Battling BPPV: What You Need to Know About Benign Paroxysmal Positional Vertigo

Did you know that humans have tiny calcium-based crystals in our inner ears that regulate our senses of balance and orientation?

Benign paroxysmal positional vertigo, or BPPV for short, is a common inner ear disorder that causes sudden, brief episodes of dizziness or vertigo when you move your head in certain positions. It is the most common form of dizziness or vertigo, affecting about 2.4% of the general population each year.

BPPV occurs when tiny calcium carbonate particles, known as otoconia, break free from their normal location in the inner ear and become trapped in one of the ear’s fluid-filled canals. These otoconia can then move in response to changes in head position, causing the inner ear to send conflicting signals to the brain about the body’s orientation in space. This results in the sensation of dizziness or vertigo.

The vertigo episodes associated with BPPV are typically short-lived, lasting only a few seconds to a few minutes. These symptoms are usually triggered by specific head movements, such as rolling over in bed, getting up from a lying position, bending forward or tilting your head back to look up.  However, these symptoms can be very disruptive and can lead to falls or can impact an individual’s daily activities, such as driving, working, or socializing. Other symptoms may include nausea, vomiting, and a loss of balance or unsteadiness.

BPPV is more common in older adults, and women are more likely than men to develop the condition. Other risk factors include a history of head injury or ear surgery, as well as certain medical conditions such as diabetes or osteoporosis.

BPPV courtesy of Symetrics

Finding your balance: Managing BPPV and regaining control with the help of a Physiotherapist

Physiotherapists can play a significant role in helping individuals with BPPV manage their symptoms and improve their quality of life.

Assessment for BPPV usually involves techniques, such as the Dix-Hallpike maneuver, to establish which ear is affected by the otoconia.   The Dix-Hallpike test involves moving the individual from a seated to a lying position with the head turned to one side. The test can elicit symptoms of vertigo, nystagmus (an involuntary rhythmic side-to-side, up and down or circular motion of the eyes), and nausea in individuals with BPPV.  Physiotherapists will then use this test to determine which ear is affected and the best course of treatment.

Once the location of the otoconia has been determined,  canalith repositioning maneuvers, such as the Epley maneuver, can then be used to reposition the otoconia out of the affected canal and back into their proper location in the inner ear. These techniques can often provide immediate relief from symptoms. 

Physiotherapists can also provide education and advice to individuals with BPPV, including tips on how to prevent triggering their symptoms. They may recommend that individuals avoid sudden head movements, sleep with their head elevated, and avoid lying on the affected side. Additionally, physiotherapists can teach individuals exercises to improve their balance and coordination, which can be particularly helpful for those who experience dizziness or unsteadiness.

In some cases, BPPV may resolve on its own without treatment. However, if the symptoms persist or recur, further treatment may be necessary. In cases where the individual’s symptoms are severe or long-lasting, physiotherapists may work with other healthcare professionals, such as an ear, nose, and throat (ENT) specialist or a neurologist, to develop a comprehensive treatment plan. This may involve medications to control symptoms, such as nausea or dizziness, or referral for surgery to remove the affected ear canal.

Overall, physiotherapy can play a vital role in helping individuals with BPPV manage their symptoms and improve their quality of life. By providing education, performing diagnostic tests, guiding individuals through canalith repositioning maneuvers, and recommending exercises, physiotherapists can help individuals with BPPV regain their balance, reduce their risk of falls, and return to their daily activities. If you are experiencing symptoms of BPPV, it is important to talk to your doctor or physiotherapist to determine the underlying cause and develop an appropriate treatment plan.

Dizziness vs. Vertigo courtesy of Symetrics


This appointment is your opportunity to tell us what hurts and discover whether physiotherapy or chiropractic care is a good fit for you! During this session, you will talk with a physiotherapist or chiropractor on a phone call (or online) and create the right care plan specifically for your pain. There is no obligation on this session is to find out whether physiotherapy or chiropractic care can help you getting back to doing the things you love in life.

Frequently Asked Questions

In some cases, BPPV may resolve on its own without treatment. However, this can vary depending on the individual and on the severity of their symptoms. In many cases, BPPV can persist for several weeks or months without treatment, and may even recur over time. It is important to talk to a doctor or physiotherapist if you are experiencing symptoms of BPPV, as treatment can help manage your symptoms and reduce your risk of falls.

The duration of BPPV can vary depending on the individual and the severity of their symptoms. In most cases, BPPV lasts for a few seconds to a few minutes, and is typically triggered by changes in head position. However, some individuals may experience longer episodes of vertigo or more frequent episodes. Treatment for BPPV, such as canalith repositioning maneuvers, can help reduce the duration and frequency of vertigo episodes.

There is some evidence to suggest that lack of sleep can contribute to dizziness or vertigo in some individuals. Sleep plays an important role in regulating the body’s balance system, and disruption to sleep can affect this system. Additionally, lack of sleep can contribute to stress, anxiety, and fatigue, which can also exacerbate symptoms of vertigo. If you are experiencing symptoms of vertigo or dizziness, it is important to talk to a doctor or healthcare provider to determine the underlying cause and develop an appropriate treatment plan.

About Danielle Cousineau

Danielle has been a proud owner of SYMETRICS since 2000. She brings much enthusiasm and experience to the clinic as she truly cares for her patients and her staff.

Danielle graduated from the University of Ottawa with a Bachelor of Science in Physiotherapy in 1992. She quickly developed an interest in manual therapy when she worked at the North Bay General Hospital from 1992-1996. She then joined the Physiotherapy North team in 1996 and helped in the transition of the clinic to what SYMETRICS has become.

Medical Disclaimer:

The information presented in this blog post is for educational purposes and should not be interpreted as medical advice. If you are seeking medical advice, treatment or a diagnosis, consult with a medical professional such as one suggested on this website. The Clinic Accelerator Inc. and the author of this page are not liable for the associated risks of using or acting upon the information contained in this article.

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