BPPV

How it works

The inner ear has two small organs that sense gravity and straight-line movement. Each holds a bed of calcium carbonate crystals, the otoconia, resting on hair cells³. Next to them are three fluid-filled loops, the semicircular canals, which sense rotation. Sometimes crystals break loose and drift into a canal, most often the rear one¹. Now, when you tilt your head, the crystals sink through the fluid and push on the rotation sensor. The brain gets a signal that you are spinning, while your eyes say you are still. The mismatch produces vertigo, flicking eye movements called nystagmus, and nausea¹.

Each episode lasts less than a minute¹. Triggers are rolling over in bed, lying down, sitting up, looking up at a shelf, and bending forward¹. Between episodes there is often a mild unsteadiness.

About 2.4% of people get BPPV in their lifetime¹. It is the most common cause of vertigo¹. Most cases are in people over 50, but it can happen at any age and sometimes follows a knock to the head¹.

Is it a problem?

BPPV itself is not dangerous. It does not affect hearing and does not damage the ear. It often clears on its own within weeks. The real risk is a fall during an episode.

Get it checked because it is easy to fix. A doctor confirms BPPV with the Dix-Hallpike test, which tilts your head and watches your eyes⁴. The treatment is the Epley manoeuvre, a sequence of head positions that rolls the crystals back out of the canal². It takes a few minutes and works for most people, often in one session². Do not copy the manoeuvre from a video before a diagnosis, because other causes of vertigo need different care.

See a doctor promptly if vertigo comes with hearing loss, double vision, weakness, trouble speaking, a severe headache, or if it lasts for hours¹.

History and culture

The Epley manoeuvre is named after John Epley, an American ear surgeon who developed it in 1980². Many doctors doubted it at first because it needed no drugs or surgery.