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Understanding Your BPPV

Benign Paroxysmal Positional Vertigo, also known as BPPV, is a condition of the inner ear and the most common cause of vertigo. 
Although its name is complex, it outlines really well what is going on


Meaning it is not life-threatening


Sudden brief spells


Symptoms are brought on by certain head movements or positions


A sensation of spinning

What is Causing My BPPV?

Inside our inner ear lives our vestibular system, which consists of 3 semicircular canals. These canals tell our brain about our head’s movement, like when we turn side to side or up and down. In BPPV, small crystals from another part of our inner ear break free and fall into one of these canals. When enough of these crystals accumulate, they change the canal’s response to gravity. This false information does not match what the rest of our body is sensing, and the mismatched information is perceived in our brain as vertigo and dizziness.

There are two different types of BPPV that can occur. One type is where the crystals are floating in the semicircular canal (canalithiasis) and one type where the crystals are adhered within the canal (cupulolithiasis). Each type will present slightly differently, however both types are treatable.

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BPPV Signs and Symptoms

The most common symptom of BPPV is vertigo, which is a sensation of spinning. Typically, this sensation is brought on when we move our head or body, such as when lying down, rolling over in bed, looking up towards the ceiling, or tilting our head back to wash our hair. For most people these episodes are brief and last under one minute. However, for some, it can last for a few minutes. Even after the sense of spinning is gone, we still may feel “off”.

Many people report the following symptoms in addition to their vertigo:

Dizziness  /  Lightheaded  /  Unsteady  /  Sense of tilt  /  Nauseous  /  Vomiting  /  Trouble walking  /  Sense of floating  /  Blurred vision

Who is Affected?

BPPV is a fairly common condition, with 2.4% of people experiencing it at some point in their lifetime. It can occur to anyone at any age; however, the highest rates are in people over the age of 65 years.

For the majority of people there is no direct cause of BPPV, it is something you get seemingly out of the blue. However, BPPV can occur after a head injury or following an inner ear infection. There have also been associations made with migraines, diabetes, osteoporosis, and reduced blood flow.

How is BPPV Diagnosed?

Medical imaging including MRIs are not able to pick up on the crystal’s positions within the inner ear and thus cannot be used to diagnoses BPPV. Instead, your therapist diagnoses BPPV through tests which put your head in specific positions that cause the crystals to move and trigger your symptoms. The most common tests used are: The Dix-Hallpike, The Side-Lying Test and The Roll Test.

In addition to symptoms being triggered, your eyes will also move in a specific pattern, which is called “nystagmus”. This is an important sign that your therapist will use to determine not only the presence of crystals in the semicircular canals, but which canal those crystals are in. Once your therapist knows which canal is causing the problem, he or she can then use the appropriate treatment maneuver to resolve your BPPV.

How is BPPV Treated?

Treatment for BPPV works by moving your head in specific orientations to help move the crystals out of the semicircular canal, restoring the vestibular system’s proper function once again. Knowing which treatment maneuver to do is the roll of your therapist. The success of these treatment maneuvers is very good, well into the 90% range within 1-3 treatments. 

One of the most common maneuvers used is The Epley Maneuver. This is because this maneuver treats crystals that are in the posterior canal, which is the most common canal in BPPV. Other common maneuvers include the Semont’s Maneuver, BBQ Roll, Gufoni Maneuver, and Casani Maneuver.

Post-Treatment Information

Once your BPPV has been resolved, it is normal to feel mild residual sensitivity to motion and unsteadiness. Often this will go away on its own within 24-48 hours, but it’s important to follow up with your therapist in case you require additional rehabilitation strategies to improve these symptoms.

Can My BPPV Return?

Yes, unfortunately BPPV is a condition that can re-occur, with long-term recurrence rates as high as 50% within 5 years. There is also a slightly higher recurrence rate for BPPV cases related to trauma. The good news is that BPPV tends to re-occur in the same canal, so management of your BPPV will typically look the same each time. 

Online tools such as the Healing Vertigo App are a great option to help guide you through self-management of BPPV. 

Looking for BPPV Treatment?

Healing Vertigo offers virtual vestibular therapy for all Ontario Residents. Connect to learn more about our services and book an appointment today!