Understanding this injury
BPPV — Benign Paroxysmal Positional Vertigo — is the most common cause of vertigo, and it has a very specific signature: brief, intense spinning that happens when you change head position. Rolling over in bed, looking up to reach a top shelf, tilting your head back at the hair salon, or lying down can all trigger 30-60 seconds of strong room-spinning, often with nausea.
It happens when tiny calcium crystals (otoconia) that normally live in one part of your inner ear become dislodged and float into one of the semicircular canals, where they don't belong. The wonderful news: BPPV is almost always fixable in 1-3 visits with simple positional maneuvers (Epley, Semont) that move the crystals back where they belong. There's no medication that works as well as the right manual technique.
Common symptoms
- Brief spinning sensation with head movement
- Dizziness when rolling over in bed
- Nausea during episodes
- Loss of balance or unsteadiness
What causes it
- Spontaneous (most common — crystals just dislodge for no clear reason)
- Head injury (concussion, fall, car accident)
- Age-related changes in the inner ear
- Prolonged bedrest or being supine for surgery
- Inner ear infection or inflammation
Who's most at risk
- Adults over 50 (much more common with age)
- Women (about 2x the rate of men)
- People recovering from head injury or concussion
- Patients after prolonged bedrest
- Anyone with prior BPPV — it can recur
How we treat it
Your PT will start with a careful exam, including the Dix-Hallpike test and roll test, to confirm BPPV and figure out exactly which ear and which canal are involved. This precision matters — the treatment maneuver depends entirely on the diagnosis. Once we know, we'll perform the appropriate canalith repositioning maneuver (Epley for posterior canal, Lempert/BBQ roll for horizontal canal) which physically guides the displaced crystals back to where they belong.
Most patients have dramatic improvement after a single treatment, with full resolution after 1-3 visits. We'll also teach you what to do at home if symptoms partially return, post-treatment positioning guidance, and balance and gaze-stability work if any residual dizziness or unsteadiness remains. If your dizziness turns out not to be BPPV, we'll guide you to the right next step (sometimes that's medical workup for other vestibular causes).
If your symptoms aren't improving in 2-3 weeks, are getting worse, or starting to limit daily activities, call us or schedule an appointment online today — early intervention almost always means a faster, fuller recovery.
Recovery timeline
Most patients are 70-90% better after one visit and fully resolved within 1-3 visits. Some people are recurrence-prone and benefit from learning to perform a home maneuver if symptoms return.
What you can do at home today
- After treatment, avoid lying flat with the treated ear down for 24 hours
- Sleep slightly propped up the first night after treatment
- Move your head slowly and deliberately the first few days
- If symptoms return, schedule a follow-up — don't suffer through it
- Stay hydrated and avoid sudden head-down positions for a week
These tips support recovery but don't replace a professional evaluation. If you're unsure or symptoms worsen, please reach out.
When to call us right away
If your dizziness comes with sudden headache, vision changes, slurred speech, weakness, numbness, chest pain, or it doesn't fit the brief positional pattern (e.g. constant vertigo, vertigo with hearing loss), go to the ER — these can signal stroke or other serious conditions that need urgent care.