What is BPPV vertigo?
Vertigo is the feeling that you, or the room around you, is spinning. BPPV is a type of vertigo, and the medical term explains it: benign means it is not caused by a serious disease, paroxysmal means it comes in sudden, brief attacks, positional means it is set off by moving your head, and vertigo describes the spinning. A typical story is the room spinning when you wake up and roll over, settling within a minute.
What causes it
The inner ear contains crystals of calcium carbonate that sit in a gel layer and help detect gravity and movement. If some break free, usually with age, after a head knock, or for no clear reason, they can drift into a semicircular canal, which detects rotation. There they move with gravity when the head changes position and send a false signal that the head is spinning.
What are the crystals in your ear?
They are called otoconia: tiny particles of calcium carbonate that normally sit in a part of the inner ear called the utricle. You cannot see or feel them, and they are not the same as white flakes or wax in the ear canal. Loose crystals can gradually dissolve or settle, which is why BPPV often clears by itself over weeks to a few months, but there is no fixed timescale, and treatment is usually much faster.
What it feels like
Short bursts of spinning vertigo, usually lasting less than a minute, triggered by specific movements: turning over in bed, lying down or sitting up, looking up to a high shelf, bending forward. Between episodes there may be mild unsteadiness or a sense of being off. Nausea is common. Hearing is not affected. Symptoms often start suddenly on waking.
How it is diagnosed
A positional test, usually the Dix-Hallpike, in which the head is moved into the triggering position while the examiner watches for a characteristic eye movement. This identifies which ear and which canal are involved, and no scan is needed in a typical case.
BPPV treatment: how it is treated
A repositioning manoeuvre, most commonly the Epley, moves the head through a sequence of positions that let gravity carry the crystals back out of the canal. It takes a few minutes, may provoke vertigo during the sequence, and resolves BPPV in around 80 per cent of people after one session and most of the rest after a second. Recurrence happens in some people and is treated the same way.
Medical treatment of BPPV
The recommended medical treatment is a repositioning manoeuvre matched to the affected canal. The Epley treats the posterior canal, the most common type; horizontal canal BPPV needs a different roll manoeuvre. You can read what the Epley manoeuvre is, or follow our step-by-step Epley guide. Anti-sickness medicine may ease nausea for a short time but does not treat the cause. Surgery is very rarely needed.
Can BPPV be cured?
For most people, yes, a correctly aimed manoeuvre clears the episode, although BPPV can return later. See can BPPV come back. Brandt-Daroff exercises are a home option for mild or recurring symptoms.
What does not work
Medication for dizziness does not move the crystals. Waiting sometimes works, over weeks, but treatment is quick.
When to get urgent help
Call 999 or go to A&E if vertigo comes with double vision or loss of vision, hearing loss, trouble speaking, or weakness, numbness or tingling in an arm or leg. These are not features of BPPV. If vertigo comes with a severe headache, being sick or a very high temperature, ask for an urgent GP appointment or call NHS 111. If you are unsure, read is my dizziness BPPV.
BPPV treatment at Omnia in Chiswick
Vestibular First at our Chiswick clinic assesses for BPPV and treats it in the same session where it is found. Vertigo and BPPV assessment and treatment costs £50. See what happens at a vestibular assessment, or book online.
8 to 9 Bedford Corner, The Avenue, Chiswick W4 1LZ, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking.