Conditions we treat
Benign Paroxysmal Positional Vertigo (BPPV)
The most common cause of vertigo — and one of the most treatable.
What Is BPPV?
Your inner ear contains tiny calcium crystals that help your brain sense movement and gravity. In BPPV, some of those crystals come loose and drift into one of the inner ear's fluid-filled balance canals, where they don't belong. When you move your head a certain way, the displaced crystals shift the fluid and send your brain a false, brief signal that the world is spinning.
That's why BPPV vertigo is so specific: it's triggered by changes in head position, it comes on suddenly, and it usually passes within a minute. It's called "benign" because it isn't dangerous and "paroxysmal" because it comes in short bursts — but anyone who's had it knows there's nothing minor about how it feels.
BPPV becomes more common with age, and it frequently appears after a concussion, head injury, or whiplash. It's often overlooked — many people live with it for months, assuming nothing can be done, when it can usually be corrected quickly.
What BPPV Feels Like
Most people describe symptoms like:
- "The room spins when I roll over in bed."
- "I look up and suddenly everything whirls."
- "Bending down to tie my shoes sets it off."
- A short, intense burst of spinning that fades after a few seconds to a minute
- Nausea or queasiness after an episode
- Feeling off-balance or "wobbly" between episodes
- A wave of dizziness when lying down or sitting up quickly
Common triggers include rolling over in bed, lying down, sitting up, looking up to a high shelf, or bending forward.
Why Vestibular Physical Therapy Is the Right Treatment
BPPV is a mechanical problem — crystals in the wrong place — so it needs a mechanical solution. It doesn't respond to medication. Drugs like meclizine may blunt the dizzy feeling, but they don't move the crystals back, and they can actually slow recovery by masking the very symptoms needed to pinpoint the problem.
The recommended treatment is a canalith repositioning maneuver: a precise, guided series of head and body movements that uses gravity to float the crystals back to where they belong. Performed correctly, it's remarkably effective, and clinical practice guidelines recommend it as the first-line treatment for BPPV.
The catch is precision. There are several balance canals, and BPPV can occur in any of them — sometimes more than one at once. The correct maneuver depends entirely on which canal is involved, and on which side. A trained vestibular therapist first identifies exactly where the loose crystals are, then performs the specific maneuver that matches. That's the difference between guessing with a video at home and treating the actual problem.
What to Expect in Treatment
Evaluation. Your visit starts with a conversation about your symptoms and history, then positional testing — most often the Dix-Hallpike test, where your therapist guides your head and body into specific positions to provoke (and observe) the telltale eye movements called nystagmus. Infrared video goggles may be used to see eye movements that aren't visible to the naked eye, improving accuracy.
A note on testing: the positional tests are designed to briefly reproduce your dizziness. It can be uncomfortable for a few seconds, but it's how we confirm exactly which canal is involved — and it passes quickly.
Treatment. Once the involved canal is identified, your therapist performs the matching repositioning maneuver. Many people feel noticeably better right away.
Follow-up. BPPV often resolves in one or two visits. Your therapist will recheck to confirm the crystals have cleared, give you simple after-care guidance, and address any lingering unsteadiness or motion sensitivity that can remain once the spinning is gone.
Benign Paroxysmal Positional Vertigo (BPPV) FAQ
How many visits will I need?
BPPV frequently resolves in just one or two visits, though some cases need a few follow-ups — especially if more than one canal is involved or symptoms recur.
Will the treatment make me dizzy?
Briefly, yes. Both the testing and the repositioning maneuver can trigger short-lived dizziness. It's expected, closely monitored, and usually settles within seconds to minutes.
Can BPPV come back?
It can. BPPV recurs in some people, particularly after a head injury or with age. The good news is that it's just as treatable the second time — and we'll teach you what to watch for and what to do if it returns.
Do I need an MRI or other imaging first?
For classic BPPV, imaging usually isn't necessary — the diagnosis is made through positional testing. If your evaluation turns up anything that doesn't fit the typical pattern, we'll help coordinate appropriate medical follow-up.
Can't I just do the Epley maneuver from a video at home?
Sometimes home maneuvers help, but they assume you know which canal and which side are affected — and using the wrong maneuver can move crystals into a different canal and make things worse. A quick, accurate evaluation takes the guesswork out and tends to resolve things faster.
Do I need a referral to be seen?
No. You can book directly.