10 April, 2020
Benign Paroxysmal Positional Vertigo (BPPV)
Approximate reading time: 3 minutes
Benign Paroxysmal Positional Vertigo is shortened to BPPV. It’s the most common vestibular disorder, affecting about 2.4% of people.
What does BPPV actually mean? We can understand the symptoms by looking at the name itself.
- Benign - not serious
- Paroxysmal - starts & resolves suddenly
- Positional - comes on with changes in position
- Vertigo - movement sensation
Typically people wake up with BPPV.
They roll over to get out of bed. Boom. The spinning starts. It’s intense. Maybe you feel sick to the stomach.
Then it calms down and has gone. You might even feel fine between bouts.
Mechanisms of BPPV
Our ears contain crystals. These little crystals get a bit lost in BPPV. They end up in the semicircular canals.
When your head moves, the canals send messages to the brain. However, the crystals confuse the canals - they can’t tell when the movement has stopped. It’s inertia!
This is why the dizziness starts after you move.
Types of BPPV
BPPV can affect any of the six semicircular canals. Posterior BPPV is the most common type however it can affect any of the semicircular canals.
- Canalithiasis - the crystals are floating about freely
- Cupulolithiasis - the crystals are more stubbornly stuck
Each variations require a different treatment.
Diagnosis of BPPV
The symptoms of BPPV are usually quite telling to the trained practitioner. Your GP, Chiropractor, neurologist or physio will then do special hands-on testing to confirm their suspicion.
This testing doesn’t feel pleasant if you have BPPV. In fact, it can feel down-right horrible. But it only lasts a moment.
Your Doctor will be looking into your eyes to see how they react as well as asking you how you feel.
Whilst uncomfortable, this testing is very important so that the most appropriate treatment can be given. This testing lets the practitioner know that it is indeed BPPV and what type it is.
Will I need an MRI or CT?
No - BPPV won’t show anything on an MRI or CT scan. Structurally, your brain and inner ears are all intact. They are just functioning a little crookedly.
BPPV Treatment Options
Treatment is usually quite straightforward. Your neurologically-trained Chiropractor will use the Epley Manoeuvre or other similar exercises depending on your test results.
These manoeuvres are only performed after a careful examination. Sometimes they may need to be modified - or even avoided entirely.
This typically resolves quickly with the appropriate treatment. In fact, 90% are fixed within 1 to 3 treatments.
Some people experience “leftover” dizziness. These often require home exercises - called Vestibular Rehabilitation.
Will I require Medication?
Generally not. Sometimes you may be prescribed ‘band aid’ medication to mask the dizziness and nausea.
The best evidence points to a hands-on approach.
Will I get BPPV again?
Maybe. Unfortunately up to 50% do experience BPPV again.
It may be in the same type or another. It may even be another type of dizziness all together - like Persistent Postural-Perceptual Dizziness. This is why it’s suggested that you see your health practitioner at each flare up.
- Benign Paroxysmal Positional Vertigo is the most common form of vertigo
- It’s a non-serious disorder, frequently treated within 1-3 sessions
- There are several different forms of BPPV - each requires a different treatment
- Some people require home exercises (Vestibular Rehabilitation) after hands-on treatments
Similar articles you'll enjoy:
- Fife TD et al. (2008). Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report on the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2008;70:2067-74.
- Parnes LS et al. (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003 169(7):681-693.
- von Brevern M, Radtke A, Lezius F, et al. (2007). Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007;78:710–5.