WHAT IS BPPV?

DO YOU SUFFER FROM SUDDEN DIZZINESS WHEN YOU MOVE YOUR HEAD?

If you’ve ever felt the room spin when you roll over in bed, look up, or tilt your head, you might be experiencing BPPV, or Benign Paroxysmal Positional Vertigo. Despite the long name, it’s a common and usually treatable cause of dizziness.

COMMON SYMPTOMS

• Short bursts of spinning or vertigo
• Nausea or feeling unsteady
• Eye movements called nystagmus

RISK FACTORS

Some factors can make you more likely to develop BPPV:

• Age: BPPV is more common in people over 50, as inner ear structures can become more fragile with age
• Head injury: Even a mild bump can trigger BPPV, such as from sports injuries, car accidents, falls, or dental trauma
• Inner ear problems: Conditions like ear infections or labyrinthitis can affect the inner ear and increase the risk
• Prolonged bed rest: Long periods lying down, for example after surgery or illness, can allow crystals to shift
• Other health conditions: Migraines or certain neurological conditions may make BPPV more likely
• Previous BPPV: Once you experience BPPV, you are more likely to develop it again in the future

HOW PHYSIOTHERAPY CAN HELP

Physiotherapists use gentle, specific head and body movements, called repositioning manoeuvres, to guide the crystals back where they belong. The Epley manoeuvre, a type of canalith repositioning procedure, is one of the most studied and widely used techniques in clinical practice.

We will often send you home with simple self-treatment exercises, so you can continue your progress between appointments. These exercises can help speed recovery and reduce the chances of BPPV returning.

EVIDENCE FROM RESEARCH 

• A Cochrane systematic review found strong evidence that the Epley manoeuvre is safe and effective for treating posterior canal BPPV, leading to significant symptom resolution and conversion of positive diagnostic tests to negative compared with sham or control treatments (Hilton & Pinder, 2014).
• A systematic review and meta-analysis confirmed that the Epley manoeuvre significantly reduces vertigo symptoms in both primary-care and specialist settings (Saishoji et al., 2023).
• Another review of randomised controlled trials showed that Epley’s manoeuvre leads to significant improvements in dizziness, nystagmus, and quality of life for people with BPPV (PubMed, 2009).
• Observational studies in physiotherapy practices show most people are symptom-free after 2–3 physiotherapy sessions involving repositioning and vestibular exercises (Brandt & Daroff).

TIPS FOR MANAGING BPPV AT HOME 

• Move slowly and avoid sudden head turns
• Sleep with your head slightly elevated
• Avoid looking up or tilting your head for long periods
• Perform your physiotherapist’s home exercises as instructed

Most people see improvement within just a few sessions. If dizziness is affecting your daily life, getting assessed by a physiotherapist is the first step to feeling steady and confident again.

BOTTOM LINE

BPPV may be common, and it can recur, but it does not have to control your life. With the right assessment, evidence-based treatment, and home exercises, you can get back to moving freely without the room spinning around you.

REFERENCES

Hilton, M. P., & Pinder, D. K. (2014). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo (BPPV). Cochrane Database of Systematic Reviews, (12). https://www.cochrane.org/evidence/CD003162_epley-manoeuvre-benign-paroxysmal-positional-vertigo-bppv

Saishoji, Y., Yamamoto, N., Fujiwara, T., et al. (2023). Epley manoeuvre’s efficacy for benign paroxysmal positional vertigo (BPPV) in primary‑care and subspecialty settings: A systematic review and meta‑analysis. BMC Primary Care, 24, Article 262. https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02217-z

PubMed. (2009). Meta-analysis on the efficacy of Epley’s manoeuvre in benign paroxysmal positional vertigo. https://pubmed.ncbi.nlm.nih.gov/20643039

Brandt, T., & Daroff, R. B. Various years. Comparison of particle repositioning manoeuvres. Included in systematic reviews such as Cochrane, showing the Epley manoeuvre is highly effective for symptom resolution. https://www.cochrane.org/evidence/CD003162_epley-manoeuvre-benign-paroxysmal-positional-vertigo-bppv