Menu
Skip to main content
Table of Contents

Benign Paroxysmal Positional Vertigo (BPPV)

What is BPPV?

BPPV is one of the most common causes of vertigo, or a false feeling that you are spinning or moving.

BPPV happens in the inner ear (vestibular system), which helps control balance. Inside the inner ear are tiny crystals that help your brain sense movement. Sometimes these crystals move out of place and fall into one of the nearby balance canals.

When this happens, certain head movements can send the wrong message to the brain. This may cause short episodes of spinning, dizziness, or imbalance.

BPPV can happen for no clear reason. It is more common as people get older. It can also happen after a head injury, including a concussion, an inner ear illness, ear surgery, or a long period of bed rest.

Normal Inner Ear

Inner Ear with BPPV

BPPV stands for:

Benign: not life-threatening
Paroxysmal: symptoms come and go
Positional: triggered by head position or movement
Vertigo: a false feeling of movement or spinning

The good news is that BPPV is very treatable!

What is Happening in My Body?

When the misplaced crystals move inside the inner ear canal, they trigger a false sense of movement.  This frequently is triggered when you:

  • Roll in bed
  • Bend forward
  • Move your head to look up

Because of this, you may feel:

  • Brief spinning (usually seconds to under a minute)
  • Nausea (sometimes vomiting)
  • Feeling unsteady or “off”
  • Anxiety about moving
  • Wanting to avoid certain positions

It is important to know:

  • These symptoms are real and common.
  • Most people improve quickly with the correct treatment.
  • There is no medication to fix BPPV.  
  • Some mild lightheadedness or imbalance may occur after treatment but usually improves within a day or two.
  • About 1 in 3 people may have BPPV return at some point. If it does, it can usually be treated successfully again.
  • BPPV does not cause hearing loss. 
  • BPPV can increase risk of falling, especially in older adults, 
  • Between episodes of vertigo/dizziness you may feel completely normal.

How is Benign Paroxysmal Positional Vertigo (BPPV) Diagnosed?

BPPV is diagnosed by a trained provider who:

  • Listens to your medical history
  • Moves your head/body into specific positions
  • Watches your eye movements

The direction of your eye movement (called nystagmus) helps identify which ear and canal are involved.  Some providers use special infrared video goggles that make it easier to see these eye movements clearly. MRI or CT scans cannot diagnose BPPV. Imaging is only ordered if symptoms are unusual or something more serious is suspected.  Learn more about BPPV Testing.

What Your Provider May Ask:

To prepare you for a visit to a clinician, think about or write down your answers to the following questions. Try to be as specific as possible. This will help you provider better understand your dizziness experience.

  • What movements trigger your symptoms?
  • How long does the spinning last?
  • Do you feel nausea or vomit during episodes?
  • Did this begin after a fall or head injury?
  • Have you had this before?
  • Have you fallen or felt unsafe walking?
  • Do you have other symptoms like weakness, numbness, trouble speaking, double vision, fainting, or a severe headache? (These could suggest something more serious than BPPV).

Common Tests Used to Confirm Diagnosis

  • BPPV testing positions
    • Dix-Hallpike Test 
    • Supine roll test
  • Eye movement exam to insure your eyes are moving normally
  • Focused neurologic screen which includes:
    • vestibular (inner ear) ocular (eye) exam
    • assessment of eye movement
    • sensation of feet/legs
    • strength, balance, walking, and overall mobility to help rule BPPV in or out or identify and other complications

An example of a Dix-Hallpike Test with a patient wearing Infrared Video Goggles

How is Benign Paroxysmal Positional Vertigo (BPPV) Treated?

BPPV is a mechanical problem in the inner ear, so medication does not fix it.  Treatment involves specific head and body movements called Canalith Repositioning Maneuvers (CRM). These maneuvers guide the crystals back to where they belong.

Common maneuvers include:

  • Epley maneuver
  • Liberatory (Semont) maneuver
  • Barbeque roll maneuver

The correct maneuver depends on which ear and canal are involved, which is best evaluated by a qualified vestibular clinician.  Most people feel dramatically better after treatment.  Meclizine (Antivert) is usually not recommended because it can increase fall risk. Short-term nausea medication may be used if symptoms are severe.

