what is benign paroxysmal positional vertigo?

Benign Paroxysmal Positional Vertigo (AKA BPPV)

BPPV is when you experience a spinning sensation or “dizziness” with change in position (particularly of your head).

• Benign - not life threatening (though it may feel pretty serious)
• Paroxysmal – symptoms occur in episodes/ “comes and goes”
• Positional – related to a change in position of your head
• Vertigo - the spinning sensation

​Many people will experience symptoms of BPPV when rolling over in bed, getting into or out of bed,
looking up, or when bending forward (to tie shoes or pick up an object from the ground). People will
usually describe it feeling like the room is spinning around them. The true vertigo symptoms only last
about 20-45 seconds, though the “aftermath” can be quite disabling, as well.

What is happening to cause BPPV?

​Our vestibular system is responsible for telling our brain where our head is oriented relative to the space around us. It works to tell our brain how to work with our other balance strategists (eyes, feet, muscles in your back and neck) to help maintain our balance and posture (example – the vestibular system helps keep you from falling over when tying your shoes or rinsing your hair in the shower). The vestibular system is located deep in our inner ear and houses a system of balance canals that detect movement and balance organs that detect gravity. The gravity organs have tiny calcium carbonate crystals in them, which are often referred to as “rocks.” These “rocks” are housed on tiny hair cells in a fluid called endolymph. When we move our head, the fluid moves and causes the hair cells to bend and causes a reaction in the vestibular nerve sending a message to the brain and causing the appropriate reaction to movement. These rocks occasionally “fall off” and find their way to the canals and, when you turn your head into those certain positions, the rock pushes on the canal, and the brain thinks you are whirling around. If you stay in that position and open your eyes, within a few seconds the brain figures it out and you stop “whirling.” But this is a scary feeling, so most people with BPPV don’t stay in that position or open their eyes.

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What can I do if I think I have BPPV?

​It may be tempting to go to the ER or urgent care because the symptoms are severe, but you will likely be given a medication such as Meclizine or Benzodiazepine which suppress the vestibular system and delay the brain’s ability to compensate and heal. Good news!! Physical Therapists can help you “cure” your BPPV with a relatively simple evaluation and treatment protocol. You would visit the clinic and the therapist will perform a test called the Dix-Hallpike in which you are put through a series of positions to try to elicit your vertigo symptoms and help determine which canal your “rocks” are located. Once we know the location, we treat the condition with a maneuver called the Epley Maneuver. It usually takes 2-3 “rounds” of the maneuver to eliminate or significantly reduce symptoms. Your therapist will likely also assign you a home exercise program to maintain or finish the treatment. You will perform these exercises until you are symptom free for 3 consecutive days. You can follow up with your PT as needed for symptom management or to address any residual balance deficits etc. 

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Author

Christina Bateman, PT, DPT