Benign Paroxysmal Positional Vertigo – What Exactly Is It and What Should be Done About It

Vertigo – the sensation of motion in which the person or the person’s surroundings appear to spin and whirl – is, generally an undesirable event. It can affect your balance, resulting in falls which can be serious in the elderly, and may be coupled with dizziness, a feeling that you’re spinning or falling, and in extreme instances migraine headaches, nausea, vomiting, an inability to see properly (nystagmus), as well as fainting.

There are various different types of vertigo with varied root causes. Audiologists generally encounter benign paroxysmal positional vertigo, abbreviated BPPV, because it’s related to your sense of hearing. BPPV is due to naturally-forming calcium crystals in the inner ear called otoconia or otoliths, and which normally cause no problems. In benign paroxysmal positional vertigo, the crystals migrate from their normal locations into the semicircular canals of the inner ear. When an individual with BPPV reorients their head relative to gravity, these crystals displace endolymph fluid and cause vertigo.

BPPV is characterized by the episodic (paroxysmal) nature of the episodes, and can be triggered by such commonplace movements as looking up or down, tilting the head, rolling over in bed, or any other rapid head motion. Changes in barometric pressure, lack of sleep and anxiety can make the symptoms worse. BPPV may appear at any age, but it is most commonly observed in people over 60. The initial trigger for the BPPV is typically hard to determine. An unexpected blow to the head (such as in an automobile accident) is among the more well-known causes.

Benign paroxysmal positional vertigo is different from other types of vertigo or dizziness because the attacks are quite short (generally under a minute), and because it is always brought on by head movements. Doctors may diagnose it by having the patient lie on their back and then tip their head to one side or over the edge of the exam table. There are more rigorous tests which can be used to diagnose BPPV, such as videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, or magnetic resonance imaging (MRI), which is used primarily to rule out other possible causes of the vertigo.

The standard therapy for BPPV is canalith repositioning, including the Semont maneuver and the Epley maneuver, both of which are a sequence of physical movements used to shift the crystals to a position in the inner ear in which they no longer cause trouble. In some cases (under 10 percent), if these therapies do not provide relief, surgery may be suggested. If you’ve encountered inexplicable vertigo or dizziness that persists for over a week, see your health care provider.