Benign paroxysmal positional vertigo

Attacks of dizziness can be caused by a disorder in the balance organ in the ear. This is called benign paroxysmal positional vertigo. It is unpleasant but harmless.

At a glance

  • Benign paroxysmal positional vertigo causes attacks of dizziness.
  • They are triggered by tiny stones in the balance organ in the inner ear.
  • The attacks usually stop by themselves after a few weeks.
  • Otherwise a so-called canalith repositioning can help.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Positional vertigo: older woman sitting on a bed with her upper body leaning forward slightly, clutching her forehead with her left hand. The woman’s mouth is open slightly. She looks exhausted.

What is benign paroxysmal positional vertigo?

If you have the feeling that everything is spinning or swooping around you, this is called dizziness (vertigo). It may occur while standing, walking, or lying down. Depending on the cause, the duration of this type of vertigo attack can vary. Associated ill effects may include feeling dazed or nauseous.

Benign paroxysmal positional vertigo is usually caused by a disorder in the balance organ. Certain movements then trigger vertigo for a short time. Benign paroxysmal positional vertigo is easy to identify and treat. It is harmless, though unpleasant.

What are the symptoms of benign paroxysmal positional vertigo?

Someone having an attack of vertigo has the feeling that everything is spinning around them, like being on a carousel. Benign paroxysmal positional vertigo usually occurs as a result of the head moving quickly, for example when the person:

  • nods or turns their head, or presses it into their neck.
  • bends down.
  • lies down.
  • turns round while lying down.
  • sits up from lying down.
Benign paroxysmal positional vertigo is usually caused by rapid head movements.

The feeling of dizziness only usually lasts a short while: between a few seconds and five minutes at most.

Nausea may occur during or after the attack of vertigo, and vomiting too, though rarely.

What causes benign paroxysmal positional vertigo?

It seems that loose deposits in the semicircular canals of the inner ear trigger benign paroxysmal positional vertigo. The semicircular canals are a ductal system filled with fluid. They form part of the balance organ and they use sensory cells to sense whether and in which direction the head is turning.

Diagram showing an ear. The diagram shows, clockwise from left to right: inner ear, middle ear, outer ear.

How these deposits occur is unclear. They are usually minute stones (otoliths) in the rear of the semicircular canal. When the sufferer moves their head, the “trickling” stones irritate the sensory cells. Because this faulty information does not match the other sensory perceptions, such as those of the eyes, dizziness occurs.

Rarer causes of vertigo attacks include ear inflammations, skull injuries, blood circulation disorders and being bedridden.

How common is benign paroxysmal positional vertigo?

Around two percent of the people in Germany are affected by benign paroxysmal positional vertigo at some point in their lives. It occurs twice as frequently in women as in men. Benign paroxysmal positional vertigo occurs most commonly in the 40 to 70 age group.

Ungefähr 2 % der Deutschen haben in ihrem Leben einen gutartigen Lagerungsschwindel. Am häufigsten im Alter von 40 bis 70 Jahren.

Repeat, brief attacks of dizziness are typical of benign paroxysmal positional vertigo. But once the stones settle in the semicircular canals and are decomposed by the body, it usually disappears by itself. For this reason, around half of those affected are free of the complaint once more within three months.

How is benign paroxysmal positional vertigo diagnosed?

Benign paroxysmal positional vertigo is usually easy to identify due to the ill effects and the sufferer's previous history. It is easily distinguished from other types of vertigo. Doctors normally ask whether the dizziness is constant, comes in attacks, or is caused by particular triggers.

Suspected benign paroxysmal positional vertigo can be confirmed by using the so-called Hallpike test. This involves the doctor helping the patient to quickly move the head and trunk in a prescribed sequence. A case of benign paroxysmal positional vertigo is confirmed if these movements trigger an attack of vertigo.

During the vertigo attack typical, wobbly eye movements (nystagmus) occur. Special glasses (“Frenzel goggles”) can be used during the test to help detect these.

How is benign paroxysmal positional vertigo treated?

It is often enough to wait until the benign paroxysmal positional vertigo vanishes by itself. But there are also optional treatments, such as canalith repositioning. With this, certain movements of the head and body cause the stones to settle so that they stop triggering attacks of vertigo.

Medication for nausea is another treatment. However, these are only required on odd occasions.

For further information on this subject and what can be done should one suffer benign paroxysmal positional vertigo, go to

What are the effects of benign paroxysmal positional vertigo?

Vertigo attacks can unsettle people – particularly if it is unclear whether it is harmless positional vertigo.

In older people in particular, vertigo attacks increase the risk of falling. Reducing activity for fear of the next attack can restrict a person's everyday life. 

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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