Vertigo

Learn more about vertigo and how it is treated.

Overview

Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo.

It is a benign (not life-threatening) balance disorder of the inner ear that causes sudden (or paroxysmal) episodes of mild to severe vertigo.

It is called positional vertigo because it is triggered by changes to your head’s position. These positions include tipping your head up or down, lying down, turning over or sitting up in bed.

Symptoms come and go and usually last for less than a minute. Episodes can also disappear for some time and then recur.

Your care

Learn more about the care provided in the Emergency Department at Mount Sinai Hospital.

This content is intended for informational purposes only and is not intended to be used or relied upon for any diagnostic or treatment purposes. It does not replace the need for consultation with a health-care professional. Please speak with your health-care professional for questions about your health.

Symptoms

Symptoms of BPPV

The following signs and symptoms may indicate that you have vertigo:

Dizziness
Jumping eyes (known as nystagmus)
Loss of balance or unsteadiness
Nausea and / or vomiting

Causes

BPPV is caused by tiny calcium crystals, called otoconia, dislodging from their normal location in a sensory organ in the inner ear called the utricle.

These crystals then float into the semicircular canals of the ear, where they can cause shifts that lead to dizziness and nausea.

Managing at home

The most effective treatments for BPPV are physical maneuvers (movements) that reposition and remove the crystals from the semicircular canal. One of the most effective maneuvers is called the Epley maneuver.

If your right ear is the affected ear, the steps are as follows:

Sit up in bed, with a pillow behind you. Make sure there is enough room behind you to lay down. When you lay down, your shoulders should be on the pillow.
Turn your head to the right side and lie back. Stay in this position for about one minute or until your symptoms stop.
Without lifting your head, turn your head to the left side for about one minute.
Turn your whole body to the left side and continue to turn your head so your nose is pointing to the floor next to the bed for about one minute.
Sit up slowly on the left side, with your legs hanging over the edge of the bed, and tilt your head forward for about one minute.

If your left ear is the affected ear, the steps are as follows:

Sit up in bed, with a pillow behind you. Make sure there is enough room behind you to lay down. When you lay down, your shoulders should be on the pillow.
Turn your head to the left side and lie back. Stay in this position for about one minute or until your symptoms stop.
Without lifting your head, turn your head to the right side for about one minute.
Turn your whole body to the right side and continue to turn your head so your nose is pointing to the floor next to the bed for about one minute.
Sit up slowly on the right side, with your legs hanging over the edge of the bed, and tilt your head forward for about one minute.

Your health-care provider will review the Epley maneuver with you for your affected ear. Follow the guidance provided by your care team, which may include a routine of performing the maneuver three times a session, for three sessions a day until you have been symptom-free for 24 hours.

Please see the guide in the additional resources section for more information on how to perform the Epley maneuver.

When to return to the ED

Return to the Emergency Department if you experience any of the following symptoms:

New, different or severe persisting dizziness
New, different or severe headache
Fevers
Loss or change in vision
Difficulty speaking
Numbness or tingling
Leg/arm weakness or difficulty walking
Loss of consciousness
Seizures

Additional resources

These evidence-based resources provide more information about BPPV:

Benign Paroxysmal Positional Vertigo: A brochure on BPPV from our colleagues at the University Health Network.