Benign Paroxysmal Positional Vertigo

Terry D. Fife, M.D.


Semin Neurol. 2009;29(5):500-508. 

In This Article

Abstract and Introduction


Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and has a lifetime prevalence of 2.4% in the general population. Benign paroxysmal positional vertigo is caused when calcium carbonate material originating from the macula of the utricle falls into one of the semicircular canals. Due to their density relative to the endolymph, they move in response to gravity and trigger excitation of the ampullary nerve of the affected canal. This, in turn, produces a burst of vertigo associated with nystagmus unique to that canal. Recognition of this condition is important not only because it may avert expensive and often unnecessary testing, but also because treatment is rapid, easy, and effective in >90% of cases. Two well-established methods of treating BPPV are discussed and explained in this article along with a brief discussion of the most commonly used method for treatment of horizontal canal BPPV. Recurrence rates approach 50% in those followed for at least 5 years.


Benign paroxysmal positional vertigo (BPPV) is a common clinical disorder characterized by brief recurrent spells of vertigo often brought about by certain head position changes as may occur with looking up, turning over in bed, or straightening up after bending over. The Dix-Hallpike maneuver induces vertigo and a burst of nystagmus with characteristic directional features that permit localization to the affected side and the affected semicircular canal in most cases.

Benign paroxysmal positional vertigo is an important cause of vertigo with a prevalence of 11 to 64 per 100,000 and a lifetime prevalence in general practice of 2.4%.[1–3] In one study, 9% of elderly patients that underwent a comprehensive evaluation for nonbalance-related problems were found to have previously unrecognized BPPV.[4] Delays in the proper diagnosis and treatment of this condition are still common,[5] and can lead to unnecessary costs and limitations of function.[3,6]

The importance of recognizing this condition is underscored by the ease and effectiveness of treatment techniques that eliminate symptoms and the need for expensive testing.[7] The pathophysiologic mechanisms that underlie this condition will be reviewed, as well as the clinical features of BPPV that allow its diagnosis, and the effective methods for treating BPPV.