Benign Positional Vertigo

Benign positional vertigo (BPV; AKA benign paroxysmal positional vertigo or BPPV) is a common cause of dizziness characterized by sudden onset of dizziness with position change that resolves in 20-30 seconds.

Clinical presentation of benign positional vertigo

  • Presents with complaints of lightheadedness, dizziness, vertigo, and nausea
  • Symptoms precipitated by changes in head position (eg, rolling over in bed or looking up)
  • 50% of dizziness in older people due to BPV
  • Thought to be caused by displaced utricular otoconia in semi-circular canals
  • Most common is posterior canal BPV: reclining or head extension causes vertigo (“top-shelf vertigo”)

Dix-Hallpike maneuver for diagnosis of BPV

  • Upward nystagmus when patient is reclining (head extended back 20◦ and tilted at 45◦)
  • Downward nystagmus when sitting up


Canalith repositioning procedure as treatment for benign positional vertigo

  • “The Epley maneuver”
    • Usually a definitive treatment (~80% success)
  • Brandt-Daroff exercises
    • Similar to Epley maneuver
    • Patient lies down on side
    • Head tilted 45◦ for 30s
    • Switches to the other side

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About the Author: Jeffrey Waggoner MD