head position and movement [2]. This system includes fluid-filled canals with hair-like sensors. Normally, there are small calcium granules in a part of the inner ear that help stimulate these sensors to tell the brain about head position and movement [2]. BPPV occurs when these granules slip out of place and enter a part of the inner ear where they should not be. When these granules move in the wrong place, they send confusing signals to the brain about head movement, causing the sensation of vertigo [2].

What are the symptoms of Benign Paroxysmal Positional Vertigo?

The main symptom of BPPV is a sudden, brief feeling of vertigo or dizziness, as if you are spinning or your surroundings are spinning [1]. These episodes typically last only a few seconds and occur upon changing head position [2]. Other symptoms may include:

A feeling of imbalance or unsteadiness [1].
Nausea or vomiting in some cases [1].
Difficulty walking [1].

These symptoms may worsen when walking, standing, or moving the head [1]. It is important to distinguish between vertigo, which is the sensation that you or the room is spinning, and dizziness, which may include a feeling of lightheadedness, unsteadiness, or fainting [1].

How is Benign Paroxysmal Positional Vertigo diagnosed?

To diagnose BPPV, the doctor typically asks about symptoms and medical history [1]. The doctor may perform a physical examination and test hearing, balance, and gait [1]. A common test is the Dix-Hallpike maneuver, where the doctor moves the patient's head quickly into different positions to observe eye movement [2]. This maneuver can reveal whether the vertigo is caused by changes in head position or a more serious condition [2]. In some cases, other balance tests such as electronystagmography (ENG) or videonystagmography (VNG), which measure involuntary eye movements, may be needed [2].

What is the treatment for Benign Paroxysmal Positional Vertigo?

BPPV often improves on its own, but if it persists, a doctor can help find the cause and appropriate treatment [1]. Treatment is primarily based on Canalith Repositioning Procedures, the most common being the Epley maneuver [1]. This maneuver involves a series of head and body movements performed by the doctor with the aim of returning the calcium granules to their correct place in the inner ear [2]. You may need to perform this maneuver several times to achieve complete recovery. In some cases, the doctor may recommend home balance exercises [1].

If you suffer from BPPV, you can visit Benign Paroxysmal Positional Vertigo: Seconds-Long Dizziness During Head Movement (Arabic) to learn more about this condition.

Is Benign Paroxysmal Positional Vertigo dangerous?

Although BPPV can be bothersome and affect quality of life, it is not considered dangerous in most cases [2]. Its name 'benign' indicates that it is not caused by a serious medical condition [3]. However, it can increase the risk of falls, especially in the elderly [2]. It is important to seek immediate medical help if you experience sudden or severe vertigo accompanied by vision problems, slurred speech, or weakness in the limbs, as these may be signs of a more serious condition requiring urgent evaluation [1].