If you have had it, vertigo requires no introduction. If you never have, be grateful because it can be a truly horrible experience.

‘Vertigo’ is a sensation of movement, typically of spinning and sometimes rocking, ranging from low grade to debilitating and often accompanied by a feeling of nausea. There are many different causes for dizziness, not all of which are treatable with Physiotherapy. However, Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo and usually responds well to treatment. Originating from the inner ear, the name describes it well - its symptoms are disturbing for sufferers, but are ‘benign’ meaning there is no serious health issue acting as the cause of the symptoms. ‘Paroxysmal’ means the dizziness starts abruptly and is very brief. Positional means that it is triggered by changes in head position. Vertigo means the sensation of spinning. It is a common disorder that is sometimes treated by either a Physiotherapist in the clinical setting, or through a program of simple home based exercises.

BPPV is characterized by recurrent attacks of momentary ‘spinning’ which last usually no more than a few seconds, and are triggered by rapid head movements like looking up rapidly or rolling over in bed. There are usually no associated symptoms of hearing loss or other health issues, although inner ear problems such as Meniere’s disease may co-exist with it.

‘Why am I getting vertigo?’

The above diagram shows the inner ear. BPPV is caused by microscopic debris (small particles of calcium carbonate called ‘otoconia’) accumulating within a part of the inner ear called the posterior semicircular canal. This canal is lined by small hairs and contains fluid; the normal movement of the two is how we perceive our balance and sense position. Debris is produced by the utricle and can migrate into the canal because of either damage incurred by injury, infection, or simply the degeneration of the ear with advancing age. As the otoconia disturb the hairs in the canal, it leads to a malfunction in our sense of balance, aggravated by changes in head position.

When the sufferer steadies him/herself the debris settles and the vertigo stops. However, a recurrent rapid movement will cause this to again be stimulated by the debris and a sensation of vertigo will return.

Nobody knows what causes this debris to accumulate within the posterior canal. Some patients will describe a history of a blow to the head or a viral infection immediately prior to the onset of symptoms. Usually there is no identified cause.

Diagnosing BPPV

BPPV has a very characteristic pattern of severe episodes of vertigo triggered by head motion in specific directions. Getting into or out of bed, or rolling over in bed are common triggering motions. When assessing you, your therapist may deliberately move your head into positions which trigger the vertigo. It will usually last for 60 seconds or less, and during the vertigo, a patient will have highly characteristic eye movements (called ‘nystagmus’) that are easily observed.

If the history and findings on examination are typical, there is often no need for further testing. However, there are other causes of dizziness, and your GP may run a number of tests or refer you to a medical specialist in order to be certain of a correct diagnosis. This is an important precautionary step to take, since some of the other causes of vertigo are worthy of further investigation.

Other forms of vertigo can also be treated by Physiotherapists - for example, one type can originate from your neck. An experienced Physiotherapist will be able to distinguish different forms of vertigo and advise of the best treatment options for you.


  • Because the debris involved can ‘float’, it is possible to reposition and effectively move it out of the canal in which it is causing the trouble. Doing so will often bring a quick end to the dizziness.
  • In diagnosing the problem, your doctor or therapist may employ head movements designed to trigger the vertigo. In turn, following a systematic method of head repositioning can be an effective treatment. The goal of treatment is to remove the debris from the affected side.
  • Treatment is then generally followed up with a simple program of home based exercises that reinforce the benefits gained from treatment.