Sydney Headache & Migraine Centre

What Is Benign Paroxysmal Positional Vertigo (BPPV)

The most common form of vertigo is a condition called Benign Paroxysmal Positional Vertigo (BPPV).  It causes short episodes of dizziness after moving your head in certain positions. Although the dizzy spells are short lasting, they can be quite debilitating, impacting your ability to move, drive and work.

Benign: not dangerous or likely to have a lasting effect

Paroxysmal: rapid, short frequent symptoms

Positional: dependent of change in head position in relation to gravity

Vertigo: abnormal sensation of spinning – the room or self

The inner ear is made up of the cochlea (hearing) and vestibular apparatus (balance). It is very well protected in the bony part of our skull. It is fluid-filled with a delicate membranous system.

Moving our head makes the fluid flow through semicircular canals. It pushes on and bends the hair cells at the end of the canal. This enables the brain to detect direction and speed of head movement. 


The inner ears control our eyeball muscles so we can stabilise our gaze during head movement. If we have an inner ear dysfunction this reflex to control our eyes is disturbed. The eyes are no longer held steady, instead they flicker. We call this nystagmus. It gives us the illusion that the room or our head is spinning. This is what we call vertigo.

To understand BPPV, let’s take an even closer look at the inner ear. There are five balance organs: 

Two structures, called the saccule and utricle, sense linear movements our head makes and are gravity sensitive. 

Three semicircular canals, (anterior or superior, posterior and horizontal canals), detect any angular movements our head makes. 

BPPV occurs when small calcium carbonate crystals, which are usually attached to the membrane, become loose and migrate into one of the semicircular canals. This happens when we move our head in relation to gravity. The cause of the crystals becoming loose is mostly unknown. It can be a virus, a bump to the head, or other pathology in the area, but mostly it happens for no known reason. 

BPPV can occur when lying back in bed, rolling over in bed, bending over in the garden, looking up into a high cupboard, leaning over to unpack the dishwasher or when we move our head in other ways, in relation to gravity. 

Vertigo typically lasts 10-15 seconds when the crystals are moving in the canal. Once the crystals settle the vertigo stops. 

The good news is BPPV can be treated effectively by qualified Vestibular Physiotherapists. Sydney Concussion Centre practitioners treat the BPPV with particle repositioning manoeuvres.  We have specialised infra-red goggles that watch abnormal eye movements of your eye in the dark. We lie you back, with head turned slightly to the right or left, and detect which canal the crystals are loose. We then turn and roll to the opposite side to bring the crystals back in to the sensory organ where they should be. 

BPPV can occur again but do not limit your activities to avoid it coming back. Get back to normal movement as soon as possible to avoid any neck stiffness or pain. If it does recur prompt treatment is important. 

Appointments for BPPV can be made by clicking on the link below:

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