Benign positional vertigo is the most common type of vertigo. Vertigo is the feeling that you are spinning or that everything is spinning around you. It may occur when you move your head in a certain position.
Vertigo - positional; Benign paroxysmal positional vertigo; BPPV; Dizziness - positional
Benign positional vertigo is also called benign paroxysmal positional vertigo (BPPV). It is caused by a problem in the inner ear.
The inner ear has fluid-filled tubes called semicircular canals. When you move, the fluid moves inside these tubes. The canals are very sensitive to any movement of the fluid. The sensation of the fluid moving in the tube tells your brain the position of your body. This helps you keep your balance.
BPPV occurs when small pieces of bone-like calcium (called canaliths) breaks free and floats inside the tube. This sends confusing messages to your brain about your body's position.
BPPV has no major risk factors. But, your risk of developing BPPV may increase if you have:
- Family members with BPPV
- Had a prior head injury (even a slight bump to the head)
- Had an inner ear infection called labyrinthitis
BPPV symptoms include any of the following:
- Feeling like you are spinning or moving
- Feeling like the world is spinning around you
- Loss of balance
- Nausea and vomiting
- Hearing loss
- Vision problems, such as a feeling that things are jumping or moving
The spinning sensation:
- Is usually triggered by moving your head
- Often starts suddenly
- Lasts a few seconds to minutes
Certain positions can trigger the spinning feeling:
- Rolling over in bed
- Tilting your head up to look at something
Exams and Tests
Your health care provider will do a physical exam and ask about your medical history.
To diagnose BPPV, your provider may perform a test called the Dix-Hallpike maneuver.
- Your provider holds your head in a certain position. Then you are asked to lie quickly backward over a table.
- As you do this, your provider will look for abnormal eye movements (called nystagmus) and ask if you feel like you are spinning.
If this test doesn't show a clear result, you may be asked to do other tests.
You may have brain and nervous system (neurological) tests to rule out other causes. These may include:
- Electroencephalogram (EEG)
- Electronystagmography (ENG)
- Head CT scan
- Head MRI scan
- Hearing test
- Magnetic resonance angiography of the head
- Warming and cooling the inner ear with water or air to test eye movements (caloric stimulation)
Your provider may perform a procedure called the (Epley maneuver). It is a series of head movements to reposition the canaliths in your inner ear. The procedure may need to be repeated if symptoms come back, but this treatment works best to cure BPPV.
Your provider may teach you other repositioning exercises that you can do at home, but may take longer than the Epley maneuver to work. Other exercises, such as balance therapy, may help some people.
Some medicines can help relieve spinning sensations:
But, these medicines often do not work well for treating vertigo.
Follow instructions on how to take care for yourself at home. To keep your symptoms from getting worse, avoid the positions that trigger it.
BPPV is uncomfortable, but it can usually be treated with the Epley maneuver. It may come back again without warning.
People with severe vertigo may get dehydrated due to frequent vomiting.
When to Contact a Medical Professional
Call your provider if:
- You develop vertigo.
- Treatment for vertigo doesn't work.
Get medical help right away if you also have symptoms such as:
- Slurred speech
- Vision problems
These may be signs of a more serious condition.
Avoid head positions that trigger positional vertigo.
Baloh RW, Jen JC. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 400.
Bhattacharyya N, Gubbels SP, Schwartz SR, et al; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3_Suppl):S1-S47. PMID: 28248609 www.ncbi.nlm.nih.gov/pubmed/28248609.
Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 165.
- Last reviewed on 6/23/2019
- Alireza Minagar, MD, MBA, Professor, Department of Neurology, LSU Health Sciences Center, Shreveport, LA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.