Vertigo and BPPV


Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo (BPPV for short) is the most common form of vertigo related to the inner ear. BPPV results in intense but brief episodes of dizziness. It can be a debilitating and frustrating condition.

The culprit of symptoms are tiny crystals of calcium carbonate within the inner ear canals. When functioning well, the different canal directions help to orient the brain by the movement of fluid within the canals. Kind of like our own internal spirit level! If these particles dislodge from their reservoir and travel within the ear canal fluid, nerve endings are stimulated telling the brain that we are rotating or moving our head when in fact we aren’t!

Conflicting information from the ears and eyes to our brain results in a feeling of spinning on a playground round about. Nausea during or between vertigo attacks is a common symptom.


For many cases there is no known cause of BPPV onset, though some causes do include:

  • head injury
  • age related degenerative changes to the inner ear (wrinkles on the inside!)
  • damage caused by an inner ear disorder

As there are many other causes of dizziness within the body (such as blood pressure or glucose irregularities), assessment and advice from a primary health care practitioner is important.


Usually BPPV symptoms are triggered by certain positions. These most commonly include:

  • bending over to pick something up
  • laying down in bed
  • rolling over in bed
  • looking up (sometimes known as top-shelf vertigo)

Symptoms can reduce very quickly by remaining still and not repeatedly moving in a manner that provokes symptoms.


Your GP may be the first port of call, and can help to prescribe anti-metic drugs to help with nausea symptoms. They may refer you to a physiotherapist, to help perform what is known as the ‘Epley manoeuvre’. This sequence of movements can be incredibly helpful in re-locating the inner ear particles away from the sensitive ear canals.

A physiotherapist will guide you through this complex movement and help achieve the best result possible. After-care advice is important and can help improve the chances of success.

After your treatment

Often one session is all that is needed to resolve vertigo symptoms.

In other cases, the particles can be VERY easy to stir up again, simply due to our active lifestyles! It is often advised to avoid the above ‘trigger’ movements for 24 – 48 hours after performing the Epley manoeuvre. Wearing a soft collar can help to avoid these movements and act as a gentle reminder. Avoid ‘testing out’ aggravating movements within 24 hours, this will simply re-start the process. It is also recommended to sleep semi-reclined for a few nights (propped up with pillows or in a recliner) until the particles have settled.

If you would like help with this condition from one of our physiotherapists, contact us here. No referral is necessary!