The vertigo caused by BPPV comes on after movement into certain positions and may be delayed for 5-20 seconds and usually lasts for less than a minute. The vertigo may be mild, or it may be severe enough to cause nausea. Benign paroxysmal positional vertigo is most common in people over the age of 50. It may occur in younger people, especially in those who have had a head injury. It occurs in women twice as often as in men.

What causes BPPV?

BPPV is thought to be caused by crystals (canaliths) accumulating in the semicircular canals of the inner ear. Vertigo is often triggered by a change in the position of the head, such as turning over in bed, turning the head quickly, bending over, or tipping the head back. If the head movement that causes the vertigo is repeated, the effect may be less each time. After 3 to 4 repetitions, the vertigo may no longer occur. This is called fatigability. Only after several hours will the same movement again result in vertigo.

How is BPPV diagnosed?

A doctor will conduct a medical history and physical examination to diagnose BPPV. The Dix-Hallpike test for vertigo may also be necessary to confirm the diagnosis. The Dix-Hallpike is a short series of head and body positions changes that may illicit dizziness. During the Dix-Hallpike, eye movements will be monitored by the person performing the test.

How is BPPV treated?

Treatment of BPPV usually involves a series of head movements (maneuvers) to move the crystals (canaliths) in the semicircular canals to a position that does not affect balance. If not treated, BPPV may resolve itself in a process called compensation. Occasionally, vestibular rehab is utilized to diminish symptoms of BPPV. This is performed by a physical therapist over a series of days or weeks. If the vertigo is severe and causing nausea, medications may be used to control the discomfort on a short-term basis.

What happens after the treatment?

It takes time for the crystals to dissolve. Therefore, patients must follow specific instructions to ensure the crystals do not shift back to the positions that caused the dizziness. This treatment is effective 85-95% of the time.