Neurological Balance and Medical Disorders

Guide

BPPV: Causes, Symptoms & Treatment with Physical Therapy

Authored by: The DrSensory Editorial Team

Reviewed by: 🛡️ DrSensory Clinical Review Board – Doctor of Therapy Rehab Division

Last updated: June 2025

All medical content on this page has been reviewed and approved by licensed Doctors on the DrSensory Clinical Review Board. Our reviewers follow strict editorial standards and ensure alignment with current APTA guidelines, evidence-based practice, and orthopedic rehabilitation protocols.

14 min read

Benign Paroxysmal Positional Vertigo (BPPV): Causes, Symptoms & PT-Based Recovery

What Is BPPV (Benign Paroxysmal Positional Vertigo)?

BPPV is one of the most common causes of vertigo, a false sensation that you or your surroundings are spinning or moving. This condition occurs when tiny calcium carbonate crystals (otoconia) dislodge from the utricle and move into the semicircular canals of the inner ear, disrupting your body’s balance system.

Although BPPV is more common in older adults, it can occur at any age, including children, especially following head trauma or inner ear disorders.

Who Is Affected by BPPV?

BPPV can affect both children and adults, with highest prevalence among:

  • Adults over 50 years
  • Women more than men
  • Individuals with a history of head injury
  • People with vestibular migraines, inner ear infections, or Meniere’s disease
  • Children with concussions or vestibular dysfunction

While rare in very young children, pediatric cases are often misdiagnosed or underrecognized.

Common Symptoms of BPPV

BPPV is triggered by changes in head position. Symptoms usually last seconds to minutes and may include:

Core Symptoms

  • Sudden episodes of spinning (vertigo) when turning the head
  • Dizziness when lying down, rolling over, or looking up
  • Feeling off-balance or unsteady
  • Nausea or vomiting
  • Nystagmus (involuntary eye movements)

In Children

  • Complaints of the “room spinning”
  • Avoidance of certain head movements
  • Balance issues or frequent falls
  • Unexplained motion sensitivity

What Causes BPPV?

  • Common causes include:
    • Aging (degeneration of inner ear structures)
    • Head trauma or concussion
    • Inner ear infections or vestibular neuritis
    • Surgery, especially ear or dental procedures
    • Prolonged bed rest or inactivity
    • Sometimes, no identifiable cause (idiopathic)

Diagnosing BPPV

Diagnosis is clinical and can be done by a trained physical therapist, ENT, or neurologist using specific positional tests, most commonly:

  • Dix-Hallpike Maneuver – Tests for BPPV in the posterior canal
  • Roll Test – Identifies horizontal canal involvement

Symptoms reproduced during these maneuvers, along with nystagmus, confirm BPPV.

Physical Therapy Treatment for BPPV

Physical therapy is the first-line treatment for BPPV. Therapists trained in vestibular rehabilitation therapy (VRT) can accurately diagnose and resolve symptoms using repositioning maneuvers.

Repositioning Maneuvers

These are safe, non-invasive procedures to guide displaced crystals out of the semicircular canals:

  • Epley Maneuver (most common)
  • Semont Maneuver
  • Brandt-Daroff Exercises (home-based)
  • BBQ Roll (for horizontal canal BPPV)

Relief is often immediate or occurs within 1–3 sessions.

Vestibular Rehabilitation Therapy (VRT)

If symptoms persist or recur, PTs may also use:

  • Balance retraining
  • Gaze stabilization
  • Habituation exercises
  • Fall prevention strategies

This therapy is especially helpful for older adults, post-concussion patients, or those with recurrent BPPV.

Can BPPV Return?

Yes—BPPV recurs in up to 50% of cases within five years. Regular follow-ups and vestibular therapy may reduce recurrence and help manage flare-ups.

Triggers for recurrence include:

  • Stress
  • Inactivity
  • Sudden head movements
  • Underlying vestibular conditions

How DrSensory Helps You Find a BPPV Specialist

DrSensory makes it easy to find licensed physical therapists who specialize in vestibular rehabilitation and BPPV treatment. Our growing directory includes:

  • Verified Physical Therapists (PTs)
  • In-person or telehealth options
  • Therapists with experience treating pediatric and adult vestibular conditions

📍 [Search Vestibular Physical Therapists Near Me →]

Frequently Asked Questions (FAQ)

Is BPPV dangerous or life-threatening?

No, BPPV itself is not life-threatening. However, the sudden vertigo it causes can increase fall risk, especially in older adults. Early treatment by a physical therapist reduces these risks.

Can children get BPPV?

Yes. Although less common, children can develop BPPV—especially after concussions, ear infections, or head injuries. Pediatric physical therapists can perform age-appropriate maneuvers and rehabilitation.

What if I feel dizzy but don’t have spinning sensations?

Not all dizziness is BPPV. Other conditions like vestibular migraines, labyrinthitis, or orthostatic hypotension may be the cause. A trained vestibular therapist or physician can evaluate the exact source of your symptoms.

How do I prevent BPPV from coming back?

While not always preventable, you can reduce recurrence risk by:

  • Staying physically active
  • Practicing safe head movements
  • Avoiding extended bed rest when possible
  • Getting regular PT follow-ups if you’ve had recurrent episodes

This page provides general educational content and is not a substitute for professional medical advice. Always consult a licensed provider for diagnosis and treatment.

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