Benign paroxysmal positional vertigo (BPPV) causes brief spinning brought on by particular head movements. It is diagnosed from a compatible history and positional examination. Not every episode of dizziness is BPPV.
How BPPV is assessed
The clinician asks about timing and triggers, hearing symptoms, headache, neurological symptoms, falls and previous episodes. Positional tests are selected to identify whether the findings fit BPPV and, when possible, which ear and semicircular canal are involved. Atypical findings may require a different assessment or referral.
Canal-specific repositioning
When posterior-canal BPPV is confirmed, an appropriate canalith-repositioning procedure may be offered. Horizontal-canal variants require different positioning and manoeuvres. A posterior-canal manoeuvre should not be presented as the treatment for every horizontal-canal pattern. The selected manoeuvre must follow the positional diagnosis and laterality.
What this page does not recommend routinely
Routine post-manoeuvre postural restrictions are not recommended for typical posterior-canal BPPV. Vestibular-suppressant medicines should not be used routinely as the primary treatment for BPPV; they may impair function or obscure symptoms and should be considered only for an individualized clinical reason. Do not start or stop medicine based on this page.
Recovery, recurrence and follow-up
Symptoms may improve after repositioning, but one session is not guaranteed and recurrence can occur. Persistent symptoms need reassessment to confirm whether BPPV remains present or another vestibular, neurological, cardiovascular or medication-related cause should be considered.
Fall safety
- Sit down promptly when spinning starts.
- Use support on stairs and avoid driving or hazardous work while attacks remain unpredictable.
- Ask for help if imbalance creates a fall risk.
- Return for review if symptoms change, persist or are accompanied by hearing or neurological signs.
Medical information: Repositioning is diagnosis- and canal-specific; this page is not a substitute for positional examination.