Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo causes brief spinning sensations when a change in head position disturbs the inner ear.

It happens when tiny calcium crystals move into a part of the inner ear that detects head movement. The brain then receives a movement signal that does not match what the eyes and body are sensing. BPPV is not the same as light-headedness from dehydration or faintness.

Vertigo is a very common presentation of BPPV, often brought on by rolling in bed, looking up, bending down or sitting up. Dizziness may accompany the spinning sensation. Episodes commonly settle when the head is kept still, although nausea or unsteadiness can linger afterward.

Seek urgent medical help for new weakness, facial drooping, trouble speaking, severe headache, chest pain, fainting, or an inability to walk steadily. These features need prompt assessment because they are not typical of uncomplicated positional vertigo.

The inner ear contains fluid-filled canals that help detect rotation. In BPPV, displaced crystals can move with gravity inside a canal and trigger an inappropriate signal during certain head movements. It may arise without an obvious trigger, and it can also follow a head injury, a period of reduced movement, or another inner-ear problem.

Symptoms may come and go. A spell can be brief but repeat with the same movement, which can lead people to avoid turning their head. BPPV can return after a symptom-free interval, so a previous episode is useful information to share if similar symptoms develop again.

BPPV becomes more likely as people get older because inner-ear crystals may be more prone to shifting. Previous head injury, inner-ear inflammation and extended time in bed can also be relevant. These factors do not confirm the diagnosis; the movement pattern and examination remain important.

A clinician will ask which movements trigger symptoms, how long they last, and whether hearing changes or neurological symptoms are present. They may perform a carefully guided positional test while observing the eyes for a characteristic involuntary movement. This helps identify the affected canal and distinguishes BPPV from other causes of dizziness.

A repositioning manoeuvre can guide the crystals out of the sensitive canal. The Epley manoeuvre is commonly used when the examination supports the relevant type of BPPV; it is best learned from a trained clinician so the movements match the diagnosis and your neck or back needs. Medicine may ease nausea in selected situations but does not reposition the crystals.

A GP consultation is a sensible starting point when spinning is new, recurring, unclear, or affecting daily activities.

Until symptoms settle, move from lying to sitting slowly and pause before standing. Use a light when getting up at night and avoid ladders, driving, or machinery if turning your head could bring on spinning. Tell a clinician about neck problems, mobility limitations, or pregnancy before attempting a manoeuvre.

Arrange review if symptoms persist despite repositioning, keep returning, or no longer follow a clear positional pattern. A clinician may refer you for vestibular assessment, hearing assessment, or specialist care when the history or examination suggests another cause.