What is benign positional vertigo (BPV)?
Benign positional vertigo (BPV) is the most common cause of vertigo, the sensation of spinning or swaying. It causes a sudden sensation of spinning, or like your head is spinning from the inside.
You can have brief periods of mild or intense dizziness if you have BPV. Changing the position of your head can trigger an episode. Other actions that can trigger an episode of BPV include:
- tilting your head up or down
- lying down
- turning over
- getting up
BPV can be uncomfortable, but it’s rarely serious except when dizziness causes someone to fall.
BPV is the result of a disturbance inside your inner ear. The semicircular canals, or the tubes inside your ears, contain fluid that moves when you change your body’s position. The semicircular canals are extremely sensitive.
BPV develops when small crystals of calcium carbonate that are normally in another area of the ear break free and enter the semicircular canals. It can also happen when these crystals form inside the semicircular canals. This causes your brain to receive confusing messages about your body’s position.
There are no major risk factors for BPV, but there’s some indication it could be an inherited condition. Many people with BPV have relatives who also have the condition.
There are also other conditions that can make some people more prone to developing BPV. These include:
- prior head injuries
- an inner ear condition
The symptoms of BPV can include:
Symptoms of BPV can come and go. They commonly last less than one minute.
A variety of activities can bring on BPV. However, most symptoms occur when there’s a change in your head’s positioning. Abnormal eye movements, also called nystagmus, usually accompany symptoms of BPV. Although it’s extremely rare, you can have BPV in both ears.
In some extreme cases of BPV, people can develop dehydration due to vomiting.
Your doctor can diagnose BPV by performing a maneuver called the Dix-Hallpike test. Your doctor will hold your head in a certain position while asking you to rapidly lie down with your back over a table. They’ll look for abnormal eye movements during this test, and they may ask you if you’re experiencing a spinning sensation.
Your doctor will also give you a general physical exam. They’ll get a complete medical history and perform a neurological exam to rule out any other disorders or diseases.
Additional tests might include:
- caloric stimulation, which involves warming and cooling the inner ear with water or air to observe eye movements
- an MRI of the head
- a magnetic resonance angiography (MRA) of the head, which is similar to an MRI
- a CT scan of the head
- a hearing evaluation
- an electronystagmography (ENG) to record eye movement
- an electroencephalogram (EEG) to measure brain activity
A variety of treatments are available to help treat BPV. These include:
Some doctors consider the Epley maneuver the most effective treatment for BPV. It’s a simple exercise you can try at home that doesn’t require any equipment. It involves tilting your head in order to move the piece of calcium carbonate to a different part of your inner ear. Learn how to perform the Epley maneuver, and about other home remedies for vertigo.
There are steps you can take to manage the dizziness associated with BPV. Be aware of your surroundings and avoid placing yourself at risk. Losing your balance is always a possibility. Falls can cause serious injuries.
Take a seat whenever you feel dizzy. Sitting down during a dizzy spell can help you avoid falling.You should also take precautions such as having good lighting around your home and using a cane for stability.
Also, learn what triggers your episodes. Preventing symptoms of vertigo from becoming worse during episodes of BPV can be as simple as avoiding the positions that trigger it.
Your doctor may prescribe medications to relieve spinning sensations. These may include:
- sedative-hypnotics, or sleeping aids
- anticholinergics, which work by blocking the neurotransmitter acetylcholine
However, medications are often not effective in treating vertigo.
You may need to call your doctor if the treatment for vertigo isn’t working, or if you develop weakness, slurred speech, or vision problems.
Keep in mind that symptoms of BPV can sometimes be related to other, more serious conditions.
Living with BPV can be challenging. It can affect relationships with friends and family, productivity at work, and quality of life. There’s also no cure for BPV. And it can occur again without warning, even after successful treatment. However, while BPV may sometimes be uncomfortable, it is manageable and usually improves with time.