Benign Paroxysmal Positional Vertigo: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Benign Paroxysmal Positional Vertigo?
An otolaryngologist, an ear, nose, and throat doctor, treats BPPV. A primary care doctor can start the evaluation. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is benign paroxysmal positional vertigo?
Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. Vertigo is the feeling that you are spinning or that everything is spinning around you. It is caused by a problem in the inner ear. It comes in sudden, short spells. Certain head positions or movements can trigger a spell.
Symptoms
BPPV symptoms include any of the following:
- Feeling like you are spinning or moving.
- Feeling like the world is spinning around you.
- Loss of balance.
- Nausea and vomiting.
- Vision problems, such as a feeling that things are jumping or moving.
The spinning sensation is usually triggered by moving your head and often starts suddenly. It lasts a few seconds to minutes. Rolling over in bed and tilting your head up to look at something can trigger it.
Causes and who gets it
The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to any movement of the fluid. The sensation of the fluid moving in the tube tells your brain the position of your body. This helps you keep your balance.
BPPV occurs when small pieces of bone-like calcium, called canaliths, break free and float inside the tube. This sends confusing messages to your brain about your body's position.
BPPV has no major risk factors. But your risk may increase if you have family members with BPPV, a history of a head injury, even a slight bump to the head, or a history of an inner ear infection called labyrinthitis.
How doctors diagnose it
Your provider will do a physical exam and ask about your medical history. To diagnose BPPV, your provider may perform a test called the Dix-Hallpike maneuver. Your provider holds your head in a certain position. Then you are asked to lie quickly backward over a table. As you do this, your provider will look for abnormal eye movements, called nystagmus, and ask if you feel like you are spinning. If this test doesn't show a clear result, you may be asked to do other tests, such as a head CT scan, a head MRI scan, or a hearing test.
Treatment
Your provider may perform a procedure called the Epley maneuver. It is a series of head movements to reposition the canaliths in your inner ear. The procedure may need to be repeated if symptoms come back, but this treatment works best to cure BPPV. Most of the time, treatment will cure BPPV. Sometimes, vertigo may return after a few weeks. About half the time, BPPV will come back later on. If this happens, you will need to be treated again.
Your provider may teach you other repositioning exercises that you can do at home, but these may take longer than the Epley maneuver to work. Balance therapy may help some people. Some medicines, such as antihistamines, can help relieve spinning sensations, but these medicines often do not work well for treating vertigo. Rarely, in a few people, the canaliths may move into another canal in the inner ear and continue to cause vertigo.
When to see a doctor
Contact your provider if you develop vertigo or if treatment for vertigo doesn't work. Call 911 if you also have weakness, slurred speech, trouble speaking, double vision or sudden loss of sight, fainting, or a head injury. These may be signs of a more serious condition, such as a stroke. Tell your doctor if the spinning comes with hearing loss or a full feeling in the ear. To keep your symptoms from getting worse, avoid the positions that trigger it. After treatment, do not bend over for the rest of the day, and do not sleep on the side that triggers symptoms for several days. Follow any other specific instructions your provider gave you.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This doctor can start the evaluation and rule out other causes of dizziness. The doctor can also refer you to vestibular rehabilitation and see you again if the vertigo comes back.
Common questions
What causes BPPV?
Small pieces of bone-like calcium, called canaliths, break free and float inside the fluid-filled tubes of the inner ear. This sends confusing messages to your brain about your body's position. Your risk may be higher after a head injury or an inner ear infection called labyrinthitis.
Is BPPV dangerous?
Usually not. BPPV is a benign condition. But call 911 if you also have weakness, slurred speech, trouble speaking, double vision or sudden loss of sight, fainting, or a head injury. These may be signs of a more serious condition.
How is BPPV treated?
The Epley maneuver is a series of head movements to reposition the canaliths in your inner ear. It works best to cure BPPV, and most of the time treatment will cure it. About half the time, BPPV will come back later and needs to be treated again.
Do medicines help?
Some medicines, such as antihistamines, can help relieve spinning sensations. But these medicines often do not work well for treating vertigo.
Sources
- MedlinePlus - Benign positional vertigo
- MedlinePlus - Epley maneuver
- MedlinePlus - Benign positional vertigo - aftercare
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
