What is Beingn Positional Vertigo?

Benign Positional Vertigo or Benign Paroxysmal Positional Vertigo is a conditions characterized by feeling dizziness brought on by sudden head movement. You may feel that everything around you is spinning. This feeling is called “vertigo”. You may also feel nauseous with that.

It is thought to be caused by debris which has collected within a part of the inner ear. This debris are small crystals of calcium carbonate derived from a structure in the ear called the “utricle”. Normally, these particles are distributed evenly in the inner ear 3 canals. When you move your head, the calcium particles stimulate nerve cells inside the canals. These cells send your brain a signal telling it what direction your head is moving.

However, the particles can break loose and clump together forming a debris in one of the canals. When this happens, the nerve cells tell your brain that your head has moved more than it actually has. This incorrect signal results in vertigo.

How it is treated?

The most common manuevre to treat BPPV is Epley maneuver. It is usually performed in the doctor’s office. If done correctly, it has a very high success rate(approximately 85-90%).

The Epley maneuver is also called the particle repositioning, canalith repositioning procedure, and modified liberatory maneuver. It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

Epley maneuver steps (1):

  • Have the patient sit upright on the gurney with the head turned 45° to the affected side (this was predetermined using the Hallpike test). Make sure the patient is sitting far enough back in the gurney so that the head will hang over the edge of the gurney when the patient is laid back. Make sure the guardrail on the opposite side has been lowered (the patient will eventually sit up so his or her legs overhang the edge of the gurney).
  • Place your hands on either side of the patient’s head and guide the patient down with the head dependent (as in the Hallpike test).
  • Rotate the head 90° to the opposite side with the patient’s face upward and be sure to maintain the head-dependent position (head is hanging over the edge of the gurney).
  • Ask the patient to roll onto his or her side while holding the head in this position and then rotate the head so that it is facing downward (tell the patient to look to the ground).
  • Raise the patient to a sitting position while maintaining head rotation (This author finds that sitting the patient up so that he or she is sitting with his legs hanging over the edge of the gurney is easier. This is why the side guardrails need to be lowered before the procedure is started).
  • Simultaneously rotate the head to a central position and move it 45° forward.

You CAN WATCH the VIDEO here or here.


  1. Benign Positional Vertigo – eMedicine.com
  2. Dizziness and Vertigo – Medlineplus.gov

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