BPPV
Benign Paroxysmal Positional Vertigo
BPPV is one of the most common causes of rotational vertigo. Complaints are usually triggered by specific head movements and last a short time. Although the symptoms can be intense, BPPV can usually be treated effectively.
Key points
- BPPV is one of the most common causes of rotational vertigo.
- Complaints are triggered by specific head movements such as turning in bed, lying down, sitting up, or bending over.
- The vertigo usually lasts a few seconds up to a maximum of one minute.
- Between attacks, people can often feel relatively normal again.
- BPPV is caused by dislodged calcium crystals in the vestibular organ.
- BPPV can usually be treated effectively with specific manoeuvres.
Symptoms
- Rotational vertigo when turning in bed.
- Dizziness when lying down or sitting up.
- Dizziness when bending over or looking up.
- Short episodes of rotational vertigo with head movements, lasting seconds to a maximum of one minute.
- Sometimes nausea during an episode.
Causes
- BPPV occurs when small calcium crystals (otoconia) become dislodged and enter the semicircular canals of the vestibular organ.
- Head movements can cause these crystals to stimulate the vestibular system, resulting in a brief sensation of rotational vertigo.
- The exact cause is not always clear; BPPV can occur spontaneously.
- BPPV can develop after a period of illness or bed rest.
- BPPV can develop after a fall or head trauma.
- BPPV can develop after inflammation of the vestibular organ.
- Ageing of the vestibular system may play a role.
Treatments
- Treatment consists of specific repositioning manoeuvres aimed at moving the crystals back to a part of the vestibular organ where they no longer cause symptoms.
- In many cases, symptoms can reduce or resolve quickly as a result.
- A physical therapist can assess whether the complaints fit BPPV and which treatment is appropriate.
What is BPPV?
In BPPV, small calcium crystals become dislodged in the vestibular organ. These crystals, also called otoconia, can stimulate the balance system during head movements. The brain then receives incorrect movement signals, which can cause a brief sensation of rotational vertigo.
BPPV is one of the most common causes of rotational vertigo and can usually be treated effectively.
Calcium crystals
Otoconia
Small calcium crystals become dislodged and enter the semicircular canals.
Triggered by movement
Head movements
Turning, bending, lying down, or sitting up can stimulate the balance system.
Short duration
Seconds to a minute
The vertigo usually lasts a short time and resolves on its own. Between episodes there is often no dizziness.
How is BPPV assessed?
When the complaints fit BPPV, a physical therapist can perform an assessment in which the body is positioned in different head positions.
During this assessment, the occurrence of vertigo, the response of the vestibular system, and characteristic eye movements (nystagmus) are observed. Tests such as the Dix-Hallpike test or the Supine Roll test can help determine which part of the vestibular organ is involved.
What can physical therapy offer?
When the complaints are caused by BPPV, treatment can consist of specific repositioning manoeuvres. These manoeuvres are designed to move the crystals back to a part of the vestibular organ where they no longer cause symptoms.
In many cases, symptoms can reduce or resolve quickly as a result of these manoeuvres.
Would you like to have your symptoms assessed?
An initial assessment can help determine whether your symptoms fit BPPV and which treatment might be appropriate.