Benign Positional Vertigo

What Is Benign Positional Vertigo?

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

If you have BPV, you can have brief periods of mild or intense dizziness. An episode is generally triggered by changing the position of your head. In particular, the following actions can trigger an episode of BPV:

• tilting your head up or down
• lying down
• turning over
• getting up

BPV can be annoying, but it’s rarely serious except when a person falls due to dizziness.

Causes

What Causes Benign Positional Vertigo?

BPV is the result of a disturbance inside your inner ear. Fluid inside tubes in your ear, called semicircular canals, moves when your position changes. 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 find their way to the semicircular canal in your inner ear. This causes your brain to receive confusing messages about your body’s position.

Risk Factors

Who Is at Risk for Benign Positional Vertigo?

There are no major risk factors for BPV, but there’s some indication that it could be an inherited condition. Many diagnosed individuals have indicated that multiple relatives also have had the condition.

Prior head injuries, osteoporosis, diabetes, or an inner ear condition can also make some people more prone in developing BPV.

What Are the Symptoms of Benign Positional Vertigo?

The symptoms of BPV can include:

• vomiting
• vertigo, which is a sensation of spinning or swaying
• blurred vision
• nausea
• dizziness
• lightheadedness
• loss of balance
• unsteadiness

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 BPV symptoms. 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.

Diagnosis

How Is Benign Positional Vertigo Diagnosed?

Your doctor can diagnose BPV by performing a test called the Dix-Hallpike maneuver. 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 is a warming and cooling the inner ear with water or air to observe eye movements
• magnetic resonance angiography of the head
• hearing evaluation
• MRI of the head
• CT scan of the head
• electronystagmography (ENG) to record eye movement
• electroencephalogram (EEG) to measure brain activity

Treatment

What Are the Treatments for Benign Positional Vertigo?

Epley’s Maneuver

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

Medication

Your doctor may prescribe medications to relieve spinning sensations. These drugs may include:

• sedative-hypnotics
• anticholinergics
• antihistamines

However, medications are often not effective in treating vertigo.

Home Treatment

There are steps you can take to manage the dizziness associated with BPV.

Losing your balance is always a possibility. Be aware of your surroundings and avoid placing yourself at risk. Falls can cause serious injuries.

Whenever you feel dizzy, take a seat. Sitting down during a dizzy spell can help you avoid falling. You should also take precautions such as using good lighting around the 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.

What Are the Complications of Benign Positional Vertigo?

It may be necessary 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.

Outlook

What Is the Long-Term Outlook?

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 can occur again after successful treatment, and it may return without warning. There’s no cure for BPV.