​Benign Paroxysmal Positional Vertigo



Benign Paroxysmal Positional Vertigo is a disorder of the vestibular system, that is, the system associated with parts of the inner ear and brain that help control balance and eye movements. It is the most common vestibular disorder, leading to recurrent episodes of vertigo (a feeling of spinning of the head). The spinning sensation usually lasts for a few minutes and stops on its own, though there may be repeated episodes later.

BPPV (Benign Paroxysmal Positional Vertigo) is not associated with any serious illness, hence being called 'benign' and it is recurrent and comes and goes, and hence it is called 'paroxysmal'. Patients cannot predict when a BPPV episode will occur, leading to much frustration. However, it is not a serious disorder, with the only risk being that of the patient falling due to vertigo. Although benign paroxysmal positional vertigo can affect individuals of any age, it is more common in older people over the age of 60.

This disorder occurs due to the dislodgement of small, micro-sized calcium crystals called otoconia from their usual location, into one of the ear's semi-circular canals. When the position of the head is changed relative to gravity (such as when looking up or down, rolling over in bed, or due to any sudden head movement, head injury or tilting of the head), it triggers the otoconia to move, resulting in displacement of fluid in the semi-circular canal, leading to the sensation of spinning or vertigo. While there are no definite reasons or events which will result in benign paroxysmal positional vertigo, prolonged reorientation of the head due to certain activities or causes can act as triggers for this disease. Some of these include:​

  • Mild or severe head injury.

  • Keeping the head in a tilted position for a long time, such as while sitting on the hair dresser’s chair.

  • High intensity workouts and exercises.

  • Amusement park ride.

  • Vestibular migraines.

Besides these, viral infections, complication in an ear surgery, ear infections or medicinal side effects may also trigger the onset of this disorder​.

Vertigo or a spinning sensation is the most obvious symptom experienced by patients of benign paroxysmal positional vertigo. The symptoms are triggered by reorientation of the head against gravity due to certain activities, as mentioned above. Other symptoms that may occur are normally associated with vertigo, such as:​

  • Imbalance and unsteadiness when getting up or walking, which may even lead to falling down in some cases.

  • Nausea and vomiting.

  • Symptoms associated with motion sickness.

  • Abnormal rhythmic eye movement.​

Benign paroxysmal positional vertigo may start very suddenly, panicking patients, some of whom even think that they are experiencing a stroke. The vertigo takes place in recurrent episodes, and patients cannot predict their onset. The symptoms lessen over a period of weeks to months.​

If you frequently experience episodes of vertigo which interfere with your daily activities, or if you have experienced a severe spinning sensation resulting in a fall or nausea, consult a doctor working with the Eye, Ear, Nose and Throat​ Service Line​ at The Aga Khan University Hospital to get an expert medical opinion and guaranteed quality health care. 

Sudden problems with balance, sudden severe headache, confusion, dizziness, periodically recurring vertigo and severe nausea or vomiting must not be ignored and it is advisable to consult your doctor to discuss these symptoms. If your vertigo and nausea interfere with your normal daily activities, it demands immediate medical attention.

At The Aga Khan University Hospital the only internationally accredited hospital of Pakistan, you can be confident of receiving multidisciplinary care under one roof to help personalize a treatment plan for you. The internationally accredited staff at the Eye, Ear, Nose and Throat Service Line can provide you with professional medical advice to relieve you from discomfort associated with benign paroxysmal positional vertigo. With our commitment to quality healthcare, you can discuss your symptoms with your doctor at The Aga Khan University Hospital in complete confidence and receive personalized treatment and care.​

Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.​

Often, doctors can make an initial diagnosis for benign paroxysmal positional vertigo based on a physical examination and the patient's medical history. These involve taking a medical history to check if the typical symptoms discussed above have been experienced by the patient and observing the existence of any other symptoms, such as rhythmic eye movement or unsteadiness.

You may also be required to undergo a Dix-Hallpike test and/ or the 'roll test', which are diagnostic procedures carried out to determine if the patient is suffering from benign paroxysmal positional vertigo.

In the Dix-Hallpike test procedure, the patient's head is rotated at various degrees and then allowed to barely rest at the edge of the examining table. This triggers a strong vertigo sensation. The patient's eyes are then observed for any rhythmic movement in response to changes in the head position (called nystagmus), which confirms that the patient is suffering from benign paroxysmal positional vertigo. This test also allows to doctors identify which ear in particular is causing symptoms of the disorder.

The roll test involves rotating the patient's head on both sides and then checking for vertigo and nystagmus symptoms.

For both procedures, the doctor will particularly note if the symptoms are triggered at a certain position of the head, and observe any important characteristics associated with this condition.

For treatment of benign paroxysmal positional vertigo, a combination of different courses of action may be taken to cure your symptoms.

A number of repositioning manoeuvres are carried out as part of the treatment plan. These include the Roll manoeuvre, Epley manoeuvre, the Semont manoeuvre, and Brandt-Daroff exercises. These manoeuvres involving tilting and changing the head position to move the calcium crystals which cause this disorder in the first place. These can be carried out by a professional therapist, done by the patient at home, or a combination of both home-practised and therapist-assisted manoeuvres. In some cases, a vibrator may be used to dislodge crystals in the inner ear that lead to this disorder.

In addition, patients may also be prescribed special medications to suppress symptoms.

While surgery is also an option for treating benign paroxysmal positional vertigo, it is recommended as a very last resort by doctors due to the risks associated with neurosurgical procedures.

The highly trained staff at The Aga Khan University Hospital will ensure that your treatment plan is carried out thoroughly to provide you maximum relief from your symptoms​.

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly



The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider. ​​