Benign Paroxysmal Positional Vertigo

A sudden sensation of spinning when turning the head may be a manifestation of benign paroxysmal positional vertigo, or BPPV. One possible cause is BPPV, the most common type of vertigo. It usually runs a benign course.

What benign paroxysmal positional vertigo is

BPPV is generally considered a pathology of the inner ear in which episodic vertigo occurs when the position of the head changes. In terms of prevalence, it accounts for 17 to 35 percent of all cases of vertigo, and among types of vertigo it is considered the most common. This is a problem of the inner ear.

Why positional vertigo occurs: the mechanism

The inner ear contains fluid-filled canals — the semicircular canals. When the head moves, the fluid moves within them, and this signal tells the brain the position of the body, helping to maintain balance. In BPPV, small bone-like calcium particles, otoliths, break loose and float within the canal, sending the brain conflicting signals about body position. The main theory links the condition specifically to the displacement of otoliths into one of the semicircular canals. One of the founders of this theory is considered to be the English physician Charles Hallpike, and back in the early 20th century the Russian physician S. I. Belinov pointed to the possible role of otoliths. Other views also exist, such as impairment of the inhibitory function of the vestibular cerebellum.

How paroxysmal vertigo manifests

The condition manifests as sudden short-lived but intense attacks: it seems that you are spinning or everything around you is. An attack is usually triggered by head movement, often begins suddenly, and lasts from a few seconds to minutes. Typical triggers are turning in bed and tilting the head back to look up. Loss of balance, nausea and vomiting are possible, and sometimes visual problems in the form of a sensation that objects are jumping or moving.

• A sensation of spinning of oneself or the surrounding world
• Loss of balance
• Nausea and vomiting
• A sensation that objects are jumping or shifting

Why vertigo is called benign

BPPV usually runs a benign course: exacerbations, when attacks recur daily, alternate with spontaneous improvement, sometimes for several years. At the same time, the condition can also be severe, with frequent attacks, noticeably reducing quality of life. Balance disturbances during an attack can be dangerous, for example at height or while driving. Possible complications include dehydration due to frequent vomiting.

How positional vertigo is diagnosed

The doctor performs an examination and asks about the medical history. To diagnose BPPV, the Dix–Hallpike test is used: the head is held in a certain position, then the patient is asked to lie back quickly over the edge of the couch while the doctor observes involuntary eye movements, nystagmus, and clarifies the sensation of spinning. Nystagmus can be observed using Frenzel goggles or a videonystagmograph. If the result is unclear, other examinations are ordered, including electronystagmography, CT or MRI of the head, MR angiography, hearing testing, and caloric stimulation.

When to see a doctor

You should see a doctor if the vertigo does not go away or returns. Immediate medical help is required for weakness, slurred speech, and visual problems — these may be signs of a more serious condition.

Positional vertigo on its own is not a reason to call an ambulance; 103 or 112 — if vertigo is accompanied by double vision or loss of vision, hearing loss, difficulty speaking, weakness, numbness or tingling in an arm or leg.

This material is for reference: it explains the mechanism and the boundaries of normal, but does not replace a consultation with a doctor who will assess your specific situation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer