BPPV (Benign Paroxysmal Positional Vertigo)
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. It occurs when small calcium carbonate crystals, called otoconia or otoliths, become dislodged from their normal position in the utricle (part of the vestibular system) and migrate into one of the semicircular canals. When the head moves into certain positions, these displaced crystals move within the fluid-filled canal and trigger a false signal to the brain indicating head rotation, causing a brief but intense spinning sensation.
Episodes of BPPV-related vertigo typically last less than one minute, are triggered by specific head movements (such as rolling over in bed, looking up, or bending forward), and are often accompanied by nystagmus (involuntary eye movement). BPPV can affect people of any age but is more common in adults over 50. It may occur without a clear cause, or it may follow a head injury, inner ear infection, or prolonged bed rest.
Diagnosis involves the Dix-Hallpike and roll tests, which reproduce the vertigo and characteristic nystagmus under controlled conditions. Treatment is highly effective: canalith repositioning maneuvers such as the Epley maneuver guide the displaced crystals back to their origin. Most cases resolve after one to three treatments. BPPV can recur, and some people benefit from home exercises to manage future episodes.
