There is a multitude of reasons why an individual might experience symptoms of dizziness and nausea.  Some individuals with these symptoms might be suffering from dehydration, food poisoning or a host of other health issues, including morning sickness during pregnancy.  In the cases where an individual is diagnosed with BPPV or benign paroxysmal positional vertigo, a common denominator is that the symptoms of dizziness, vertigo and perhaps nausea, only occur when the individual changes their position in space.  In other words, if an individual has vertigo, perhaps accompanied by nausea upon getting out of bed in the morning, or when they tilt their head to look up or when they enter a reclining position such as they do when they go to sleep at night, they may very well have BPPV.

What is BPPV?

BPPV is actually an inner-ear disturbance.  Inside the ear are 3 semicircular canals.  Also inside the ear are other structures called “otolith organs”, which monitor movements of the head and its relation to gravity.  These otolith organs contain crystals that become dislodged in some individuals and inappropriately enter into one of the ear’s semicircular canals.  This abnormal process causes the body to become sensitive to head position changes, especially when lying down.


BPPV Symptoms

When an individual first has an episode of BPPV, the symptoms can be quite strong.  Patients typically report feelings of dizziness, vertigo, a loss of balance and great difficulty walking or conducting any normal activities.  Some, although not all patients also report symptoms of nausea and may even vomit.  During an episode, an individual will often have abnormal eye movements called nystagmus, however, the person experiencing the episode is unlikely to know this is occurring.

Typically the symptoms only last about a minute at most, but if the individual changes their position too quickly, the symptoms can immediately recur.  To the unaware, it is disconcerting, to say the least, to experience symptoms of BPPV and some people have experienced falls due to an unexpected bout of BPPV.


Causes of BPPV

For some, there is no known cause for their episodes of BPPV.  In other cases, a blow to the head often stemming from a vehicle accident or some other kind of physical trauma is a common factor.  Rarer still are disorders or surgery that damaged the inner ear.  Most cases of BPPV occur in people over the age of 50, with women more likely to experience it than men.  There is also some evidence that migraine sufferers have a greater tendency to experience BPPV than the average person.



If a patient suspects they have BPPV, they should seek a concrete diagnosis from a physician.  The physician should ask about their previous medical history, including any head trauma, and will try to gain an understanding of exactly what conditions tend to bring on the episodes of vertigo and perhaps nausea.

Typically, the physician will guide the patient through a series of movements with the patient’s head and body, which should bring on the symptoms if the patient has BPPV.  While the patient is experiencing vertigo, the physician will view the patient’s eyes to see if they can see any symptoms of nystagmus.  In some cases where it is difficult to make a diagnosis, a physician might have their patient undergo an ENG test, designed to detect abnormal eye movement or have them get an MRI to rule out other health issues.


Physical therapists typically use a two-pronged approach when working with a patient who is experiencing BPPV.  Since BPPV sufferers have a higher than normal risk of falling, physical therapists will help their patients by instructing them on how to move from one position to another in such a manner as to reduce their risk of falling.  They can also instruct their patients on which positions to avoid until their BPPV resolves.

To encourage the re-positioning of ear crystals back to their normal area in the ear, physical therapists can also instruct patients on a series of exercises they can perform at home.  In some instances they may recommend “Brandt/Daroff” exercises or more likely, a series of exercises called “Epley/Semont maneuvers”.


Most cases of BPPV resolve within a few weeks, although some patients may experience symptoms for several months, only to have their BPPV go away and come back again at a later time.  If you are dealing with BPPV, please call (570-208-2787) or email us (, the balance and dizziness experts at Cawley PT and Rehab today, to get back on your feet and feeling healthy again.