Benign Positional Paroxysmal Vertigo

It can come on suddenly, with no warning. You roll over in bed or turn your head into a certain position and all of a sudden the room is spinning… You may also feel nauseated and vomit. Often you feel off balance and unsteady. It is an awful, scary sensation.

This could be caused by BPPV.

What is it? The inner ear has tubes, known as semicircular canals, that are filled with fluid. The movement of the fluid within the canals communicates information to your brain about your body’s position. BPPV is a condition in which the crystals (the ‘otoconia’) in the inner ear detach and migrate to the wrong canal. Usually it only affects one side, and when you change position the brain receives conflicting signals from the right and left side. This ‘confusion’ causes vertigo, and can also cause nystagmus (the visible ‘jumping’ of the eyes from side to side), as well as nausea. Although the strong sensation of spinning usually passes quickly, the person is at increased risk of falls, and often becomes fearful of moving. This is especially concerning for the older population, where a fall could lead to an injury such as a fractured hip.

Why does it happen? The cause of BPPV is not well understood. Occasionally it can be caused by a trauma such as a motor vehicle collision, a fall, or a prior ear infection, but most often – about 50% of the time – it has no apparent cause. Unfortunately there is nothing in particular you can do to prevent it.

What can we do? If you think you might have BPPV, come in for an assessment sooner rather than later. If it is BPPV we can treat it with an extremely high rate of success: greater than 80% of cases will be treated in one or two physiotherapy sessions. When you come in, we will go over a thorough history, discuss medical conditions, and attempt to rule out other possible causes of the vertigo. If there are no ‘red flags’ for other more serious conditions (for example weakness, facial paralysis, or slurred speech, which may be signs of a stroke), we will do a test to see if we can stimulate the vertigo – if the test is positive (ie it provokes the symptoms), then we can treat it immediately with the Epley Maneuver (or other maneuvers depending on the assessment), which is a series of positions that essentially move the crystals in the inner ear back to where they should be. It doesn’t feel great at the time, and there is a small chance of feeling sick, but it is worth it for the chance to feel 100%.

For a more in depth and detailed discussion of BPPV, click here:

For a recent (2010) high quality systematic review of the effectiveness of the maneuvers for BPPV, click here: