BPPV: Why Certain Head Movements Cause Brief Vertigo

Benign paroxysmal positional vertigo, or BPPV, is a common inner-ear cause of vertigo. It produces brief episodes of spinning triggered by changes in head position, such as rolling over in bed, looking upward, bending down or getting up. Episodes usually last seconds to less than a minute, although nausea or unsteadiness may continue longer. BPPV occurs when tiny calcium crystals that normally sit in one part of the inner ear move into a semicircular canal. Head movement then shifts the crystals and sends an incorrect movement signal to the brain. Diagnosis is based on the symptom pattern and positional examination. A clinician may perform a test such as the Dix–Hallpike manoeuvre while observing for characteristic eye movements called nystagmus. Brain imaging is not routinely required when the history and examination are typical, but may be needed when symptoms or neurological findings are unusual. Treatment commonly involves a canalith-repositioning manoeuvre, such as the Epley manoeuvre, performed according to the affected canal and side. These manoeuvres guide the crystals back to an area where they no longer trigger vertigo. Medication may reduce nausea temporarily but does not correct the displaced crystals. BPPV can recur, and some patients may be taught appropriate home exercises after diagnosis. Seek urgent care if dizziness occurs with weakness, numbness, difficulty speaking, severe new headache, fainting, chest pain, inability to walk, continuous vomiting or sudden hearing loss, as these features are not typical of uncomplicated BPPV.