Benign paroxysmal positional vertigo, or BPPV, is a common inner-ear condition that causes brief episodes of spinning dizziness after certain head movements. It occurs when tiny calcium carbonate particles move into a semicircular canal and send misleading movement signals to the brain.
Typical symptoms
- Sudden spinning when turning over in bed
- Vertigo when lying down, sitting up, looking upward or bending
- Episodes that usually last less than one minute
- Nausea, imbalance or lingering unsteadiness
Hearing loss, continuous severe vertigo and neurological symptoms are not typical of uncomplicated BPPV and need further assessment.
Diagnosis
A trained clinician can diagnose BPPV using positional tests such as the Dix-Hallpike or supine roll test. The test aims to reproduce symptoms and identify characteristic involuntary eye movements. Determining which ear and canal are affected is important because treatment manoeuvres differ.
Treatment
A canalith repositioning manoeuvre, such as the Epley manoeuvre, moves the particles out of the affected canal and is often effective. It may need to be repeated. Medicine can reduce severe nausea but does not correct the underlying problem.
Do not perform an unsupervised repositioning manoeuvre for a first episode or when the diagnosis and affected side are uncertain. Some manoeuvres may be unsuitable for people with significant neck, back, vascular or eye problems. A clinician or vestibular physiotherapist can provide safe individual instruction.
Safety and recurrence
Move carefully during active vertigo and avoid driving, ladders or other hazardous activities. BPPV can return, and a previously taught home manoeuvre may then be useful if symptoms are identical. Persistent imbalance may benefit from vestibular rehabilitation.
When to seek urgent help
Call emergency services for dizziness with facial drooping, one-sided weakness or numbness, difficulty speaking, severe new headache, inability to walk, fainting, chest pain, double vision or persistent vomiting. Seek medical review for a first episode, after head injury, with new hearing loss, or when symptoms are continuous or do not improve.
Sources
Reviewed: 28 August 2026