Overview
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in adults. Vertigo is the feeling that you or the room is spinning.
Your inner ear has tiny calcium crystals that help sense movement. In BPPV, some break loose and float into the wrong part of the ear. When you move your head, they send confusing signals to your brain. BPPV isn't dangerous, but it can cause falls.
Symptoms
Spells start suddenly with head movement.
- Room-spinning sensation when you move your head
- Dizziness
- Spinning when rolling over in bed, lying down, or looking up
- Spells that last seconds to a minute or two
Less common
- Nausea or vomiting
- Loss of balance
- Feeling that things are jumping or moving
How it usually goes
- Each spell: Seconds to a minute or two.
- After the Epley maneuver: Often better right away or within days.
- Later: About half of people have it come back at some point.
When to get medical care
Causes
BPPV happens when calcium crystals in the inner ear slip into the wrong place. Often no cause is found. It can follow a head injury, even a mild bump, or an inner ear infection. It also becomes more common with age.
Does it spread or run in families?
- It isn't contagious. You can't catch it from someone else.
Who is more likely to get it
- Being older
- A past head injury
- A past inner ear infection
- Family members with BPPV
Possible complications
- Falls and head injuries: From losing balance
- Dehydration: From vomiting, if severe
Diagnosis
A healthcare professional can usually tell it's BPPV with a simple test in the office.
Questions you may be asked
- What triggers the spinning, like rolling over or looking up
- How long each spell lasts
- Hearing loss, ringing in the ears, or ear pain
- Recent head injury or ear infection
- Weakness, numbness, vision changes, or trouble speaking
The exam
In the Dix-Hallpike test, they turn your head and lay you back quickly while watching your eyes for jumping movements.
Tests
Other tests are only needed if the cause isn't clear:
- Hearing and balance tests: To check for other inner ear problems.
- Brain scan: If there are signs of a stroke or other brain problem.
Treatment
The Epley maneuver moves the crystals back where they belong. It often works quickly.
Self-care
- Sit down right away when you feel dizzy
- Get up slowly, sitting for a moment before you stand
- Avoid the head positions that trigger spinning
- After the Epley maneuver, avoid bending over for the rest of the day and don't sleep on the bad side for a few days
- Don't drive, climb, or use machines while you have symptoms
- Ask about home exercises you can do yourself
Medicines
Medicines don't fix BPPV, but can ease nausea for a short time.
| Medicine | Helps with | Good to know |
|---|---|---|
| Antihistamines for motion sickness | Nausea and spinning, short term | Cause drowsiness. Often don't work well for BPPV. Older adults are more likely to fall or get confused. |
The Epley maneuver works better than medicine for BPPV.
If BPPV keeps coming back or doesn't clear, vestibular (balance) therapy with a physical therapist can help.
How it compares
| BPPV | Inner ear inflammation | Meniere's disease | Stroke | |
|---|---|---|---|---|
| Spinning lasts | Seconds to minutes | Days | 20 minutes to hours | Constant |
| Trigger | Head movement | None; often after a cold | None | None |
| Other signs | None | Nausea, unsteady | Hearing loss, ringing, ear fullness | Weakness, trouble speaking |
| Urgency | See a doctor | Same day | See a doctor | Call 911 |
Prevention
There's no sure way to prevent BPPV, but you can lower the risk of falls:
- Move your head slowly, and get up slowly
- Use a night light and keep floors clear
- Hold onto something when standing if you're dizzy
- Wear a helmet for sports to prevent head injuries
Which doctor treats this
- Start with your primary care provider (family doctor or internist).
- They may send you to an ENT doctor (ear, nose, and throat doctor).
Children, pregnancy, and older adults
- Older adults: BPPV is common and raises fall risk. Treat it early and make your home safer.
- After a head injury: BPPV can start after even a mild bump. Get checked.
Pregnancy and breastfeeding
- If you're pregnant or planning to be, tell your prenatal provider about this condition.
- Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
- Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
- Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.
Outlook
Treatment usually cures BPPV, often in one visit. It comes back for about half of people, but can be treated again the same way.
Getting ready for your visit
Note exactly what movements set it off.
What to bring
- What triggers your spells and how long they last
- A list of medicines
- Any recent head injury or ear infection
Questions to ask
- Is this BPPV?
- Can you do the Epley maneuver today?
- Can I do exercises at home?
- What should I do if it comes back?
Research studies
Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.
Sources
Last updated 2026-11-12.