What is benign paroxysmal positional vertigo?

Benign paroxysmal positional vertigo (BPPV): Overview

Benign paroxysmal positional vertigo, also called BPPV, is an inner ear problem. It causes a spinning or whirling sensation when you move your head. This sensation is called vertigo.

The vertigo usually lasts for less than a minute. People often have vertigo spells for a few days or weeks. Then the vertigo goes away. But it may come back again. The vertigo may also cause unsteadiness, nausea, and vomiting. You may be at risk for falls.

When you move, your inner ear sends messages to the brain. This helps you keep your balance. Vertigo can happen when tiny calcium "stones" move into an area of your inner ear called the semicircular canal. This can cause the inner ear to send the wrong message to the brain.

Your doctor may move you in different positions to help your vertigo get better faster. This is called the Epley maneuver. Your doctor may also prescribe exercises for you to do on your own.

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a balance problem that makes you feel like you're spinning or tilting (vertigo) if you move your head a certain way. BPPV is caused by a problem in your inner ear. Tiny calcium "stones" inside your inner ear help you keep your balance. Sometimes these stones move into an area of your inner ear called the semicircular canal. When you move your head in certain ways, the stones move. Sensors in the semicircular canal are triggered by the stones, which causes a feeling of dizziness.

A vertigo attack usually lasts less than a minute. A doctor can move your head in ways that adjust the stones so they don't affect your balance. But even without treatment, the attacks will usually go away on their own in a few weeks.

What happens when you have benign paroxysmal positional vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) causes a whirling, spinning sensation even though you are not moving. The vertigo can cause nausea or vomiting and can put you at risk for falls. The vertigo attacks happen when you move your head in a certain way, such as tilting it back or up or down, or by rolling over in bed. It usually lasts less than a minute. Moving your head to the same position again may trigger another episode of vertigo.

BPPV often goes away without treatment. Until it does, or is successfully treated, it can repeatedly cause vertigo with a particular head movement. Sometimes it will stop for a period of months or years and then come back.

What are the symptoms of benign paroxysmal positional vertigo (BPPV)?

The main symptom of BPPV is the feeling that you or your surroundings are spinning, whirling, or tilting. This sensation is called vertigo. It usually lasts less than a minute.

It's important to understand the difference between vertigo and dizziness. People often use those two terms as if they meant the same thing. But they are different symptoms, and they may point to different problems.

  • Vertigo is the feeling that you are spinning or the world is spinning around you. It happens when your body's balance sensory systems disagree about what kind of movement they sense. You may find it hard to walk or stand. You may even lose your balance and fall. If your vertigo is bad enough, you may also have nausea and vomiting.
  • Dizziness isn't a feeling that you are spinning. It is a woozy or unsteady feeling.

How is benign paroxysmal positional vertigo (BPPV) treated?

BPPV may go away in a few weeks by itself. If treatment is needed, it usually involves your doctor moving your head in different directions.

Can you prevent benign paroxysmal positional vertigo (BPPV)?

In most cases, benign paroxysmal positional vertigo (BPPV) cannot be prevented. But some cases may result from head injuries. Wearing a helmet when bicycling, motorcycling, playing baseball, or doing other sports activities can protect you from a head injury and BPPV.

How is benign paroxysmal positional vertigo (BPPV) diagnosed?

BPPV is diagnosed with a physical exam. Your doctor will ask questions about your symptoms and past health. You may have a Dix-Hallpike test. In this test, your doctor watches your eyes while turning your head and helping you lie back.

Who can diagnose and treat benign paroxysmal positional vertigo (BPPV)?

The following health professionals are able to diagnose and treat benign paroxysmal positional vertigo(BPPV) and the causes of vertigo:

  • Family medicine physician
  • General practitioner
  • Physician assistant (PA)
  • Nurse practitioner (NP)
  • Internist
  • Otolaryngologist (ear, nose, and throat specialist)
  • Neurologist

How can you care for benign paroxysmal positional vertigo (BPPV)?

Vertigo causes loss of balance and puts you at risk for falling. Be extra careful so that you don't hurt yourself or someone else if you have a sudden attack of vertigo.

  • Don't drive or ride a bike if you are having vertigo.
  • Keep floors and walkways free of clutter so you don't trip.
  • Avoid heights.

Your doctor may suggest that you do the Epley maneuver at home. Here's how:

  • Sit on the edge of a bed. Turn your head halfway between looking straight ahead and looking to the side that causes the worst vertigo (45 degrees).
  • Tilt yourself backward until you are lying on your back. Your head should stay at the 45-degree turn. Hold for 30 seconds. If you have vertigo, stay in this position until it stops.
  • Turn your head all the way to the other side without lifting it. Your chin should be raised and over your shoulder. Hold for 30 seconds or until your symptoms stop.
  • Keeping your head in the same position, roll your body the same direction you are facing. You should now be on your side and looking down. Hold for 30 seconds or until your symptoms stop.
  • Slowly push yourself up to a sitting position.

What increases your risk of developing benign paroxysmal positional vertigo (BPPV)?

Scientists think you're more likely to develop benign paroxysmal positional vertigo (BPPV) if you have one of these conditions:

  • You are an older adult.
  • You have a head injury.
  • You have an inflammation of the inner ear or of the nerve that connects the inner ear to the brain, a condition called vestibular neuritis.
  • You have ear surgery.
  • You have a history of migraines.
  • You have high blood pressure.
  • You have had a stroke.
  • You have high cholesterol.

What is benign paroxysmal positional vertigo (BPPV)?

Vertigo is the feeling that you are spinning or the world is spinning around you. Benign paroxysmal positional vertigo is a balance problem that causes brief vertigo spells that come and go.

For many people, BPPV goes away by itself in a few weeks, but treatment can help. It can come back again.

BPPV isn't a sign of a serious health problem.

What causes benign paroxysmal positional vertigo (BPPV)?

BPPV is caused by a problem in the inner ear. Tiny calcium "stones" inside your inner ear help you keep your balance. When you have BPPV, these stones move into the semicircular canal in your inner ear where they can cause a feeling of spinning.

How can you stay safe when you have benign paroxysmal positional vertigo (BPPV)?

The loss of balance BPPV causes puts you at risk for falling. You can reduce your risk of injury by being extra careful and making your home environment safe. At home, keep floors free of clutter and avoid heights. Avoid driving if you have vertigo.

Benign paroxysmal positional vertigo (BPPV): When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have sudden dizziness that doesn't get better.
  • You have dizziness along with symptoms of a heart attack. These may include:
    • Chest pain or pressure, or a strange feeling in the chest.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
    • Lightheadedness or sudden weakness.
    • A fast or irregular heartbeat.
  • You have symptoms of a stroke. These may include:
    • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
    • Sudden vision changes.
    • Sudden trouble speaking.
    • Sudden confusion or trouble understanding simple statements.
    • Sudden problems with walking or balance.
    • A sudden, severe headache that is different from past headaches.

Call your doctor now or seek immediate medical care if:

  • You have new or worse nausea and vomiting.
  • You have new symptoms such as a fever, a headache, hearing loss, or ringing in your ears.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You are not getting better as expected.

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