Feeling Dizzy? Understanding the Causes and Symptoms of BPPV.
Selena O’Dwyer – Physiotherapist
Have you ever felt like the world is spinning when you move your head, or struggled to regain your balance after a sudden dizzy spell? If so, you’re not alone — these dizzy vertigo sensations might be caused by a common condition called BPPV (Benign Paroxysmal Positional Vertigo).
BPPV occurs when calcium carbonate crystals (otoconia) dislodge from the inner ear and move into one of the semicircular canals. This interferes with the normal flow of fluid in the canals. When this flow is altered, the brain receives conflicting signals, leading to symptoms of dizziness and vertigo.
What are the symptoms of BPPV?
BPPV presents with the following symptoms:
Sudden, brief episodes of vertigo (dizziness): Often triggered by specific head movements such as turning in bed, looking up, or tilting the head.
Nausea or imbalance: These feelings accompany the spinning sensation during episodes.
Short duration: Episodes typically last less than a minute but can be intense.
What are the causes of BPPV, and WHY does it happen?
The exact cause of BPPV isn’t always clear, but certain factors increase the risk:
Age
BPPV is most common in older adults, particularly those aged 50 and above. As we age, the structures of the inner ear, including the otoconia, can become more prone to degeneration or dislodging, making older adults more susceptible to BPPV.
The risk of developing BPPV increases as the elasticity of the inner ear structures declines with age.
Vestibular Conditions & Infections
Vestibular neuritis and labyrinthitis are conditions caused by infections that affect the vestibular nerve or the inner ear, leading to balance issues, vertigo, and sometimes hearing loss. After recovery from these infections, BPPV can sometimes develop due to the damage to the inner ear structures.
Viral Infections
Viral infections (e.g., upper respiratory or ear infections) can lead to inflammation that affects the vestibular system. Sometimes, the inflammation or the healing process results in changes to the inner ear, making it more prone to BPPV.
Head Trauma
Head trauma (such as a concussion or whiplash) can cause displacement of the otoconia, leading to BPPV. A blow to the head, a fall, or even a car accident can increase the risk of developing BPPV, particularly if the trauma involves the cervical spine or the inner ear structures.
Post Surgical
BPPV can sometimes develop after a surgical procedure, especially those involving the head, neck, or ear. Surgeries like cataract surgery, spinal surgery, or any surgery that affects head position or involves head manipulation during recovery can potentially trigger BPPV.
Prolonged bed rest after surgery or illness may also contribute to BPPV by affecting the position of the otoconia.
Migraines
People who suffer from migraines or vestibular migraines may have an increased risk of developing BPPV. It’s not fully clear why, but both conditions involve disturbances in the vestibular system, and people with migraines may have a more sensitive vestibular system, which could predispose them to the dislodging of otoconia.
Vestibular migraine can cause episodic vertigo and balance disturbances, which sometimes overlap with the symptoms of BPPV.
BPPV is most common in older adults, particularly those aged 50 and above. As we age, the structures of the inner ear, including the otoconia, can become more prone to degeneration or dislodging, making older adults more susceptible to BPPV.
The risk of developing BPPV increases as the elasticity of the inner ear structures declines with age.
What are some other causes of dizziness you should know about and how is it diagnosed?
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Labyrinthitis (Vestibular Neuritis): Prolonged vertigo with nausea, not triggered by head movement.
Meniere’s Disease: Episodic vertigo, hearing loss, and tinnitus.
Vestibular Migraines: Vertigo linked with headache and light sensitivity.
Central Vestibular Disorders: Stroke or transient ischemic attack (TIA) can mimic BPPV but often includes other neurological symptoms.
Orthostatic Hypotension or POTS: Dizziness upon standing due to blood pressure changes.
Cervicogenic Dizziness: Dizziness caused by neck issues.
Multiple Sclerosis (MS): MS can affect the vestibular system and present with vertigo, imbalance, and visual disturbances, often in episodes.
Anxiety or Panic Disorders: Anxiety can cause symptoms of dizziness or lightheadedness, sometimes mistaken for vertigo. Panic attacks may also cause a feeling of dizziness, shortness of breath, and racing heart, which may be confused with vertigo.
Diagnosis of BPPV typically involves a combination of clinical assessment, a detailed medical history, and a series of diagnostic tests completed by our Physiotherapist Selena O’Dwyer.
Selena will also ask you about your symptoms, history and perform a physical examination to assess your vestibular system. The success rate for BPPV treatment is high, often resolving symptoms after just one or two sessions with our physiotherapist.
