Benign Paroxysmal Positional Vertigo
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you’re spinning or that the inside of your head is spinning.
Benign paroxysmal positional vertigo causes brief episodes of mild to intense dizziness. Benign paroxysmal positional vertigo is usually triggered by specific changes in the position of your head. This might occur when you tip your head up or down, when you lie down, or when you turn over or sit up in bed.
Although benign paroxysmal positional vertigo can be a bothersome problem, it’s rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor’s office visit.
The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:
- A sense that you or your surroundings are spinning or moving (vertigo)
- A loss of balance or unsteadiness
The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of benign paroxysmal positional vertigo can disappear for some time and then recur.
Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Some people also feel out of balance when standing or walking.
Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo.
When to see a doctor
Generally, see your doctor if you experience any unexplained dizziness or vertigo that recurs periodically for more than one week.
Seek emergency care
Although it’s uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:
- A new, different or severe headache
- A fever
- Double vision or loss of vision
- Hearing loss
- Trouble speaking
- Leg or arm weakness
- Loss of consciousness
- Falling or difficulty walking
- Numbness or tingling
The signs and symptoms listed above may signal a more serious problem.
Often, there’s no known cause for BPPV. This is called idiopathic BPPV.
When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back, such as in a dentist chair. BPPV also has been associated with migraines.
The ear’s role
Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.
Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head’s position related to gravity. These otolith organs contain crystals that make you sensitive to gravity.
For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you’re lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to, which is what makes you feel dizzy.
Benign paroxysmal positional vertigo occurs most often in people age 50 and older, but can occur at any age. Benign paroxysmal positional vertigo is also more common in women than in men. A head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.
Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. The dizziness of BPPV can make you unsteady, which may put you at greater risk of falling.
Tests and diagnosis
Your doctor may do a series of tests to determine the cause of your dizziness. During a physical examination, your doctor will likely look for:
- Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute
- Dizziness with specific eye movements that occur when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed
- Involuntary movements of your eyes from side to side (nystagmus)
- Inability to control your eye movements
If the cause of your signs and symptoms is difficult to determine, your doctor may order additional testing, such as:
- Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air.
- Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.
Treatments and drugs
Benign paroxysmal positional vertigo may go away on its own within a few weeks or months. But, to help relieve BPPV sooner, your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure.
Performed in your doctor’s office, the canalith repositioning procedure consists of several simple and slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs in your ear where these particles don’t cause trouble and are more easily resorbed.
Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure is usually effective after one or two treatments.
Your doctor will likely teach you how to perform the canalith repositioning procedure on yourself so that you can do it at home if necessary.
In very rare situations in which the canalith repositioning procedure isn’t effective, your doctor may recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear that’s causing dizziness. The plug prevents the semicircular canal in your ear from being able to respond to particle movements or head movements in general. The success rate for canal plugging surgery is approximately 90 percent.
Lifestyle and home remedies
If you experience dizziness associated with benign paroxysmal positional vertigo (BPPV), consider these tips:
- Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
- Sit down immediately when you feel dizzy.
- Use good lighting if you get up at night.
- Walk with a cane for stability if you’re at risk of falling.
- Work closely with your doctor to manage your symptoms effectively.
BPPV may recur even after successful therapy. Fortunately, although there’s no cure, the condition can be managed with physical therapy and home treatments.