Benign Paroxysmal Positional Vertigo

If you experience brief episodes of spinning vertigo that are triggered by changes in head position, such as looking up or down, bending forward, or rolling over in bed, you may have Benign Paroxysmal Positional Vertigo (BPPV). These episodes often appear suddenly and can feel quite intense, even though they are short. The spinning sensation typically lasts 2-30 seconds and usually no more than 2 minutes.

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What Is BPPV?

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BPPV stands for Benign Paroxysmal Positional Vertigo. It describes vertigo that occurs suddenly when you change the position of your head. Although the sensation can be alarming, it is a common and well-understood condition.​ If the spinning sensation is constant instead of being brief and triggered by movement, it is unlikely to be BPPV. In these cases, we must consider other causes such as inflammation of the inner ear. The term benign means that the condition is not dangerous, even though the symptoms can be very unpleasant and sometimes anxiety-provoking.

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What Happens in the Inner Ear?

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Inside the inner ear is the vestibular labyrinth, which contains three semicircular canals filled with fluid. These canals detect rotational movements of the head and play an important role in maintaining balance and stable vision.​ When you move your head, the fluid inside these canals shifts and stimulates tiny sensory hair cells. These cells send signals to the brain, helping it understand how your head and body are moving in space.​ 

 

Adjacent to the canals are the utricle and saccule, which detect linear movements such as moving forward or up and down. These organs contain tiny crystals called otoconia that help sense gravity and motion.

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​In BPPV, some of these crystals become dislodged and migrate into one of the semicircular canals. When they move within the canal, they disturb the normal movement of the fluid and send incorrect signals to the brain, which creates the sensation of vertigo.

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When the crystals move freely, this is called canalithiasis and symptoms usually last only a few seconds. When the crystals attach to the sensory structure, it is called cupulolithiasis and symptoms may last longer.

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Treatment for BPPV

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BPPV is treated with specific repositioning manoeuvres that aim to move the crystals back to their normal location. During your first session, I assess whether BPPV is present and determine which canal is involved.

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​Then I perform the appropriate manoeuvre to guide the crystals back to where they belong. Many patients experience significant relief immediately after treatment or within a short time.

A follow-up session helps confirm that the treatment was successful. Sometimes the manoeuvre needs to be repeated, or additional treatment may be recommended if other factors contribute to ongoing dizziness.

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With an accurate diagnosis and appropriate vestibular physiotherapy, most causes of dizziness and vertigo can be effectively treated. The goal is to help you regain balance, confidence, and quality of life so that you can return to your normal activities.

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