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Benign Paroxysmal Positional Vertigo


What is benign paroxysmal positional vertigo (BPPV)?

BPPV is an inner ear condition. BPPV is also called positional vertigo or benign (not life-threatening) paroxysmal nystagmus. Nystagmus is a quick, shaky eye movement that you cannot control. BPPV causes sudden attacks of vertigo when you change your head position. Vertigo is the feeling that you or the room is moving or spinning. With each attack of vertigo, you may have nystagmus. The attacks of vertigo and nystagmus last from a few seconds up to 1 minute. BPPV symptoms often happen when small pieces of calcium float into the semicircular canals in your inner ears.

What increases my risk for BPPV?

  • Older age
  • Chronic or returning ear infections
  • Being a woman
  • Long-term bed rest, especially if you lie on the same side of your head most of the time
  • A medical condition such as diabetes, high blood pressure, migraine headaches, or Ménière disease
  • An injury or trauma to your head or neck

What are the signs and symptoms of BPPV?

Head movements, such as looking up or down and bending over, may lead to an attack of vertigo. Vertigo may also occur when you first lie down or roll over in bed. The nystagmus will decrease with vertigo attacks that occur close together. When you have an attack of BPPV, you may also have the following symptoms:

  • Changes in your vision
  • Nausea or vomiting
  • Poor balance and feeling unsteady when you walk

How is BPPV diagnosed?

Your healthcare provider will ask about your symptoms and any health problems you have. Tell him if you have had surgeries, ear infections, or head injuries. He will look inside your ears. He may also check your eyes. Tell him if you are taking any medicines, including herbs, supplements, or over-the-counter (OTC) medicines. You may also need any of the following:

  • The Dix-Hallpike maneuver is used to check for symptoms caused by certain head movements and positions. You will sit on a table with your legs out in front of you. Your healthcare provider will turn your head to one side and tip your neck back slightly. He will then lay you on your back. Your head will be supported as it hangs over the end of the table. Your healthcare provider will watch your eyes for nystagmus and time how long the movements last. He may have you do these steps again with your head turned to the other side. You may feel nauseated from the Dix-Hallpike maneuver.
  • The supine roll test is used to check for symptoms caused by quick head movements. You will lie on your back on a table. Your healthcare provider will quickly turn your head to one side and check for nystagmus. He will then move your head back to the face-up position until the nystagmus stops. He will then quickly turn your head to the other side and watch for nystagmus. You may feel dizzy during the supine roll test.
  • Electronystagmography (ENG) is done to test for problems you may have with balance or dizziness. Sticky pads with wires are placed on the skin around your eyes. The wires are connected to a machine that records information during your ENG. Warm and cool air or water is put into your ears while your eye movements are recorded. Do not drink alcohol or eat a heavy meal before this test. You may feel dizzy or nauseated after the test.
  • MRI or CT scan pictures may be taken of your head to look inside your ears and brain. Do not enter the MRI room with anything metal. Metal can cause serious injury. You may be given contrast liquid to help your ears and brain show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.

How is BPPV treated?

Your healthcare provider may wait to see if your symptoms go away without treatment. If you do need treatment, he may give you medicine to prevent nausea during treatment. You may need any of the following:

  • Maneuvers (specific movements) may be done by your healthcare provider to help relieve your symptoms. The maneuvers can help calcium pieces move into a different part of your ear. For some of the movements, only your head will be moved. Your whole body will be moved or rolled during other treatments. Your healthcare provider may teach you certain movements to help manage your symptoms at home. For example, he may have you turn or roll your entire body to the side of your healthy ear. You will need to stay in this position for up to 12 hours. Do not try the movements at home unless directed, and only after you are taught how to do them correctly.
  • Vestibular and balance rehabilitation therapy (VBRT) is used to teach you exercises to improve your balance and strength. VBRT may help decrease your dizziness and prevent injuries if you are at risk for falls.
  • Surgery may be needed if other treatments do not work. Surgery may be used to fill part of your ear canal with bone chips or medical glue to keep the calcium pieces out. Surgery may also be used to cut certain nerves in your ear.

What can I do to prevent or manage my symptoms?

  • Avoid sudden head movements.
  • Do not bend over at the waist.
  • Keep your head raised when you lie down. Place pillows under your upper back and head or rest in a recliner.
  • Try not to stay in bed for long periods of time. Change your position often when you are in bed. Try not to lie with your head on the same side for long periods of time.
  • Wear a helmet when you ride a bike or play sports. A helmet helps protect your head from injury.

Where can I find more information?

  • American Academy of Family Physicians
    11400 Tomahawk Creek Parkway
    Leawood , KS 66211-2680
    Phone: 1- 913 - 906-6000
    Phone: 1- 800 - 274-2237
    Web Address:
  • American Hearing Research Foundation
    275 North York Street, Suite 401
    Elmhurst , IL 60126
    Phone: 1- 630 - 617-5079
    Web Address:

When should I seek immediate care?

  • You fall during a BPPV episode and are injured.
  • You have a severe headache that does not go away.
  • You have new changes in your vision or feel weak or confused.
  • You have problems hearing, or you have ringing or buzzing in your ears.
  • Your BPPV symptoms last longer than 1 minute.

When should I contact my healthcare provider?

  • You feel anxious or depressed and do not want to leave your home.
  • You have problems with your balance, or you are falling often.
  • You have new or increased nausea or vomiting when you have vertigo.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.