Benign paroxysmal positional vertigo

Last reviewed: 28 Oct 2022
Last updated: 28 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • specific provoking positions
  • brief duration of vertigo
  • episodic vertigo
  • severe episodes of vertigo
  • sudden onset of vertigo
  • nausea, imbalance, and lightheadedness
  • absence of associated neurological or otological symptoms
  • normal neurological examination
  • positive Dix-Hallpike manoeuvre or positive supine lateral head turn
  • normal otological examination
More key diagnostic factors

Other diagnostic factors

  • age >50 years
  • female sex
  • positional vertigo in absence of nystagmus
Other diagnostic factors

Risk factors

  • increasing age
  • female sex
  • head trauma
  • vestibular neuronitis
  • labyrinthitis
  • migraines
  • inner ear surgery
  • Meniere's disease
  • otitis media
  • hypertension
  • hyperlipidaemia
  • diabetes mellitus
  • vertebrobasilar insufficiency
  • giant cell arteritis
  • osteoporosis
  • intubation
  • habitual lateral head-positioning during bed rest (ipsilateral BPPV)
More risk factors

Diagnostic investigations

1st investigations to order

  • Dix-Hallpike manoeuvre
  • supine lateral head turns
More 1st investigations to order

Investigations to consider

  • audiogram
  • brain MRI
More investigations to consider

Treatment algorithm

ACUTE

initial presentation

ONGOING

multiple repositioning manoeuvres and vestibular rehabilitation exercises ineffective

Contributors

Authors

Lorne S. Parnes, MD, FRCSC
Lorne S. Parnes

Professor

Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences

University of Western Ontario

London

Canada

Disclosures

LSP is an author of a number of references cited in this topic.

Shahin Nabi, MD, FRCSC
Shahin Nabi

Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences

University of Western Ontario

London

Canada

Disclosures

SN declares that he has no competing interests.

Peer reviewers

Joel Goebel, MD, FACS

Professor and Vice Chairman

Residency Program Director

Dizziness and Balance Center Director

Otolaryngology-Head and Neck Surgery

Washington University School of Medicine

St. Louis

MO

Disclosures

JG is an author of a number of references cited in this topic.

Stephen P. Cass, MD

Associate Professor

Department of Otolaryngology

University of Colorado

Aurora

CO

Disclosures

SPC is an author of a number of references cited in this topic.

Steven D. Rauch, MD

Associate Professor of Otology and Laryngology

Harvard Medical School

Boston

MA

Disclosures

SDR declares that he has no competing interests.

Malcolm Hilton, BA, BMBCh, FRCS (Eng), FRCS (ORL-HNS)

Consultant Otolaryngologist & Honorary Lecturer

Royal Devon & Exeter NHS Foundation Trust

Exeter

UK

Disclosures

MH is the author of one reference cited in this topic.

  • Benign paroxysmal positional vertigo images
  • Differentials

    • Meniere's disease
    • Vestibular neuronitis
    • Labyrinthitis
    More Differentials
  • Guidelines

    • Clinical practice guideline: benign paroxysmal positional vertigo (update)
    • Clinical practice guideline: benign paroxysmal positional vertigo (update)
    More Guidelines
  • Patient leaflets

    Benign paroxysmal positional vertigo

    More Patient leaflets
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