Understanding BPPV – The Most Common Cause of Vertigo


Individuals experience dizziness in numerous different forms. Some people consider it as a sense of dizziness or imbalance and feeling of light-headedness. Others might describe it as a feeling of room spinning or drunk. Even migraine headaches and seizures are often reported as dizziness. In all cases, it is vital that your doctor accurately determines the cause of dizziness for a given person and find out details regarding when, how often, and how long such attacks are triggered.

The most common form of dizziness is vertigo. Vertigo is uncomfortable and an upsetting situation. Mainly it is caused by four factors:

  • Problems in the inner ear, such as Meniere’s disease of BPPV

  • Side effects from medication such as neuro and hypertension medications

  • Spine and brain problems like a brain tumor, stroke, and more

  • Nerves and Heart problems like a cardiac issue, the problem of the carotid artery, etc.

Understanding BPPV

Among the above-mentioned causes, BPPV or Benign Paroxysmal Positional Vertigo is the most common cause of vertigo.

BPPV is a situation characterized by sessions of severe and sudden vertigo (dizziness) when you change the position of your head like reaching down, rolling over the bed, turning, looking upward, lifting head up, and getting out of bed or chair.

BPPV occurs when normally anchored particles in the inner ear tend to break free. There are particles present within the semi-circular canals of the inner ear. These inner ear structures or canals are filled with fluid that works a bit like a spirit level to determine head position and sense motion.

Small crystals that are naturally present in the ear canals can be detached after an injury such as whiplash, after an infection or because of aging. Such crystals intervene with motion sensors in ear canals, supplying false signals to the brain and causing vertigo.

The free-floating particles wreak havoc with the balance of person, especially at a given point of time, so that semi-circular canals are analogous to the gyroscope. They help the brain to identify the location of the head in space relative to the gravity.

In a normal condition, the motion of these particles is limited. When a person moves the head, these anchored particles move and then stop quickly. The movements of such particles tell how inner ear informs the brain that a head turn. However, when such particles are free-floating, they keep moving that essentially makes the inner ear inform the brain that the head is still moving even if it does not. Some of the risk factors for BPPV are vitamin D deficiency, head trauma, osteoporosis, and viral infections. More info

Symptoms of BPPV

Most of the patients suffering from BPPV showcase certain common characteristics, such as:

  • Vertigo triggered by a change in position, usually turning

  • Vertigo or dizziness attacks not lasting for more than a few minutes

  • Vomiting and nausea in severe conditions

  • Sessions of relative normalcy between dizziness attacks

  • Irregular movements of the eye occurring when the head is still

Occurrences of an intermittent pattern where BPPV may come for a few weeks, then stop, then come back again.

Causes of BPPV

For most of the individuals, the precise cause of BPPV is unknown. However, in some situations it can be because of the following reasons:

  • Rapid deceleration or acceleration of the head

  • Already existing problem of vestibular such as labyrinthitis, Meniere’s disease, neuritis, and more

  • Following a regular period of bed rest or inactivity

  • Natural aging changes to the organs within the inner ear

  • Jolting or after vigorous high impact activities like mountain biking.

Diagnosis of BPPV

BPPV can generate a huge impact on the quality of life. But the good thing is that it is easy to diagnose and can be treated.

When you experience vertigo, you must consult an experienced physiotherapist. Based on this history, the professional would perform Dix-Hallpike to confirm the diagnosis. During the process, patient’s head is rotated to one side at an angle of 45 degrees. The clinician would help the patient to lie backward with the head placed at an angle of 20 degrees extension. Such an extension can be achieved with clinician support. The expert then observes eye movement of the patients for around 45 seconds. If repetitive jumping of the eye occurs then the test for BPPV is considered positive.

An important point to consider is that vertigo or dizziness without nystagmus is not diagnostic for BPPV. The reason for dizziness is then caused by something else. Based on the diagnosis your BPPV can be classified under the following different categories:

  • Right Posterior Canal BPPV

  • Left Posterior Canal BPPV

  • Right Superior Canal BPPV

  • Left Superior Canal BPPV

  • Right Lateral Canal BPPV

  • Left Lateral Canal BPPV

Treatment for BPPV

The treatment for BPPV is to essentially move the free-moving particles into a specific location where the movement would not cause any problems. It is an analogous treatment to physically move a marble in the maze with the aim of depositing it into a hole, except the head is the maze and free-floating particles are marble.

The BPPV treatment depends on the location where free-floating particles are moving in the semi-circular canals. The semi-circular canals are made of 3 distinct canals – superior, posterior, and horizontal or lateral.

  1. Epley Maneuver

This exercise begins by letting the patient sit in an upright posture. The legs are extended, and the head is rotated to 45 degrees to the affected side. The patient is then passively forced backward into a laying position, and head is held at a 30-degree angle.

The clinician observes eyes of the patient for approximately 30 seconds. Again the patient’s head is turned to 90 degrees angle. The eye movement is again observed for 30 seconds. Finally, the patient is brought up to an upright sitting position maintaining a 45-degree angle of the head.

  1. Semont Maneuver

Another maneuver to treat BPPV is Semont Maneuver. In this process, the patient sits on an examination table with legs hanging over the edge. The head is shifted to 45 degrees horizontally towards the unaffected ear.

The head rotation of patient’s upper body is maintained while the side position is moved. One position is maintained for 3 minutes. The patient is swiftly moved to the sitting position to lying on the unaffected side or opposite side maintaining the head rotation with noise pointing to the ground. This maneuver shifts the debris towards the exit of the canal.


BPPV get resolves slowly with the recommended treatment practiced for a few minutes on a daily basis. Practicing the exercises on a daily basis would provide quick and effective results. Once the condition is resolved, some patients may need further exercises or therapies for an ongoing time interval. You can always discuss your condition with your clinician and even ask any medications may be required.

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