Dizziness & Vertigo (Benign Paroxysmal Positional Vertigo)

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Vertigo is typically a feeling of spinning when you are not moving. Other common descriptions include tilting, bobbing, and floating. There are many causes of vertigo, including problems of the inner ear balance sensors. The most common inner ear cause of vertigo is benign paroxysmal positional vertigo (BPPV).  

BPPV Treatment

Wait and Watch

Many times BPPV will resolve on its own, usually within a month or two of onset. If you choose to “wait it out,” you will need to make some changes to your daily activities to avoid triggering your symptoms. Talk with your doctor about the best treatment plan for you.

Particle Repositioning Maneuvers

Particle repositioning maneuvers are performed to move dislodged particles out of the semicircular canal by moving your head and body into different positions. There are dozens of these particle repositioning maneuvers, and the right one for you depends on which ear and which balance sensor is affected. Once the right maneuver has been decided, you may be able to do the particle repositioning maneuvers yourself at home.


No medication is effective for treating BPPV. Medication may make the dizziness of BPPV less intense, but also may have adverse effects such as sleepiness, confusion, and increased risk of falling.

Causes of Vertigo

BPPV occurs when tiny particles, or “crystals,” that belong in the inner ear sensor for head position, called the utricle, become dislodged and migrate to the inner ear sensor for head movement, called the semicircular canal. Symptoms of BPPV are vertigo or dizziness that occurs when you lie down in bed, roll over in bed, bend over or look up. The vertigo of BPPV is usually intense, but doesn’t last long – 20-30 seconds.

In most people, the exact cause of BPPV is unknown. In others, it may be caused by:

  • Head injury
  • Viral infection
  • Age-related changes to inner ear
  • Disorders of the inner ear

Symptoms of BPPV

Symptoms may include:

  • Brief spinning or dizziness when you change head position
  • Nausea
  • Vomiting
  • Loss of balance

Diagnosing BPPV

Although BPPV is common, it is not the only cause of dizziness. It is important to have a thorough evaluation to find the cause of your dizziness. Your doctor may recommend special tests, including:

  • Dix-Hallpike test – your doctor will watch for certain eye movements as you lie down quickly on an exam table
  • Videonystagmography (VNG) – recording and analyzing your eye movements during a series of short tests to find out how your inner ear balance sensors are working