Vertigo - BPPV

What is it?

BPPV (benign paroxysmal positional vertigo) a very common cause of dizziness. It can be associated with trauma to the head or neck but often occurs without an obvious injury. It is caused by a disruption to the vestibular system – the organ in the inner ear which senses position and movement of the head. In this condition the small calcium crystals in the inner ear which help sense head position, called otoconia, become dislodged from one part of the vestibular system and begin to move around in another section. This means that the system senses motion even when the head is still, resulting in an uncomfortable dizzy sensation which can often feel like the room is spinning.

BPPV is characterised by feelings of dizziness or a sensation of the room spinning. This most often occurs after changing head position, very commonly when rolling over in bed or looking up. The feeling is often transient, resolving a minute or two after the head stops moving.
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This dizziness can cause feelings of unsteadiness, loss of balance, or falling as well as nausea and even vomiting. Nystagmus – an involuntary, jerky eye movement – is also a common sign of BPPV as the eyes try to correct their position relative to the perceived head movement.

While uncomfortable, BPPV is rarely a sign of serious pathology but can become a safety risk if it causes loss of balance or falls.

Signs and Symptoms

• Dizziness – particularly after changing head position
• Feeling like the room is spinning
• Loss of balance, unsteadiness causing falls
• Nystagmus (abnormal eye movements)
• Nausea
• Vomiting

​How can physio help?
After taking a thorough history, if your physio suspects you may have BPPV they will perform a clinical test, called the Hallpike-Dix manoeuvre. This test aims to reproduce symptoms in order to confirm the diagnosis. After the diagnosis is confirmed, your physio can perform a technique called the Epley manoeuvre in order to treat the condition. This technique involves moving the head and body through a series of positions which moves the otoconia back into the correct part of the vestibular system so that the vestibular system can work properly and stop your dizziness.
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It is very common for the first treatment for BPPV to be effective, resulting in a complete resolution of symptoms. Your physio may also teach you how to perform this technique yourself at home if your symptoms recur. Your physio may also teach you some vestibular rehab exercises which can help retrain your vestibular system and improve your balance. These exercises focus on retraining eye movement control and balance training with the goal of helping you mange dizziness symptoms should they return.