Vertigo and the Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

Vertigo and the Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

What is Benign Paroxysmal Positional Vertigo or BPPV?

BPPV is the sensation of vertigo (room spinning) or intense dizziness, usually associated with movements of the head (ie. laying down, rolling in bed, looking up or down). This form of vertigo can be treated by a health care professional, often a physician or physiotherapist.

Symptoms of BPPV can also include nausea, vomiting, and a loss of balance or unsteadiness. Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo.

What Causes BPPV?

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Often there is no known cause for BPPV. When the cause is unknown, this is commonly referred to as Idiopathic BPPV. When a cause is known, it is often associated with a minor to severe blow to the head (ie. a fall, a car accident, or a concussion). Less common causes include damage to the inner ear from a virus or prolonged position on one’s back (ie. a long dental procedure or illness leaving one bedridden).

There is a small organ in the ear called the Vestibular Labyrinth that is made up of 3 semicircular, looped canals. These canals contain fluid and tiny hair-like receptors that regulate our head’s position in space. The otolith organs in the ear monitor our head movements and contain crystals that allow us to be sensitive to gravity. During episodes of BPPV, these crystals have become dislodged from their correct position and have often moved into the semicircular canals. This causes the canals to be sensitive to head position changes, which makes one feel dizzy.

The Inner Ear and it’s role in BPPV

Photographed by Hana Tichá - via Flickr Photographed by Hana Tichá - via Flickr

Assessment of BPPV often includes an extensive history taking by the physiotherapist to establish symptoms, testing of the eyes including tracking mechanism and ocular reflexes, balance testing, and the Dix Hallpike maneuver to test position change and to observe nystagmus (if present).

The Dix Hallpike involves laying back quickly with the head in an extended and slightly rotated position; this is completed with the support of the physiotherapist to keep the client safe and to observe symptoms.

Treatment of BPPV often includes repositioning procedures performed by the physiotherpist to help the crystals of the inner ear return to their correct position. These procedures often only have to be performed 1-3 times with a resulting significant reduction in patients’ symptoms. Treatment also commonly includes prescription of home exercises to help improve eye function, balance and self-repositioning techniques.

Assessment and Treatment of BPPV


  2. Wallace, B., Visual-Vestibular Approaches in Concussion Management, Concussion Health 2015, Pages: 55-62
  3. Kanegaonkar, R. G., Tysome, J. R., Dizziness and Vertigo: An Introduction and Practical Guide, CRC Press, 2014, Pages:3-6

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