Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV)

What is BPPV?

BPPV is characterised by a sudden onset of dizziness or vertigo associated with movement of the head. Vertigo has been described as feeling like you are turning around when standing still, or the sensation of standing still within a spinning room. Symptoms most commonly occur when getting out of bed in the morning or when moving the head in a specific direction. Episodes tend to be intense and short lived, with some people also experiencing nausea. BPPV appears to come and go for no particular reason, with people experiencing attacks for a few weeks, followed by symptom free periods.

BPPV is the result of displacement of small crystals in the semicircular canals within the inner ear. The semicircular canals are sensitive to gravity and changes in head position, and are an important aspect of the body’s balance system. On slight movements of the head, the crystals over stimulate the nerves that detect rotation of the head, sending a message to the brain that the head is spinning, even though it has only slightly moved. The mismatch between perceived movement and actual movement produces symptoms of vertigo, and once the fluid within the canal and the particle cease moving, the attack settles. The posterior semicircular canal is the most commonly affected however the anterior and horizontal canals can also be involved. 

Classifications of BPPV:

  • Canalithiasis is the most common form of BPPV and occurs when the crystals move within the semicircular canal. Symptoms typically resolve within 60 seconds.
  • Cupulolithiasis occurs when the crystals adhere to the cupula, with symptoms persisting for a longer period of time.



BPPV can be easily diagnosed using subjective (verbal) and physical examination findings. Your physiotherapist will perform a test of the semicircular canals and determine if your symptoms are consistent with BPPV. Your Body Rhythm Physiotherapist will also rule out any other causes of vertigo, most of which may not be amendable to Physiotherapy and may require referral to a GP. These include:

  • Meniere’s Disease
  • Vertebral Basilar Insufficiency
  • Vestibular Neuritis
  • Labyrinthitis
  • Neurological disorders
  • Cervicogenic vertigo
  • Postural hypotension


BPPV is easily treated with techniques to reposition the dislodged crystal, with typical resolution of symptoms within 1-3 sessions. Your physiotherapist will guide you through a technique that moves the free-floating crystals to an area where it will not overstimulate the nerves in the semicircular canal. A home exercise is then prescribed to maintain the improvements from the treatment session.


BPPV is a common but easily treatable cause of vertigo with immediate improvements following Physiotherapy.

Written by Physiotherapist Jake Pemberton