Benign paroxysmal positional vertigo

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 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 information

Structure 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

Structure 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.

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.

Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg 2017; 156(3_suppl): S1-S47.

Cromwell C, Tyler J, Nobbs R, Hockaday A, Donnelly S, Clendaniel R. The Necessity for Post-Maneuver Restrictions in the Treatment of Benign Paroxysmal Positional Vertigo: An Updated Meta-Analysis of the Literature. Otol Neurotol 2018; 39(6): 671-679.

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Akuter Schwindel in der Hausarztpraxis (S3-Leitlinie). AWMF-Registernr.: 053-018. July 12, 2019. (DEGAM-Leitlinien; Volume 17).

Fu W, Han J, Chang N, Wei D, Bai Y, Wang Y et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx 2019 [Epub ahead of print].

Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev 2014; (12): CD003162.

Mattle H, Mumenthaler M. Neurologie. Stuttgart: Thieme; 2013.

McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2015; (1): CD005397.

Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78(7): 710-715.

Zhang X, Qian X, Lu L, Chen J, Liu J, Lin C et al. Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis. Acta Otolaryngol 2017; 137(1): 63-70.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on April 9, 2020
Next planned update: 2023

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.