Symptoms, Causes and Remedies for Benign Paroxysmal Positional Vertigo (BPPV)

Patients with vertigo mistakenly experience movement (often a spinning motion) in their environment. Sensations of vertigo can disrupt your balance and lead to falls that can be critical in the elderly; vertigo can also be accompanied by dizziness, sensations of spinning in space, and more infrequently, nausea, vomiting, migraine headaches, visual abnormalities such as nystagmus, and fainting spells.

There can be many causes for vertigo, but one form of it – benign paroxysmal positional vertigo, abbreviated BPPV – relates to hearing. It is attributable to naturally forming calcium crystals in the inner ear. Known as otoliths or otoconia, these crystals generally cause no trouble for people. In BPPV, the crystals migrate from their normal locations into the semicircular canals of the inner ear. When a person with benign paroxysmal positional vertigo reorients their head relative to gravity, these crystals displace endolymph fluid and induce vertigo.

BPPV can be brought on by such basic actions as turning or tilting your head, rolling over in bed, and looking up or down, and is characterized by the brief (paroxysmal) nature of the attacks. The resulting vertigo can be made worse by stress, sleep disorders, or changes in barometric pressure (such as, in advance of a rainfall or snowfall). The disorder can present itself at any age, but it typically appears in people over 60. The initial trigger for the BPPV is typically hard to pinpoint. An unexpected blow to the head (for example in a motor vehicle accident) is among the more well-known causes.

Benign paroxysmal positional vertigo is readily distinguished from other types of vertigo because it is almost always triggered by movements of the head with symptoms decreasing in 60 seconds or less. Physicians usually diagnose BPPV by having the individual rest on their back on an exam table, tilting their head to one side or over the edge of the table to observe whether this motion sets off an episode. More extensive tests can be used in certain cases including videonystagmography (VNG), electronystagmography (ENG) and magnetic resonance imaging (MRI). ENG and VNG test for abnormal eye movements while MRI is used to rule out other possible causes of vertigo such as brain abnormalities or tumors.

The most common treatment for BPPV is canalith repositioning, such as the Epley maneuver and the Semont maneuver, both of which are a sequence of physical movements used to guide the crystals to an area of the inner ear in which they no longer cause trouble. In about 10 percent of cases, surgery may be recommended if these treatments don’t provide satisfactory outcomes. If you’ve experienced inexplicable dizziness or vertigo that lasts for more than a week, see your doctor.

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