Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, a spinning sensation. It causes short bursts of spinning, lasting less than a minute, when you move your head in certain ways, such as rolling over in bed or looking up. It comes from the balance organ of the inner ear, not the neck, and it can often be treated quickly with a simple head-positioning manoeuvre.
Also known as benign paroxysmal positional vertigo, positional dizziness, loose ear crystals
Symptoms
- Brief spinning that lasts seconds to under a minute
- Spinning set off by rolling over or sitting up in bed, lying down, looking up or bending forward
- Feeling sick during an episode
- Feeling slightly off balance between episodes
- No hearing loss or ringing in the ears caused by the BPPV itself
Causes and risk factors
- Tiny calcium crystals in the inner ear come loose and move into one of the balance canals
- Often there is no obvious trigger
- Being over 50
- A head injury
- An inner ear infection or ear surgery
- Long spells with the head tipped back, such as at the dentist or after bed rest
What the evidence says helps
- BPPV is diagnosed with a positioning test called the Dix-Hallpike test. Guidelines say scans and specialist balance tests are not routinely needed when the test is positive.1
- A repositioning manoeuvre, most often the Epley manoeuvre, is the recommended first treatment. A Cochrane review found it is a safe and effective treatment for the most common type of BPPV.12
- Guidelines advise against routinely treating BPPV with anti-dizziness medicines.1
- Watchful waiting is a reasonable option for some people, as BPPV often settles by itself over a period of weeks.1
- There is no need to sleep upright or restrict head movement after a repositioning manoeuvre.1
- BPPV can come back, so it is worth knowing what to do if the spinning returns.2
Things you can try at home
- Get out of bed slowly and sit on the edge for a moment before standing
- Sit down straight away if you feel the spinning start
- Squat to pick things up instead of bending forward, and take care on stairs
- Avoid ladders and heights until it has settled
- Only do repositioning exercises at home once a clinician has shown you which side and which movement
- Keep moving as normally as you can, because avoiding all head movement can slow recovery
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Dizziness with a drooping face, arm weakness or slurred speech: call 999
- Dizziness with double vision, difficulty swallowing, a severe headache or being unable to stand or walk: call 999
- Sudden hearing loss in one ear: get same-day medical help
- Dizziness with chest pain, palpitations or fainting: call 999
- Dizziness after a head injury: go to A&E
- Constant vertigo lasting hours or days with vomiting: call NHS 111 or see your GP urgently
How Apollo can help
We check whether your dizziness behaves like BPPV, like a neck-related problem or like something that needs a medical opinion. That includes positioning tests, a look at your eye movements, neck and balance, and screening questions for the urgent causes of dizziness. We explain what we find and tell you clearly whether a repositioning manoeuvre is something we can provide, or whether your GP or a vestibular service is the better route. We can also help with balance confidence and with the neck stiffness that builds up when you hold your head still to avoid the spinning.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Is BPPV serious?
BPPV itself is not dangerous, and it is not a sign of a stroke or a brain problem. The main risk is falling during an episode, especially in older people. Dizziness with other symptoms, such as weakness, speech problems or a severe headache, needs urgent medical help.
How long does BPPV last?
Each burst of spinning lasts less than a minute. Without treatment BPPV often clears over a few weeks, and a repositioning manoeuvre can clear it much sooner. It can return months or years later.
Is my dizziness coming from my neck?
Possibly, but BPPV is far more common. BPPV causes true spinning set off by changes in head position, such as lying down. Neck-related dizziness is more a feeling of unsteadiness that comes with neck pain and stiffness. An assessment can usually tell them apart.
References
- Bhattacharyya N, et al. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery 156. View source
- Hilton MP, Pinder DK (2014). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews 2014. View source
- von Brevern M, et al. (2006). Epidemiology of benign paroxysmal positional vertigo: a population based study. Journal of Neurology, Neurosurgery & Psychiatry 78:710-715. View source
- NHS. Vertigo. NHS website, accessed November 2026. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
