Benign Paroxysmal Positional Vertigo (BPPV)

The relationship between the inner ears and the eye muscles is what normally allows us to stay focused on our environment while the head is moving. Since the dislodged crystals are moving around in the balance organ, it makes the brain think a person is moving when they’re not. It mistakenly causes the eyes to move, which makes you feel like the room is spinning. These eye movements are called nystagmus.

What causes BPPV?

BPPV occurs when small crystals of calcium carbonate, shift in the inner ear and/or fall into another area within the balance canals. The crystals may move for many reasons, such as, an inner ear infection, fever, head injury or whiplash injury. BPPV can also occur along with other issues of the inner ear such as Meniere’s disease, migraines; or, it has been suggested that it is part of the “normal” aging process.

Other reasons the crystals can loosen:

• Trauma
• Diabetes
• Osteoporosis
• Lying in bed for long periods of time (preferred sleeping position, surgical procedures, and chronic illness)
• Vitamin D deficiency

How do I know if I have BPPV and what can I do to help resolve it?

The good news is that BPPV will often settle on its own with time but there are certain sets of movements (manoeuvres) that can cure the problem completely.

Ask yourself the following questions and follow the instructions below to see if there is a manoeuvre that will be able to help settle your symptoms.

1. Do you have a spinning or whirling sensation of the surroundings or yourself?
2. Do you feel dizzy mostly when your head is moved?
3. Does the dizziness last less than 3 minutes?

If YOUR answer is NO to any of these questions

If YOUR answer is NO to any of these questions, it is unlikely you have BPPV and we would advise you to contact your GP to refer you for an assessment.

If your answer to ALL these questions is YES

If your answer to ALL these questions is YES then the next set of questions should help decide which manoeuvre will work for you. The questions are used to show which canal is affected so it is important to only do the exercise that relates to your symptoms.

Please watch the video first before trying to do this yourself. Please do not perform these manoeuvres if you are unsure, alone or if feel you are unable to follow these videos safely. Having somebody like a family member to support you can help.

After the treatment has finished you may feel nauseous, dizzy, or have more trouble balancing than before. This can last for several hours but should settle if you follow the aftercare advice.

For 24 hours after treatment, you should not:

• turn your head quickly
• tilt your head far up (as if looking to the sky)
• look down (as if bending down to tie your shoes, or picking something up from the floor)

You can sleep that night in whatever position you choose, but try not to be particularly flat. You should continue your normal activity and move your head as normally as possible after the first 24 hours.

What do I do if my dizziness does not settle or I cannot carry out a manoeuvre?

When you feel dizzy, try keeping your head still and allow the symptoms to settle, it should not take long for this to happen.  Should your symptoms persist then we may be able to help.

Vestibular Physiotherapists can help you manage this condition. Most people recover with these manoeuvres although if they are not suitable for you we will look at different ways to help your symptoms. This treatment aims to move the crystals back into place.  Sometimes if the problem has been there for a while we need to add in other exercises or repeat the manoeuvre to allow your system to return to normal. It is important to return to moving naturally and stop avoiding movements or positions as this helps the system return to normal quicker

BPPV can result in continued issues of more generalised dizziness and abnormal motion even after the positioning manoeuvres have successfully resolved the vertigo. Therefore, referral to a Vestibular Physiotherapist for Vestibular rehab may be useful.

Is there any Medication that can help?

You may be prescribed medication to help with the nausea and severe room spinning. This medication can be useful in the short term to help you cope with a bad attack, however, we discourage taking this medication for long periods as this can cause side effects and delays recovery from your original problem. Talk with your GP if you feel you have been on the medication for a long time.

Timescales/ Prognosis

You may experience a return of symptoms in the future; there is no proven medication that can prevent this condition. If you have BPPV symptoms in the future, you should ask your GP to refer you back to the vestibular service or use the questions above to direct you to the correct manoeuvre to try again.

Remember, BPPV is treatable and the manoeuvres and exercises can greatly reduce your vertigo and other symptoms associated with BPPV.

Additional information

Patient information leaflet for BPPV

When to speak to a health professional

It is important to know that BPPV will NOT give constant dizziness that is unaffected by movement or a change in position. It will NOT affect your:

• Hearing
• Produce fainting
• Cause headaches
• Neurological symptoms such as numbness or “pins and needles”
• Trouble speaking
• Trouble coordinating your movements.

If you have any of these additional symptoms, you should talk to your GP. Other disorders may be misdiagnosed as BPPV at first.

Help and Support 

After following the above advice, and if your symptoms have not improved, this is what you should do:

• If you are currently under the care of the Lanarkshire ENT service or were directed to this page by one of the members of the ENT team, please contact us on 01698 752136.
• Otherwise, contact your GP who can refer you to your local vestibular balance service

You can contact your GP to refer you if they think it’s appropriate.