Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo (BPPV) accounts for 32% of all causes of vertigo (dizziness). It can occur in adults of all ages, but often affects individuals over the age of 60, and is more common in women than in men.

Symptoms of vertigo including feeling that your surroundings are moving or spinning, as well as nausea, vomiting, or motion sickness. Symptoms typically occur when there is a change to the position or orientation of the head, especially when bending forward, looking up, lying down, or rolling over in bed. BPPV also affects balance and the person may become unsteady on their feet. In addition, abnormal eye movements (nystagmus) usually accompany the symptoms of BPPV. These eye movements typically beat rhythmically in a vertical or horizontal direction.

In approximately 35% of cases BPPV occurs without a known cause, but may also be associated with head trauma (15%), and inner ear infections (15%). BPPV has also been associated with hypertension, hyperlipidemia, migraines, and stroke.

The physiological mechanism of BPPV involves the vestibular labyrinth of the ear, which contain 3 looped structures called the semicircular canals. These canals are responsible for monitoring the rotation of the head. When calcium carbonate crystals (otoconia) become dislodged from one of the inner ear organs (utricle) they can migrate into the semicircular canals. When the head changes position, so do the crystals in the canals, which causes an unwanted flow of fluid that continues even after the head has stopped moving. This causes the body to falsely interpret that the surroundings are spinning. The direction of the nystagmus (vertical vs. horizontal) can help clinicians determine which semicircular canals are affected.

It is estimated that 50% of BPPV cases resolve spontaneously. The average duration of BPPV is 2 weeks and recurrent episodes occur in 40% of patients. Treatment of BPPV may involve specific physiotherapy maneuvers and an exercise program designed to reposition the crystals out of the semicircular canals. It is then thought that the crystals are reabsorbed by the body. The results of these maneuvers can vary, with some patients experiencing immediate relief, while others may require follow up maneuvering.

If you are experiencing vertigo or dizziness please consult with your primary care provider to determine a diagnosis for your condition. There are several other medical conditions that may cause dizziness or vertigo so it is important to seek medical attention as soon as possible. If you are diagnosed with BPPV your physiotherapist can help guide you through a series of maneuvers that may help to ease your symptoms.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

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About the Author

Kristi Scott, B.Sc., M.Sc.P.T., CAFCI

Kristi is a Registered Physiotherapist. She joined her mother, Shirley Andrusiak, at Guisachan Physiotherapy after graduating from the Masters of Science in Physical Therapy Program at the University of Alberta in 2010. She also holds an Undergraduate Bachelor of Science Degree from the University of Victoria. Since graduating Kristi has completed numerous continuing education courses including manual therapy, vertigo, sport first responder, and golf related rehabilitation.  She has also completed her training with the Acupuncture Foundation of Canada Institute, and is certified to perform acupuncture, holding a designation of CAFCI.

Kristi brings an energetic, exercise based approach to her practice. She focuses on client centered care, education, exercise prescription, and manual therapy techniques. 

You can contact Kristi by email at [email protected]




The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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