Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, and one of the most treatable. It causes brief, intense spinning triggered by a change in head position.
Medically reviewed by Anuj Kumar Mishra, MPT
Last reviewed: 2 August 2026 · Our clinical team
What it feels like
- Spinning that starts when you roll over in bed, lie down, sit up, or look up
- Episodes lasting seconds — usually under a minute — not hours
- Often worst first thing in the morning
- Nausea, and a lingering unsteadiness between episodes
The pattern is the giveaway: short bursts triggered by position, rather than constant dizziness.
What causes it
The inner ear contains tiny crystals that normally sit in one part of the balance organ. In BPPV they become dislodged into one of the fluid-filled canals. When you move your head, they shift and send a false signal that you are spinning. The brain briefly believes it.
It often happens for no identifiable reason, and becomes more common with age. It can also follow a head injury or a period of prolonged bed rest.
How it is diagnosed
Diagnosis is made by positional testing — moving the head into specific positions and observing the resulting eye movements, which follow a characteristic pattern. Scans are not usually needed to diagnose BPPV.
How it is treated
BPPV is treated with repositioning manoeuvres — a sequence of head and body positions that guides the crystals back out of the canal. The Epley manoeuvre is the best known. Treatment is often effective quickly, sometimes within one to a few sessions.
These manoeuvres should be performed or taught by a trained clinician. Which one is appropriate depends on which canal is affected and on which side — performing the wrong one can make symptoms worse, and some conditions make them unsuitable.
When dizziness is not BPPV
Dizziness has many causes. If your dizziness is constant rather than positional, lasts hours, or comes with hearing loss, headache, or any neurological symptoms, it needs medical assessment rather than a repositioning manoeuvre. See causes of dizziness.
Frequently asked questions
Will it come back?
It can recur. Recurrence is usually treatable in the same way.
Do I need medication?
Vestibular sedatives may reduce nausea briefly but do not treat the cause, and prolonged use can slow recovery. Discuss with your doctor.
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Medical disclaimer: this article is general information and is not medical advice, diagnosis or treatment. It is not a substitute for individual assessment. See our medical disclaimer.