What Causes Vertigo?

Benign paroxysmal positional vertigo, abbreviated BPPV, is the most common inner ear problem and cause of vertigo (a false sense of spinning). It is more common in older people. Many of us will experience BPPV at some time in our lives.

BPPV is a specific diagnosis, and each word describes the condition:

What Causes BPPV?

Most cases of BPPV happen for no reason. It can sometimes be associated with trauma, migraine, other inner ear problems, diabetes, osteoporosis, and lying in bed for long periods of time.

We have crystals of calcium carbonate in our inner ear that help us with our balance and body motion. These tiny rocklike crystals, or “otoconia”, are settled in the center of the inner ear. BPPV is caused by the crystals becoming “unglued” from their normal place. As they float around, they can get stuck on sensors in the wrong part or the wrong canal of the inner ear. BPPV symptoms are caused by the crystals being out of position.

The most intense part of BPPV symptoms relate to how long it takes the crystals or sensors to settle down after you move or change your head or body position. As the crystals move and settle in your inner ear, your brain is getting these (false) messages telling you that you are spinning, when all you may have done is lie down or roll over in bed.  

What Are Common Symptoms of Vertigo?

Everyone will experience BPPV differently, but there are common symptoms:

• Distinct triggered spells of vertigo or spinning sensations
• Nausea (sometimes vomiting)
• Severe feeling of disorientation in space or instability

These symptoms will be intense for seconds to minutes. In some people, especially seniors, BPPV can seem more like an isolated feeling of instability that happens when changing body or head position. Sitting up, looking up, bending over, and reaching can trigger this feeling. BPPV does not cause constant severe dizziness and is usually triggered by movement. BPPV does not affect your hearing or cause you to faint. The dizziness episodes related to BPPV can increase your risk of falling.

How Is Vertigo Diagnosed?

Health care providers diagnose BPPV through a physical examination and review of your medical history. Normal medical imaging, such as scans and x-rays, or medical laboratory testing cannot confirm BPPV. Your health care provider or examiner will complete simple bedside testing to help to confirm your diagnosis. The bedside testing requires the examiner to move your head into a position that makes the crystals move, and it will make you dizzy. The testing may include hanging your head a little off the edge of the bed or rolling your head left and right while lying in bed. The examiner will be watching you for a certain eye movement to confirm your diagnosis.

How Do You Treat for Vertigo?

Medications may be used for the relief of immediate distress, such as nausea, but not for BPPV itself. Most BPPV cases can be corrected with repositioning procedures that will be performed bedside by your provider. These treatments usually take only a few minutes to complete. They have high success rates (around 80%), although sometimes the treatment needs to be repeated a few times.

These repositioning treatments (referred to as “maneuvers”) are designed to guide the crystals back to their original location in your inner ear. You may be treated during the same office visit when the diagnosis testing is performed. You might be sent to a health professional (medical provider, audiologist, or physical therapist) who can perform these maneuvers, especially if any of the following apply:

• You have severe disabling symptoms.
• You are a senior with history of past falls or fear of falling.
• You have difficulty moving around, such as joint stiffness (especially in your neck and back) and/or weakness.

You can also be taught to perform these maneuvers by yourself with supervision, which is called “self-repositioning.” Discuss learning these maneuvers with your health care provider.

Does Vertigo Go Away on Its Own?here is evidence that if BPPV is left untreated, it can go away within weeks. The natural course of BPPV is to become less severe over time. People will often report that their very first BPPV spinning episode was the worst and the following episodes were not as bad. However, remember that while the crystal is out of place, in addition to feeling sick and sensitive to motion, your unsteadiness can increase your risk for falling. You will need to take precautions not to fall. You are at a higher risk for injury if you are a senior or have another balance issue. Seniors are encouraged to seek professional help quickly to resolve symptoms.

How Long Will It Take before I Feel Better?

During the BPPV treatment, you may experience brief distress from vertigo, nausea, and feelings of disorientation. After treatment, some people report that their symptoms start to clear right away. Others report that they have continuing motion sickness–type symptoms and mild instability. You can still feel a little bit sensitive to movement even after successful treatments for BPPV. These symptoms can take a few days to a few weeks to slowly go away. Once your symptoms are slowly going away, it is important to return to normal activities that you can do safely. Exposure to motion and movement will help to speed your healing. You should discuss these activities with your provider. Seniors with a history of falls or fear of falling may need further exercises or balance therapy to clear BPPV completely.

Can Vertigo Come Back? Can I Prevent It?

Unfortunately, BPPV is a condition that can sometimes return. Your risk for BPPV returning can shift from low risk (few experiences in your lifetime) to a higher risk, which is often caused by some other factor, such as trauma (physical injury), other inner ear or medical conditions, or aging. Medical research has not found any way to stop BPPV from coming back, but it can be treated with a high rate of success. It is very important to follow-up with your health care provider if you continue to have symptoms. You may be sent for further testing to confirm your diagnosis and/or discuss other treatment o