Vertigo: Understanding Benign Positional Vertigo (BPV) and Its Management

It was a crisp autumn morning when I met Nina, a young mother in her late 20s, at the local park. She was holding her 8-month-old son, Arjun, while cautiously navigating the playground. As I approached, I noticed she seemed uneasy, frequently pausing to steady herself.

“Dr. Priya,” she said with a faint smile, “I’ve been feeling these sudden dizzy spells whenever I move my head. It’s as if the world spins for a few seconds, and then it stops. I’ve been worried about carrying Arjun because I’m afraid I might fall.”

As Nina described her symptoms, I immediately suspected Benign Positional Vertigo (BPV), a common condition that often causes such fleeting but unsettling episodes of dizziness.

What Is Benign Positional Vertigo (BPV)?

“BPV,” I explained to Nina, “is a condition that causes brief episodes of spinning sensations, or vertigo, triggered by changes in the position of your head.” For example:

• Tilting the head backward.
• Changing from a lying to a sitting position.
• Turning the head to one side.
• Lying on one ear or the other.

“The good news is that BPV is not a serious condition,” I reassured her. “It’s called ‘benign’ because it doesn’t cause long-term harm and often resolves on its own.”

What Causes BPV?

“BPV can occur for various reasons, but in most cases, the exact cause is unknown,” I explained. There are two main theories:

1. Neck Issues: Sometimes, BPV can be linked to problems in the neck, such as a “kink” in the swivel joints or nerve pathways that connect to the balance center.
2. Inner Ear Debris: Tiny calcium carbonate crystals (called canaliths) can collect in the balance center of the inner ear (the labyrinth). When disturbed, these crystals upset the balance signals sent to the brain, causing dizziness.

In Nina’s case, she recalled having a minor neck strain after lifting Arjun awkwardly. “That might have triggered it,” I suggested.

Who Gets BPV?

“BPV can affect anyone,” I told Nina, “but it’s more common in certain groups:”

• It can happen at any age but is more frequent in older adults.
• Women are twice as likely as men to experience BPV.
• It’s particularly prevalent among the elderly, making it one of the most common causes of vertigo in this age group.

Nina looked relieved to know she wasn’t alone in experiencing this.

Symptoms of BPV

I listed the key symptoms for Nina:

• Sudden, intense dizziness: Typically lasting 10 to 30 seconds, sometimes up to a minute.
• Nausea: A common side effect of the spinning sensation.
• Triggered by head movements: Actions like lying down, sitting up, or turning the head can provoke an episode.
• Quick recovery: The dizziness usually subsides shortly after the triggering movement stops.

Nina nodded. “That’s exactly how it feels,” she said. “It’s unsettling, but thankfully it doesn’t last too long.”

How Long Do BPV Episodes Last?

I reassured Nina that BPV episodes are generally short-lived:

• Each episode usually lasts less than 60 seconds but can occur in bursts.
• Most people experience improvement within a few weeks.
• Some individuals may have recurrent bouts after months or years, but others only experience it once.

What Are the Effects of BPV?

“The good news,” I said, “is that BPV rarely has long-term effects.” Unlike some other causes of dizziness, BPV doesn’t usually lead to:

• Vomiting.
• Ringing in the ears (tinnitus).
• Deafness.

“However, you do need to be cautious during an episode to prevent falls or injuries,” I advised.

How Is BPV Treated?

Nina’s concern grew as she asked, “Is there a cure for this?”

“There’s no specific medication to prevent BPV,” I said, “but the condition can be managed effectively with a combination of self-care and exercises.”

1. Avoid Triggering Head Positions: Identifying and avoiding movements that provoke the dizziness can help minimize episodes.
2. Special Neck Exercises: A physical therapist can guide you in exercises to improve neck mobility and circulation.
3. Balance Restoring Exercises: Techniques like the Epley Maneuver or Brandt-Daroff Exercises can help dislodge the crystals in the inner ear and restore balance.

What Are Brandt-Daroff Exercises?

I demonstrated the Brandt-Daroff exercises for Nina, explaining that they are easy to perform at home:

1. Starting Position: Sit upright on the edge of a bed or chair.
2. First Movement: Turn your head slightly to the left and lie down quickly on your right side. Stay in this position for 20-30 seconds or until the dizziness subsides.
3. Return to Sitting: Sit up straight again and wait another 20-30 seconds.
4. Repeat on the Other Side: Turn your head slightly to the right and lie down on your left side, waiting for the dizziness to pass.

Image courtesy Primary Care Notebook

How Often?

• Perform these exercises three times daily for best results.
• Repeat each movement five times per session, alternating sides.

When to Seek Medical Help?

I emphasized to Nina that while BPV usually resolves on its own, there are situations where professional help is necessary:

• If the dizziness persists or worsens after a few weeks.
• If symptoms are accompanied by severe headaches, fainting, or other unusual signs.
• To rule out other serious causes of vertigo, such as circulation problems in the brain.

A specialist may recommend additional treatments or refer you for tests to ensure BPV is the correct diagnosis.

Conclusion: Nina’s Path to Recovery

Two weeks later, I saw Nina again at the park. She was smiling and chasing Arjun around the playground. “Dr. Priya,” she called out, “The exercises really helped! I feel so much better now.”

I was thrilled to see her confidence restored. BPV, while uncomfortable, is a manageable condition with the right approach. With simple exercises and awareness, most individuals can regain their balance—both physically and emotionally.

FAQs About Benign Positional Vertigo