Feeling dizzy can be unsettling, especially if it happens suddenly when you turn your head or roll over in bed. One of the most common reasons for this is a condition called Benign Paroxysmal Positional Vertigo (BPPV). While the name may sound complicated, the condition itself is usually harmless and can be treated effectively.
Before moving forward, it’s helpful to understand what the name means:
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Benign – it’s not life-threatening.
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Paroxysmal – it comes in sudden, brief bursts.
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Positional – it’s triggered by certain head positions or movements.
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Vertigo – the spinning or whirling sensation you feel, even when you’re still.
In this blog, we’ll explain what BPPV is, what symptoms to look out for, how it’s diagnosed, and the treatments that can help you feel steady again.
What is BPPV?
Inside the inner ear are three loop-shaped tubes called the semicircular canals, which are filled with fluid and lined with tiny hair-like sensors. These canals detect head rotation and help your brain understand movement.
In another part of the inner ear, called the utricle (part of the otolithic membrane), there are tiny calcium carbonate crystals called otoconia. The otoconia bend the hair cells inside the utricle, sending signals to the brain to sense changes in head position, such as tilting, turning, or moving in a straight line.
In BPPV, some of these crystals become loose and move into one of the semicircular canals. When you move your head, these misplaced crystals shift around in the fluid, sending the wrong signals to your brain. This mismatch between what your eyes see and what your balance system feels causes vertigo (a sensation that you or your surroundings are spinning).
Why Do the Crystals Move?
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Primary or idiopathic BPPV: In 50%–70% of cases, there’s no clear reason why the crystals move. This is called primary BPPV.
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Secondary BPPV: In the rest of the cases, BPPV happens because of another condition. Common causes include:
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Head injury – This is the most frequent secondary cause (7%–17% of cases). A strong impact can shake loose many crystals, sometimes in both ears.
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Viral inner ear infections – Conditions like vestibular neuronitis or labyrinthitis (inflammation of the balance parts of the inner ear) can damage the utricle and cause crystals to dislodge.
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Ménière disease – A condition that causes fluid buildup in the inner ear. In some cases (0.5%–31%), it can lead to BPPV, likely due to damage to the utricle.
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Migraines – People with migraines are more likely to get BPPV and have it come back after treatment. This may be due to spasms in the tiny blood vessels of the inner ear.
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Ear surgery – Sometimes, procedures in or near the inner ear can disturb the utricle and release otoconia.
The Types of BPPV (Based on the Affected Canal)
There are three main semicircular canals in each ear: posterior, horizontal (also called lateral), and anterior (also called superior). The type of BPPV a patient experiences depends on which canal the loose crystals have entered:
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Posterior canal BPPV – The most common type. Causes vertigo when tilting your head back or rolling over in bed.
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Horizontal (lateral) canal BPPV – Less common. Usually triggered by turning your head from side to side, such as when shaking your head “no.”
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Anterior (superior) canal BPPV – Rare. Often causes vertigo when bending forward or looking down.
Knowing which canal is affected helps the doctor choose the right treatment maneuver to move the crystals back where they belong.
Symptoms of BPPV
The primary symptom of BPPV is vertigo, which can last from a few seconds to a minute. This often happens when you:
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Roll over in bed.
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Tilt your head back (like looking up at the ceiling).
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Bend forward (like tying your shoes).
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Quickly turn your head from side to side.
Other symptoms may include:
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Dizziness or feeling lightheaded.
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Loss of balance or unsteadiness.
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Nausea (feeling like you might vomit) or actual vomiting.
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Nystagmus (rapid, uncontrolled eye movements) can happen during a vertigo episode.
Nystagmus (rapid, involuntary eye movements) as seen in a patient with BPPV. GIF credit: Mr. Polaz
It’s important to note that BPPV does not cause hearing loss, ear pain, or constant dizziness. If you have these symptoms, your doctor may check for other causes.
Diagnosis and Treatment
Diagnosis
A doctor can usually diagnose BPPV through a detailed medical history and a physical test called the Dix–Hallpike maneuver. During this test:
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You start in a sitting position on an exam table.
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The doctor quickly lays you back with your head turned to one side and slightly hanging over the edge of the table.
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If you have BPPV, this movement will often trigger vertigo and cause your eyes to make specific jerking movements (nystagmus).
This reaction helps confirm that loose crystals are affecting your inner ear. In most cases, no scans or blood tests are needed unless your doctor suspects another cause.
Treatment
The good news is that BPPV can usually be treated quickly and effectively without medicine or surgery.
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Repositioning Maneuvers
The most common treatment is a series of head and body movements called canalith repositioning maneuvers. The most well-known is the Epley maneuver. This technique uses gravity to move the loose crystals out of the semicircular canal and back into the utricle where they belong. -
These maneuvers are often done in a doctor’s office, and many people feel better after just one or two sessions.
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In some cases, your doctor may teach you how to perform similar exercises at home.
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Medicines
Medication is usually not needed for BPPV, but drugs for motion sickness or nausea may be prescribed if you are feeling very unwell during an episode. -
Surgery
Surgery is very rarely needed and is usually only considered if repositioning maneuvers fail to work and symptoms are severe.
Living with and Preventing BPPV
Even after successful treatment, BPPV can sometimes return—especially in older adults. To reduce your risk or manage future episodes:
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Be cautious when changing head positions suddenly.
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Sleep with your head slightly raised.
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Avoid lying on the affected ear when possible.
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If vertigo returns, contact your doctor early so treatment can begin right away.
BPPV may have a long, complicated name, but it’s one of the most treatable causes of dizziness. It happens when tiny crystals in your inner ear end up in the wrong place, confusing your balance system and making you feel like you’re spinning. The condition is not dangerous, and with simple head maneuvers, most people recover quickly.
If you ever notice sudden dizziness when moving your head, especially when lying down, rolling over, or looking up, don’t ignore it. See your doctor for a proper diagnosis and treatment plan. With the right approach, you can get back to feeling steady on your feet and confident in your movements.
