At a glance

  • The brief dizzy spells are not dangerous.
  • They are caused by tiny crystals in the organ of balance (vestibular system) of the inner ear.
  • The dizzy spells often go away on their own after a few weeks.
  • If they don't, special "repositioning" maneuvers can help.

Introduction

Photo of a woman with vertigo (PantherMedia / Monkeybusiness Images)

Vertigo can be described as a kind of dizziness that makes it feel like everything is spinning around or moving. It can occur while standing, walking or lying down. Depending on what’s causing the dizziness, the length of an episode can vary greatly, and may be accompanied by drowsiness, nausea or other symptoms.

If it's due to a problem with the vestibular system (the organ of balance), it's most likely benign paroxysmal positional vertigo (BPPV). Here certain movements cause dizziness for a short time. BPPV is unpleasant, but not dangerous. It is quite easy to diagnose and treat.

Symptoms

BPPV makes it feel like everything is spinning. Sudden movements of the head typically make you feel dizzy – for instance, when you

  • turn or tilt your head down, to the side or backwards,
  • lie down,
  • turn over while lying down,
  • sit up from a lying position, or
  • bend over.

The dizziness usually only lasts a short while – for a few seconds to five minutes at the most.

You may feel nauseous during and after an episode of dizziness, and in rare cases it may cause vomiting.

Causes

Benign paroxysmal positional vertigo is probably caused by loose calcium deposits (crystals or “ear rocks”) in what are called the semicircular canals of the inner ear. This fluid-filled system of canals is part of the organ of balance (vestibular system). Special hair-like cells (“sensory hair cells”) in the three semicircular canals can sense whether your head is turning, and in which direction.

Illustration: Structure of the ear and the vestibular system – as described in the informationStructure of the ear and the vestibular system

In most cases, tiny crystals have collected in the posterior semicircular canal, although it is usually not clear why this happens. When you move your head, these crystals roll around the semicircular canal. This irritates the hair cells, which then transmit misleading information that doesn’t match up with the other sensory information the brain is receiving – like what the eyes are "seeing," for example. These conflicting signals lead to the dizziness.

Illustration: Structure of the vestibular system – as described in the informationStructure of the vestibular system

Less common causes of BPPV include skull injuries, ear infections, circulation problems or being bedridden.

Prevalence and outlook

About 2 out of 100 people get BPPV at some point in their lives. Women are twice as likely as men to be affected, and it's most common between the ages of 40 and 70.

BPPV can lead to regular short attacks of vertigo. Over time, the tiny crystals settle inside the semicircular canals and are broken down inside the body. As a result, BPPV often goes away on its own after a while. In about half of those affected, the symptoms clear up within three months.

Diagnosis

BPPV is usually easy to diagnose based on the symptoms and your recent medical history, and is easily differentiated from other types of vertigo. Your doctor may ask whether the dizziness you have is permanent, comes and goes in episodes or is triggered by certain things.

The Dix-Hallpike test can be used to be sure that it is BPPV: This test involves moving your head and torso quickly in a specific order with the help of a doctor. If these movements bring about a spell of dizziness, then it is benign paroxysmal positional vertigo.

During this test, the doctor will watch your eyes for signs of typical sudden eye movements (nystagmus). You may have to wear special glasses (Frenzel goggles) during the test. That makes it easier for the doctors to see your eye movements.

Treatment

Because BPPV can go away on its own, it's often a good idea to simply wait it out. But there are also a number of possible treatments. "Repositioning" maneuvers are commonly used. They involve using a certain order of head and body movements to move the loose crystals to a position where they no longer cause dizzy spells.

Your doctor helps you to do these maneuvers, but there are also versions that you can do on your own at home.

Treatments such as medication for nausea are only rarely needed.

Learn more

Everyday life

Bouts of dizziness can be scary – especially if it's not yet clear that they are only being caused by BPPV.

Feeling unsteady during a dizzy spell increases the risk of a fall, especially in older people. Some people move very little due to the fear of feeling dizzy, limiting what they can do in everyday life.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.