The BPPV pattern
BPPV has a recognisable signature. The spinning is intense but short, typically 10 to 60 seconds. It is set off by a change in head position rather than by standing up or exercising. Classic triggers are rolling over in bed, lying down, sitting up, looking up at a shelf and bending forward. Between episodes you may feel slightly off balance, but the spinning stops when you keep still. Hearing is normal, there is no ringing in the ears, and there is no headache. Nausea is common during an episode. Symptoms often begin suddenly on waking.
Signs it is probably not BPPV
Vertigo that lasts hours or days without stopping suggests an inner ear infection such as vestibular neuritis or labyrinthitis, or an attack of Meniere's disease if there is also hearing loss, fullness in the ear or tinnitus. Dizziness that comes with a migraine-type headache, light sensitivity or visual aura may be vestibular migraine. Light-headedness on standing up, rather than spinning on turning the head, is more often a blood pressure or circulation issue. A constant rocking or swaying feeling that is worse in busy visual environments suggests persistent postural-perceptual dizziness.
When to seek urgent care
Dizziness with a sudden severe headache, double vision, slurred speech, weakness or numbness in the face or limbs, difficulty walking, or chest pain needs emergency assessment, because these can indicate a stroke or cardiac cause. New hearing loss on one side should be seen by a doctor promptly.
How BPPV is confirmed
A clinician performs a positional test, usually the Dix-Hallpike, moving your head into the triggering position while watching your eyes for a characteristic flicking movement. The test takes a couple of minutes and identifies which ear and which canal are affected. No scan is needed for a typical presentation. If the test is negative and the history fits, other canals are tested with different positions.
Why the distinction matters
BPPV is treated in the same appointment with a repositioning manoeuvre and usually resolves within one to three sessions. The other causes need different approaches: rehabilitation exercises for inner ear infections and chronic dizziness, medical management for Meniere's and vestibular migraine. Treating the wrong condition wastes time, which is why assessment comes first.
At Omnia
Vestibular First at our Chiswick clinic begins with a full history and positional testing so you know what is causing your dizziness before any treatment starts. If the pattern points to something outside our scope, we say so and direct you to the right specialist.