Benign paroxysmal positional vertigo (BPPV)
BPPV is the most common cause of vertigo, produced by displaced otoconia in a semicircular canal, most often the posterior canal, and is diagnosed at the bedside with the Dix-Hallpike maneuver and treated first-line with the canalith repositioning (Epley) maneuver rather than medication.
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What this article covers
- Overview
Peripheral vestibular disorder from displaced otoconia: benign paroxysmal positional vertigo (BPPV) is caused by displacement and migration of otoconia (calcium carbonate crystals) within a…
- Epidemiology
Lifetime prevalence of 2.4%, making BPPV the most common form of vertigo encountered clinically.
- Risk factors
Head trauma: a documented precipitant, presumed to dislodge otoconia into a semicircular canal.
- Pathophysiology
Otoconial displacement from the utricle: otoconia (calcium carbonate crystals) normally embedded in the utricular macula become dislodged and migrate into a semicircular canal.
- Clinical features
Sudden-onset, recurrent, brief vertigo (usually less than 1 minute) provoked by head position change: classic triggers include rolling over in bed, getting in and out of bed, and reaching overhead or looking up.
- Differential diagnosis
Vertebrobasilar stroke (most dangerous): spontaneous, usually sustained vertigo that may worsen with positional change; a normal head impulse test in an acutely vertiginous patient is a red flag for…
- Diagnosis
BPPV is a clinical diagnosis confirmed by a positive Dix-Hallpike maneuver, the diagnostic test of choice: with the patient sitting, the head is turned 45 degrees toward the tested side, then the…
- Management
First, perform the canalith repositioning (Epley) maneuver on the affected side; this is first-line treatment, not medication, and is effective in up to 85% of patients.
- Complications
Falls and fall-related injury: disorientation and imbalance during recurrent spells are a recognized driver of falls and functional decline, particularly in older adults.
- Prognosis
Canalith repositioning is effective in up to 85% of patients with a single or repeated Epley maneuver.
- Prevention
No dietary or pharmacologic prophylaxis is established for otoconial displacement itself; prevention centers on early recognition and repositioning to shorten the symptomatic period.
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