Benign Paroxysmal Positional Vertigo

(BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)

Pronounced: Ba-nine Par-ox-see-mal Positional Ver-ta-go


Benign paroxysmal positional vertigo (BPPV) is a feeling of movement or spinning caused by changes in the position of the head. This might include standing after bending down, turning the head in bed, or stretching the neck to look up.


The inner ear contains tiny hairs and tiny crystals. These hairs can sense movement and help with balance. BPPV happens when these crystals shift or clump. This sends signals to the brain that makes it think a person is moving when he or she is not. This causes the feeling of movement.

Inner Ear

Inner ear deposits
The clump of ear crystals can lead to BPPV.
Copyright © Nucleus Medical Media, Inc.

In some people the cause is not known. In others, it may be caused by things like:

  • Surgery
  • Head injury
  • Reclining the head for a long time
  • Disorders of the inner ear

Risk Factors

Increased age raises your chances of getting BPPV.


Problems may be:

  • A feeling of spinning or moving when changing head position
  • Loss of balance
  • Nausea and vomiting
  • Ringing or buzzing sounds in the ear(s)
  • Vision or hearing problems


You will be asked about your symptoms and health history. A physical exam will be done. Certain tests will be done to look for signs of BPPV. This is enough to make the diagnosis.


BPPV may get better on its own in some people. In others, the goal of treatment is to manage symptoms. Choices may be:

Physical Therapy

Vestibular exercises may be given by a physical therapist. These use a series of eye, head, and body motions to get the body used to moving without a feeling of spinning.

Canalith Repositioning

A doctor or physical therapist will move the person's head in different positions to try to resettle the tiny crystals. It may be done more than once. A person may also be taught to do this at home.


Some people may need surgery if other methods do not help. A piece of wax may be used to plug one part of the ear. This will prevent fluid in the inner ear from moving. Another surgery may be done to cut the nerve from the inner ear.


There are no current guidelines to prevent BPPV.


American Academy of Otolaryngology—Head and Neck Surgery
Family Doctor—American Academy of Family Physicians Family Doctor


Canadian Academy of Audiology
Canadian Society of Otolaryngology


Benign paroxysmal positional vertigo. The Merck Manual Professional Edition website. Available at:,-nose,-and-throat-disorders/inner-ear-disorders/benign-paroxysmal-positional-vertigo?query=bppv. Updated October 2018. Accessed April 7, 2020.
Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed website. Available at: https://www.dyname... . Updated November 11, 2019. Accessed April 7, 2020.
Benign paroxysmal positional vertigo (BPPV). Family Doctor—American Academy of Family Physicians website. Available at:
...(Click grey area to select URL)
Updated November 6, 2019. Accessed April 8, 2020.
Benign paroxysmal positional vertigo (BPPV). Vestibular Disorders Association website. Available at: Accessed April 7, 2020.
You P, Instrum R, et al. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2019 Feb;4(1):116-123.
Last reviewed February 2020 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 4/8/2020

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