Benign Paroxysmal Positional Vertigo

The Epley maneuver may be performed in order to resolve BPPV if the cause is otolithic.

What Is BPPV?

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, the false sensation that you or the room is spinning. "Benign" means it is not life-threatening, "paroxysmal" means it comes in sudden, brief spells, and "positional" means it is triggered by changes in head position.

BPPV occurs when tiny calcium carbonate crystals (otoconia), which normally sit in a part of the inner ear called the utricle, become loose and drift into one of the fluid-filled semicircular canals. When the head moves, the crystals keep moving after the head has stopped, sending a false signal of rotation to the brain. The posterior canal is involved most often; this is what "otolithic" refers to above.

Common Symptoms

• Brief spells of spinning vertigo, usually lasting less than a minute
• Spells triggered by rolling over in bed, lying down, getting up, looking up or bending forward
• Nausea, and sometimes a feeling of imbalance between spells
• Characteristic jerking eye movements (nystagmus) during an episode

BPPV can follow a head injury, a period of prolonged bed rest or an inner ear problem, but in many people no cause is found. It becomes more common with age.

How the Epley Maneuver Works

The Epley maneuver, also called the canalith repositioning procedure, is a series of head and body positions that use gravity to guide the loose crystals out of the posterior canal and back into the utricle, where they no longer cause symptoms. A trained clinician first confirms the diagnosis and the affected side with a positional test called the Dix-Hallpike test.

Research, including a Cochrane systematic review of randomized trials, has found the Epley maneuver to be a safe and effective treatment for posterior canal BPPV, and it often relieves symptoms within one or a few sessions. Temporary nausea or dizziness during the maneuver is common. BPPV can come back in some people, and the maneuver can be repeated if it does. Other canals, such as the horizontal canal, need different repositioning maneuvers, which is one reason a proper examination matters before treatment.

When Dizziness Needs Urgent Care

Not all dizziness is BPPV. Seek emergency care right away if vertigo comes with a sudden severe headache, double vision, difficulty speaking or swallowing, weakness or numbness on one side of the body, loss of coordination, fainting or chest pain, or if you cannot stand or walk. These can be signs of a stroke or another serious condition. Dizziness after a neck or head injury is covered in Dr. Lehman's article on dizziness and vertigo, and neck injuries in our guide to whiplash symptoms and recovery.

Living With BPPV

• Get up slowly, sitting on the edge of the bed for a moment before standing
• Take extra care on stairs, in the shower and when looking up during active episodes
• Ask your clinician before trying home repositioning exercises, so you use the right maneuver for the affected side
• Keep a note of what triggers your spells to share at your appointment

Section added September 2026 by the Ask Dr. Lehman editorial team.