What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) mainly occurs in people over the age of forty and is the most common cause of vertigo. BPPV causes short periods of vertigo when the head is moved in different positions. It is due to crystal fragments (otoconia) from the inner ear being dislodged into the canals causing inaccurate messages being sent to the brain. BPPV usually resolves on its own, however, in some cases it can last a long time.  

We have specialist vestibular physiotherapists that can provide you with a comprehensive assessment and treatment of BPPV.

What causes benign paroxysmal positional vertigo?

The reasons behind BPPV are not known although it is more common as individuals get older. Other explanations include:

Injury to the ear

Ear infection/ virus

Head injury

Women are more likely to experience BPPV

What are the symptoms of benign paroxysmal positional vertigo?

Possible symptoms of BPPV include:

Spinning sensation



Symptoms of vertigo when rotating your head, looking down and looking up

Involuntary eye movements (nystagmus)


Problems when standing still or walking

How is benign paroxysmal positional vertigo diagnosed?

Your physiotherapist will take a history of your symptoms and complete a full vestibular examination. A collection of specialised positional tests will be performed that will help to identify BPPV these involves lying a patient down on a plinth with their head turned. These can cause the symptoms to be reproduced for a few seconds which is unpleasant but will mean that effective treatment of BPPV can be achieved.

What physiotherapy will be used to treat benign paroxysmal positional vertigo?

Physiotherapy may include:

The Epley Manoeuvre: this is a technique aimed at moving the crystals which are disrupting the vestibular system, to areas which will not cause any symptoms. Four specific movements are carried out to try and move the crystals

Home exercise programme to help mobilise the crystals

Balance retraining exercises

Neck mobilisations

Education about BPPV and its management