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Benign paroxysmal positional vertigo, more than just dizziness

Benign paroxysmal positional Vertigo or BPPV, is the most commonly diagnosed type of vertigo. This type of vertigo typically presents as episodes lasting several minutes, severe in nature, usually brought on by certain quick head or body movements such as rolling in bed. It can occur at random linked to movements.


You may experience severe symptoms like nausea, vomiting and nystagmus, which is rapid involuntary eye movement. It can be a debilitating disorder that may be very impactful on daily life. BPPV is most common within people aged 50-70, although can occur at any age. It is also more likely to affect women over men with a ratio of 3:1.

A little anatomy

Commonly referred to as the inner ear, there is the vestibular system. This system is made up of a series of structures that enable to us hear and regulate our balance. The current theory behind BPPV is that within those tubes are microscopic crystals/ particulates called otoconia – or sometimes referred to as ear rocks – that have formed within the inner ear system. The idea is that these ear rocks disturb the normal function of the inner ear and present as vertigo. It can also be due to the degradation of the inner ear structures, due to some form of trauma or virus and linked with migraines.


How do we diagnose BPPV?


A typical diagnosis of BPPV comes through a physical assessment including the use of something called the Dix-Hallpike maneuver. In this maneuver, we typically move you from a sitting to supine position very quickly, with the head in a particular position. If the test is positive, we will see rapid involuntary eye movement.


We will also assess your history and what positions bring on the BPPV, as unlike other dizziness usually triggered by standing up, BPPV is triggered when lying down or rolling over.


Watch here to see how the Dix-Hallpike maneuver works. Once supine, this position will be held for a little while to watch for rapid involuntary eye movement:

How can BPPV be treated and how physiotherapy can help


We often recommended a combination of self-management techniques and as well physiotherapy to control BPPV. Self-management techniques can include adjusting your positioning for sleeping, including raising your head height with pillows so that you are in a semi-recumbent position. We also would recommend not sleeping on the side in which the problem is occurring, this we can tell you during an assessment session. What we can do as physiotherapists is first confirm what type of vertigo you may be experiencing, as some types of vertigo can be brought on by headaches and neck pain or neck trauma like whiplash. We do this using the Dix-Hallpike maneuver mentioned earlier.


Dix-Hallpike maneuver for diagnosis:


We can then provide treatment using the Epley Maneuver, once we determine which ear is causing the issue. This maneuver is similar to the Dix-Hallpike, in which you are lowered in a supine position, but further adding a head movement and back to sitting position. This maneuver aims to shift the ear rocks we discussed into an area of the inner ear that will not trigger vertigo and will be performed a few times during your session. This maneuver will often provide relief after your first session but will normally require a subsequent follow-up to ensure that symptoms do not return.


If our assessment is negative, then we will look to other causes for vertigo, including cervical headaches (you can read more about them here!), neck pain or trauma like whiplash.


BPPV can reoccur so if you start experiencing symptoms again, it is recommended to have a follow-up visit to check in.

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