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  • Writer's pictureKelsy Rayl

Benign Paroxysmal Positional Vertigo: A Comprehensive Guide to BPPV

Benign Paroxysmal Positional Vertigo or BPPV is a bit of a tongue twister. You may have experienced this or know someone who has! I can’t tell you how often I get a new patient who has been referred to me for BPPV. But what is BPPV? Is it the only source of dizziness? Are you dealing with BPPV or another dizzy-causing condition? All of these are important questions to make sure you get the help you need! Keep reading to learn more about BPPV, what it is, and how it’s different from other dizzy conditions.


What does BPPV look like?

The hallmark of BPPV is room-spinning vertigo lasting 60 seconds or less, in response to quick changes in position. BPPV causes extreme vertigo which significantly impacts how we perceive the world. Those experiencing BPPV have the illusion of their world spinning when making sudden movements. You can imagine how this would make it difficult to get up, move around, and interact throughout the day. 


What BPPV does NOT look like…

If you’re experiencing constant dizziness or bouts of dizziness that last longer than 60 seconds, you most likely are experiencing another dizziness-causing condition, NOT BPPV.


What causes BPPV?

BPPV is a dysfunction of the peripheral vestibular system. The peripheral vestibular system is made up of 3 semicircular canals and 2 otolith organs. For a refresher on how your vestibular system works, check out my blog! The semicircular canals are filled with fluid and detect head motion. The otolith organs contain a membrane with microscopic crystals on them that help with sensing gravity. The membrane is like a sticky jello that holds the crystals in place. BPPV occurs when the crystals in the otolith organs get dislodged and migrate into the semicircular canals. The crystals don’t belong in the semicircular canals. Once there, they disrupt how the canals normally function and cause misinformation to be sent to the brain. The mismatch of information that the brain receives gets interpreted as the spinning sensation of vertigo. 


It’s easy to think of the crystals being dislodged from a hit to the head or a sudden change in acceleration. However, some patients have the misfortune of sitting up in bed and experiencing BPPV seemingly out of nowhere. As we age, the membrane the crystals sit on becomes “less tacky” and makes it easier for gravity to “pull” them off of the membrane. 


How do we treat BPPV?

Good news, BPPV is correctable! With a thorough evaluation, we can diagnose the specific canal and the specific ear causing the problem and then use a repositioning maneuver to get the crystal back where it belongs. BPPV can typically be resolved in 1-3 visits.


Depending on how long someone has been dealing with BPPV, they may benefit from vestibular rehab after the peripheral system has returned to baseline function. This helps the brain readjust after the BPPV has been eliminated.


If I don’t have BPPV, what’s causing my dizziness?

Statistically speaking, BPPV is the most common cause of dizziness; however, many other conditions can cause dizziness. Ultimately, it’s important to know the root cause of dizziness so we treat it correctly! Treating the below causes of dizziness with a repositioning maneuver won’t get us anywhere:


  • Vestibular Neuritis

  • Labyrinthitis

  • Vestibular Hypofunction

  • Vestibular Migraine

  • Persistent Postural-Perceptual Dizziness (PPPD)

  • Meinere’s Disease

  • Mal de Debarquement Syndrome

  • Superior Semicircular Canal Dehiscence Syndrome

  • Cervicogenic Dizziness

  • Postural Orthostatic Tachycardia Syndrome (POTS)



Have you ever experienced vertigo or dizziness? Are you wondering if you have BPPV? Don't hesitate to reach out. We'd love to be a part of your recovery and find the individualized plan that’s right for you, whether it’s BPPV or another condition that’s causing your dizziness!


Please note that the thoughts and ideas presented in this article reflect the author's viewpoint unless stated otherwise. This content should not be considered as individual medical guidance. The details shared are designed to assist readers in making well-informed choices regarding their health and well-being.


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