Benign Paroxysmal Positional Vertigo (BPPV)

By Physio Caitlin.

Feeling dizzy?

Did you know that physio can help with sudden onset dizziness?

Physio Caitlin is trained in treatment of BPPV – Benign Paroxysmal Positional Vertigo. Think that sounds complex? – let’s break it down so it makes more sense:

Benign – it is not life-threatening

Paroxysmal – it comes in sudden, but brief spells – usually lasting between 10-30 seconds (although some variations can last a little longer)

Positional – it gets triggered by certain head positions or movements like looking up or down

Vertigo – it gives the sufferer a false sense of movement – like everything is spinning

BPPV is the single most common cause of dizziness in adults. It occurs more often in women than men and will more commonly affect those between 50 and 70 years old.

50-70% of cases are idiopathic – which means there is no known cause, but it does occur more frequently amongst those who:

  • Have had a recent head injury
  • Suffer migraines
  • Have diagnosed osteoporosis or osteopenia,
  • Vestibular neuritis,
  • Or other disorders of the inner ear such a Meniere’s or Labyrinthitis

The vestibular system is a complex little place, located within the inner ear and are basically the motion sensors of your body.



Within the inner ear – we can separate the organs into the Semicircular canals, the otolith organs, and the cochlea. The cochlea is responsible for your hearing, and the semicircular canals and otolith organs are responsible for your balance. The yellow parts are the nerves going from these organs to the brain to be processed.


The semicircular canals are full of fluid and tiny little hairs. When you move your head, the fluid moves along with gravity and the little hairs move along as well. It is these little hairs that send messages to your brain to tell you where you are in space.  The otolith organs do a very similar job, but they also contain heavier crystals called ‘otoconia’. These crystals send message about positions you are spending more time in – like lying on your side or sitting upright.

So to make sense of it, you can generally say that your semicircular canals sense more of your movement to keep you balanced when you turn your head suddenly, or are playing sport, where as your otolith organs will sense what position you are when you are still.

So… next question… Where does it all go wrong?

When you are suffering from BPPV, the crystals that are supposed to be in your otolith organs have dislodged and moved into the semicircular canals. Since they are not supposed to be in there – the messages from your nerves in the semicircular canals get very confused and start relaying the wrong messages to your brain. As the problem is usually only one sided – you can imagine one ear is telling the brain one thing, but the other side is saying something completely different – it is going to be really hard for the brain to organise your balance.

How can physio help BPPV?

Physio’s are highly trained in movement and have a very good eye for detail, which makes us the perfect professional to help treat BPPV.

Assessment of someone with BPPV involves firstly a lot of questions to work out what positions aggravate you the most, followed by tests involving movement to diagnose which canal is most affected.

Treatment will then involve slowly moving you head from one position to another to enable the crystals to exit the canals. It is usually effective and provides instant relief and improvement over the next 24 hours. Usually BPPV will only take 1-3 sessions to treat.

What else can I do to help my BPPV?

Medications – Your Doctor may prescribe a medication to help relieve the symptoms of BPPV such as the dizziness or nausea (i.e. Serc/Stemetil). These will help you feel better, but probably won’t treat your symptoms entirely. NOTE: It is important if you are seeking physio treatment for BPPV that you avoid taking these medications on the day of the appointment as it can make testing difficult to perform properly therefore making it harder for the physio to work out what treatment will be most beneficial.

Avoid fast movements of the head, move slowly, avoid driving and contact Vital Core physio for an appointment as soon as possible.

After your physio appointment:

  • It is ideal to stay upright for the remainder of the day,
  • To avoid sleeping on the affected side, and
  • To sleep with a thin extra pillow under your head.
  • Continue to avoid sudden quick movements

Your Vital Core physio may choose to give you a specific home exercise to help with BPPV treatment if it is required.

You may also require follow up physiotherapy treatment for neck pain/tightness. Your neck muscles often get tight with vertigo as they are trying to reduce the amount of movement of the head. Commonly massage and trigger point release will be effective.

So if you or someone you love is suffering from BPPV, please come and see us here at Vital Core Physio so we can help get you back to living your best life.