Vertigo, defined as a sensation of movement where the person or the person’s environment seem to spin and whirl, is usually a rather uncomfortable experience. It can hinder your balance, contributing to falls that can be serious among older adults, and can be accompanied by dizziness, a sensation that you’re falling or spinning, and in serious cases migraine headaches, vomiting, nausea, an inability to see properly (nystagmus), as well as fainting.

There are a number of distinct types of vertigo with varied underlying causes. Audiologists typically encounter benign paroxysmal positional vertigo, or BPPV, since it is related to your sense of hearing. BPPV is caused by naturally-forming calcium crystals in the inner ear called otoliths or otoconia, and which normally cause no problems. In benign paroxysmal positional vertigo, the crystals travel from their normal locations into the semicircular canals of the inner ear. Once inside the semicircular canals, the crystals cause an abnormal displacement of endolymph fluid every time a person changes the position of their head (relative to gravity). This is the underlying cause of the vertigo sensations in cases of BPPV.

Benign paroxysmal positional vertigo is characterized by the episodic (paroxysmal) nature of the episodes, and can be brought on by such commonplace movements as looking up or down, tilting the head, rolling over in bed, or any other rapid head motion. Changes in barometric pressure, sleep disorders and stress can make the symptoms worse. The disorder can manifest itself at any age, but it most commonly appears in people over age 60. The initial trigger for the BPPV is generally hard to pinpoint. A sudden blow to the head (for example in an automobile accident) is among the more common causes.

Benign paroxysmal positional vertigo is differentiated from other types of dizziness or vertigo in that it is practically always prompted by head movements, and in that its symptoms usually decrease in less than a minute. Doctors usually diagnose BPPV by having the individual rest on their back on an examination table, rotating their head to one side or over the edge of the table to observe whether this triggers an episode. Additional tests which can be used to diagnose BPPV include videonystagmography or electronystagmography, which test for abnormal eye movement, and magnetic resonance imaging (MRI), whose primary role is to rule out other potential causes, such as brain abnormalities or tumors.

There is no complete cure for benign paroxysmal positional vertigo, but it can be effectively treated using canalith repositioning (either the Semont maneuver or the Epley maneuver), both of which use physical movements to shift the crystals to a position in which they no longer cause problems.In rare cases (less than 10%), if these treatments don’t provide relief, surgery can be recommended. Visit your health care provider if you have felt symptoms that sound as if they might be related to BPPV, especially if they persist for over a week.

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