Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, resulting from small calcium crystals becoming dislodged within the inner ear’s balance organs. It causes brief, intense spinning sensations triggered by specific head movements.

• Brief episodes of intense spinning sensation (vertigo), typically lasting less than a minute
• Triggered by specific head movements, such as rolling over in bed, looking up, or bending down
• Nausea, sometimes with vomiting, during episodes
• Between episodes, the person generally feels normal, distinguishing this from some other causes of dizziness
• Unsteadiness or mild imbalance may persist between episodes in some people

• Results from small calcium carbonate crystals (otoliths), normally embedded within a part of the inner ear, becoming dislodged and moving into the balance canals, where they disrupt normal balance signals during head movement.
• Can occur spontaneously, particularly with increasing age, or following head injury, prolonged bed rest, or inner ear conditions.
• The exact trigger for crystal displacement is often not identified in an individual case.

• Diagnosed through a specific positional test, in which the head is moved into particular positions by a health worker while observing for the characteristic eye movements and vertigo that confirm the diagnosis.
• Other causes of dizziness are considered, particularly if the pattern doesn't fit the classic brief, position-triggered episodes, or if there are additional neurological symptoms.

A specific repositioning manoeuvre, performed by a trained health worker, is highly effective and often resolves symptoms after just one or a few treatments by guiding the displaced crystals back to their normal position.

Medicine to suppress dizziness may be used briefly for symptom relief but does not treat the underlying cause and is not recommended for prolonged use.

Most people improve significantly with repositioning treatment, though BPPV can recur in some individuals and may need repeat treatment.

Referral for further assessment is considered if symptoms do not fit the typical pattern, do not respond to repositioning treatment, or are accompanied by other neurological symptoms.

• Seek assessment from a health worker experienced in the repositioning manoeuvre, since this is a quick and highly effective treatment.
• Move carefully when getting up from lying down or looking upward if prone to episodes.
• There is no reliable way to prevent BPPV, since it often occurs spontaneously with age, but prompt treatment resolves symptoms effectively.
• Seek further medical assessment if dizziness is prolonged, accompanied by other neurological symptoms, or does not fit the typical brief, position-triggered pattern.