Benign Paroxysmal Positional Vertigo (BPPV)

What is BPPV?

This condition affects a large amount of the population (you are not alone!). It typically occurs in older adults, but can also affect the younger population especially after a whiplash type injury. Symptoms are provoked with changes in position. This can include getting in and out of bed, washing your hair, or even just bending over to pick something up. If symptoms are present without a change in head or body position, BPPV is likely not the cause. The most common symptom with this condition is vertigo (a sensation that the room is spinning). Other symptoms may include:

  • Dizziness (feeling off, floating, on a boat)
  • Imbalance
  • Fatigue
  • Nausea/vommiting
  • Headache

Mechanism of Symptoms

You have likely heard about the “crystals” in your inner ear by now. Yes they do get dislodged from where they usually lie, although the mechanism for this movement is not always known. When this happens they escape into the actual canals of they vestibular structure causing BPPV. This is what sets the condition off. The canals have fluid with a specific thickness that moves hair cells to send signals to your brain during movement. These signals help to control eye movement independently of head movement. So lets break down the mechanism into somewhat simple steps:

  1. Calcium carbonate crystals become dislodged and enter the vestibular canals
  2. Fluid movement changes due to addition of crystals in canal
  3. Change in fluid movement leads to poor vestibular signaling to the brain
  4. Brain believes that movement is greater than it is due to increased fluid movement
  5. Eye movement is increased despite movement head and body movement being the same
  6. Sensory mismatch leads to vertigo and nausea

Treatment for BPPV

Treatment for BPPV is usually simple and usually only requires 2 treatment sessions. Treatment consists of movements of the head and body to relocate the crystals where they are supposed to be. The most common treatment is the Epley maneuver, but there are a variety of others based on which canal is involved. Your physical therapist in Charlottesville will determine which treatment is best for you.


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