This is an example of a home Epley maneuver for right-sided BPPV. Only do this after a trained clinician has evaluated you and told you it is the right treatment for you.

Common Treatment Options:

1) Canalith Repositioning Maneuvers

Moving the crystals back into the correct part of the inner ear is done through specific head movements performed by a vestibular therapists.  These are non-surgical procedures that can be done in an outpatient or home setting. Learn more about Canalith Repositioning Maneuvers.

2) Vestibular Rehabilitation Therapy (VRT)

If you still feel unsteady after the spinning stops, balance and eye exercises may help. Learn more about Vestibular Rehabilitation Therapy (VRT).

3) Lifestyle Strategies While Dealing with Active Vertigo or Dizziness Symptoms

  • Use handrails and nightlights while symptoms are active.
  • Sit on the edge of the bed before standing if you are dizzy, unsteady or have any other symptoms. 
  • Move slowly when changing positions if you need to. 

Can BPPV Come Back?

Yes. BPPV can return even after successful treatment. While it cannot always be prevented, there are steps that may help lower your risk:

  • Check your vitamin D level. If it is low, vitamin D and calcium supplements may help reduce recurrence. Check with your healthcare provider before starting supplements.
  • Manage your overall health. Conditions such as diabetes, high blood pressure, high cholesterol, osteoporosis, migraine, and sleep disorders have been linked with recurrent BPPV.
  • Keep your neck moving comfortably. Reduced neck range of motion has been associated with BPPV recurrence and may also make repositioning maneuvers more difficult.
  • Treat BPPV promptly if symptoms return. Contact a vestibular provider when the familiar spinning symptoms come back or you experience unexplained falls. Earlier repositioning treatment may help reduce future recurrence.

Ways to Reduce Recurrence of BPPV

For a printable handout on ways to lower your risk of BPPV returning, download the PDF today.

What Can I Expect Over Time?

Will I Get Better?

The vast majority of people improve quickly — often in one visit. Some may need a few sessions. Full recovery is a realistic goal.

How Long Will It Take?

Many people are free of symptoms within days to weeks once properly treated.

Can I Live a Normal Life?

Yes! Once treated, most people return to normal activities. If symptoms return and home maneuvers are not helping, return to your provider.

When Should I Call My Provider?

These symptoms are not typical of BPPV and require urgent evaluation.  Seek immediate medical care if you develop:

  • New weakness or numbness
  • Trouble walking
  • Trouble speaking
  • Double vision
  • Severe or “worst ever” headache
  • Fainting
  • Chest pain
  • Constant, worsening vertigo
  • New hearing loss
  • Repeated vomiting
  • A fall with head injury

Questions to Ask Your Provider

When you meet with your clinician, it may be helpful for you to ask the following questions. This can help you better understand your situation and feel more prepared for the visit and the future. 

  • Do my symptoms fit BPPV, and which ear/canal do you think is involved?
  • Which maneuver are you doing today, and what should I expect afterward?
  • What should I do if the spinning comes back tonight or next week?
  • When is it safe for me to drive, work, or exercise again?
  • Do I need vestibular rehab for balance or fear of movement?
  • Do I need any testing (hearing test, imaging, bloodwork), and why?
  • If this keeps coming back, should we check for vitamin D deficiency or other risk factors?
  • Do you use infrared video goggles to evaluate for BPPV?

Key Takeaways/Key Points to Remember

  • BPPV is the most common cause of brief, position-triggered spinning.
  • It happens when tiny crystals in your inner ear move from where they are supposed to be to a place where they should not be.
  • It is uncomfortable but not dangerous.
  • Repositioning maneuvers (like the Epley) are very effective.
  • Mild imbalance after treatment is common and usually short-lived.
  • BPPV can return, but it can usually be treated again successfully.
  • Get evaluated promptly to reduce fall risk and feel better faster.

Additional Resources