Benign Positional Vertigo

Written by Bree Normandin and Marijane Leonard | Published on August 16, 2012
Medically Reviewed by George Krucik, MD

Overview

Benign positional vertigo (BPV) is the most common cause of vertigo. Generally, it causes a sudden sensation of spinning, but it can also make you feel like your head is spinning from the inside.

BPV can involve brief periods of mild or intense dizziness. An episode is generally triggered by changes in the position of your head. Tilting your head up or down, lying down, turning over, and rising can bring on an occurrence of BPV.

BPV can be an annoying problem. However, it’s rarely serious except when the chance of falls is increased.

BPV Causes

BPV is caused by a disturbance originating inside the inner ear. The fluid-filled tubes in your ear, called semicircular canals, are extremely sensitive to the movement of fluid that occurs when your position changes.

BPV develops when small pieces of calcium break free and find their way to the tube in the inner ear. This causes your brain to receive confusing messages about your body’s position.

BPV Risk Factors

Although there are no major risk factors for BPV, there is some indication that it could be an inherited condition. Many diagnosed individuals have indicated that multiple relatives have also suffered from the condition. Additionally, prior head injuries or an inner ear condition can make some people more prone in developing BPV.

BPV Symptoms

Symptoms of BPV can include:

  • vomiting
  • vertigo
  • blurred vision
  • nausea
  • dizziness
  • lightheadedness
  • loss of balance
  • unsteadiness

Symptoms of BPV can be intermittent; they commonly last less than one minute.

Activities that bring on BPV can vary from person to person. However, most symptoms are brought on by a change in your head’s positioning. Abnormal eye movements, also called nystagmus, usually accompany BPV symptoms. Although it is extremely rare, you can have BPV in both ears.

In some extreme cases of BPV, sufferers can develop dehydration due to vomiting.

Diagnosing BPV

Physicians diagnose BPV by performing a test called the Dix-Hallpike maneuver. Your physician will hold your head in a certain position while asking you to rapidly lie down with your back over a table. As you perform this test, your doctor is observing you for abnormal eye movements. Additionally, the doctor may ask if you are experiencing a spinning sensation.

Your doctor will also conduct a general physical exam. He or she will obtain a complete medical history and also perform a neurological exam to rule out any other disorders or diseases.

Additional tests might include:

  • caloric stimulation (warming and cooling the inner ear with water or air to observe eye movements)
  • magnetic resonance angiography of the head
  • hearing evaluation
  • magnetic resonance imaging (MRI) of the head
  • computed tomography (CT) scan of the head
  • electronystagmography (ENG), which records eye movement
  • electroencephalogram (EEG), which measures brain activity

Treating BPV

Epley’s Maneuver

Some doctors consider this to be the most effective BPV treatment. It involves moving the offending piece of calcium to a different part of your inner ear where it will no longer cause problems.

Medication

Medications may be prescribed to assist in relieving spinning sensations. These drugs may include:

  • sedative-hypnotics
  • anticholinergics
  • antihistamines

However, medications are often not effective in treating vertigo.

Home Treatment

You can work to manage the dizziness associated with BPV with the following tips:

  • Be Vigilant. Losing your balance is always a possibility. Be aware of your surroundings and avoid placing yourself at risk. Falls can cause serious injuries.
  • Sit Down. Whenever you feel dizzy, take a seat. Sitting down during a dizzy spell can help you avoid falling.
  • Be Safety Conscious. Take precautions such as using good lighting around the home and using a cane for stability.
  • Know Your Triggers. Preventing symptoms of vertigo from becoming worse during episodes of BPV can be as simple as avoiding the positions that trigger it.

Complications

It may be necessary to call your healthcare provider if the following occur:

  • the treatment for vertigo isn’t working
  • weakness, slurred speech, and vision problems develop

Keep in mind that symptoms of BPV can sometimes be related to other more serious conditions.

Long-Term Outlook for BPV

Living with the condition can be challenging. It can affect relationships with friends and family, productivity at work, and quality of life. BPV is uncomfortable but manageable, and it usually improves with time. Unfortunately, BPV may still recur after successful treatment, and it may return without warning. There is no cure for BPV.

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