The term “vertigo” refers to the feeling that you or the outside world is spinning or tilting while, in fact, you are not moving. Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of short-duration true vertigo. BPPV originates in the inner ear when tiny crystals called otoconia become dislodged and float into the semicircular canals, three interconnected tubes in the inner ear that sense head rotations. The otoconia normally provide information about gravity and motion (linear acceleration), but when they are dislodged into the balance canals, your brain receives false information from the ear about where your head is positioned in space. The vertigo typically lasts for less than a minute and begins a few seconds after moving your head into a side-tilt position. Nausea, vomiting or nystagmus (abnormal rhythmic eye movements) may accompany the sensation of vertigo.
BPPV is triggered by a variety of activities, but changing position of the head is always involved. For example, vertigo may be initiated by rolling over in bed, looking up at a kitchen cabinet or bending down while looking forward. BPPV is most common in people over age 60, but can also occur in younger people, especially following a head injury. BPPV may be intermittent, where the symptoms last for a few days to a few weeks, disappear for a while, and then return.
Because BPPV can go away on its own, observation is one treatment option. Most commonly, however, the Epley canalith-repositioning maneuver is performed in order to move otoconia back into the place where they originated. The head is moved slowly through several positions and held in each position for about 30 seconds. Using medications to treat this type of vertigo is not recommended; however, medications to treat nausea may be prescribed. Approximately five percent of BPPV patients will require surgical intervention (semicircular canal plugging) to resolve their symptoms.