Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. It occurs when microscopic crystals in the inner ear move into a part of the balance system where they don’t belong. When the head changes position, those crystals move and briefly trigger a spinning sensation. Although the symptoms can feel alarming, BPPV is very common and usually very treatable once the correct diagnosis is made. Having successfully treated this condition hundreds of times, StillPoint Balance & Dizziness is prepared to address both typical, and atypical cases of BPPV. This experience provides pattern recognition that helps identify rare and often subtle inconsistencies that may warrant further investigation.

Common Symptoms of BPPV

Most people with BPPV notice short bursts of spinning dizziness triggered by certain head movements.

Common symptoms include:

• Spinning when rolling over in bed

• Vertigo when lying down or sitting up

• Dizziness when looking up or bending forward

• Feeling briefly off balance after an episode

• Nausea during spinning episodes

These episodes usually last less than a minute, but the sensation can feel intense. Some people also feel slightly unsteady for a short time afterward.

What Causes BPPV?

Your inner ear contains a delicate balance system that helps your brain understand how your head is moving.

Part of this system includes tiny crystals that normally sit in a small chamber of the inner ear. These crystals help detect gravity and head movement.

In BPPV, some of these crystals become dislodged and drift into one of the inner ear “canals” that senses rotation. When the head changes position, the crystals move within that canal and send incorrect signals to the brain, which creates the sensation of spinning. I think of it as a hallucination — it feels as real as real can be, even though your body isn’t moving.

BPPV may develop:

• Without a clear reason

• After a minor head injury

• Following an inner ear illness/infection

• During increased stress or environmental allergies

• After a period of illness or bed rest

• As part of normal aging of the inner ear

In many cases, people simply wake up one morning and notice the symptoms.

How BPPV Is Diagnosed

BPPV is usually diagnosed during a positional test where the head and body are gently moved into specific positions while the clinician observes the eyes.

When the inner ear balance system is stimulated, it produces small involuntary eye movements called nystagmus. These eye movements give important clues about whether BPPV is present and which part of the inner ear is involved.

A careful evaluation helps determine:

• Whether BPPV is actually causing the dizziness

• Which ear is affected

• Which inner ear canal contains the displaced crystals

This information is important because different types of BPPV require different treatments.

Treatment for BPPV

The good news is that BPPV can often be treated with a series of guided head movements designed to return the misplaced crystals to their proper location in the inner ear.

These treatments are known as canalith repositioning maneuvers.

Depending on the specific canal involved, treatment may include maneuvers such as:

• The Epley maneuver

• The Semont maneuver

• The BBQ roll maneuver

• The Deep head hanging maneuver

When the correct maneuver is performed, symptoms often improve quickly. Many patients (>90%) experience resolution within one or two treatment sessions.

When to See a Vestibular Physical Therapist

Because many different conditions can cause dizziness, it is important to make sure BPPV is truly responsible for your symptoms.

You may benefit from seeing a vestibular specialist if you experience:

• Repeated vertigo when changing positions

• Vertigo that wakes you from sleep

• Persistent imbalance after a vertigo episode

• Uncertainty about what is causing your dizziness

A vestibular physical therapist is trained to evaluate the inner ear balance system and determine the most appropriate treatment.

BPPV Treatment in Austin

At StillPoint Balance & Dizziness, care focuses on identifying the exact cause of dizziness and providing targeted treatment.

BPPV evaluation and treatment may include:

• Detailed dizziness assessment

• Positional testing of the inner ear (specialized equipment is sometimes used to best observe eyes)

• Canalith repositioning maneuvers (to move the crystals back where they belong)

• Follow-up vestibular therapy if needed

Evaluations are available through in-home visits in Austin as well as virtual consultations across Texas, depending on the situation.

With the right diagnosis and treatment, most people are able to resolve BPPV and return to normal activities quickly. It’s not uncommon for BPPV to return months or years later, but rarely is it life-altering. If you feel BPPV or dizziness is keeping you from doing the things you enjoy, or from spending time with the ones you love, please reach out so we can get things back on track.

This information is intended for educational purposes and should not replace medical evaluation or diagnosis. If you are experiencing new or severe dizziness, consult a qualified healthcare professional.