What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo - the sensation that you're spinning or that the inside of your head is spinning or dizzy.

BPPV typically causes brief episodes of mild to intense dizziness - often lasting only a minute or so. It is almost always brought on by a change in head position: when you look up or down, when you lie down or when you turn over or sit up in bed. Some people also feel out of balance when standing or walking. Abnormal rhythmic eye movements (nystagmus) can often accompany the symptoms of BPPV.

Although BPPV can be bothersome, it's rarely serious (hence the term 'benign') except when it increases the chance of falls. 

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • A loss of balance or unsteadiness
  • Nausea
  • Vomiting

Whilst it isn't a cause for serious medical concern, having BPPV can be unpleasant and quite disabling.

What causes it?

Your inner ear contains three loop shaped tubular structures (semicircular canals) that contain fluid and fine, hairlike sensors.  When your head moves around, the liquid inside the semicircular canals moves and this fluid flow displaces the hair structures. Nerves attached to the hairs feed back signals to the brain that tells it how far, how fast and in what direction the head is moving. There are also little crystals in the inner ear that move according to the law of gravity, and signal to the brain which way is 'up'.

For many reasons, these crystals can become dislodged and movements of the head can then cause them to topple into one of the semicircular canals disrupting the flow of fluids. This upsets the functioning of the semi-circular canal and causes a sensation of dizzines.



Although it's uncommon for dizziness to signal a serious illness, seek medical help if you experience dizziness or vertigo in conjunction with any of the following:

  • A new, different or severe headache
  • Fever
  • Double vision or loss of vision
  • Hearing loss
  • Trouble speaking
  • Leg or arm weakness
  • Loss of consciousness
  • Falling or difficulty walking
  • Numbness or tingling

What is the Epley Manoeuvre?

The Epley manoeuvre is a simple, non-invasive approach to treating benign paroxysmal positional vertigo (BPPV) - a specific type of vertigo - and it is generally recommended as the first line of treatment for this condition.  It is not effective for the treatment of vertigo caused by other conditions, such as labyrinthitis. Over the decades, researchers have conducted numerous studies on the effectiveness of the Epley Manoeuvre in the treatment of BPPV, which demonstrate an average success rate of 80%. 

The Epley manoeuvre involves a series of movements of the head and body that help to relocate calcium carbonate crystals to where they belong. The procedure is very safe, but should be performed with caution in patients with certain health conditions including a history of retinal detachment, vascular disease or neck/back problems.

Most people report relief from BPPV symptoms immediately following an Epley manoeuvre but sometimes the procedure needs to be repeated at a later date.

Following the Epley manoeuvre, some people may experience:

  • Nausea
  • Intense vertigo
  • Vomiting

Patients attending for this treatment should be accompanied to their appointment and should not attempt to drive themselves or others for the rest of the day.

Done incorrectly the Epley manoeuvre can make symptoms worse rather than better. For this reason we generally recommend that patients do not attempt self-treatment.