Medicines for Benign paroxysmal positional vertigo (BPPV)

What it is

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — a spinning sensation. It happens when tiny calcium crystals, which normally sit in one part of the balance organ of the inner ear, become dislodged and move into the fluid-filled canals that sense head movement. This causes short, intense episodes of spinning dizziness triggered by particular head movements — such as rolling over in bed, looking up, bending down, or tipping the head back. Episodes typically last less than a minute but can be very unpleasant and cause nausea and unsteadiness. It is more common with increasing age and can follow a head injury or inner-ear problem, though often no cause is found. Despite being distressing, it is not dangerous ("benign"), and it is usually very treatable. It is diagnosed from the typical history and a simple positional test.

How it is treated

BPPV is usually treated very effectively with specific head-movement manoeuvres (such as the Epley manoeuvre) carried out by a trained professional — or sometimes taught for home use — which move the dislodged crystals back to where they belong, often resolving the vertigo quickly, sometimes in one or a few sessions. Understanding the condition and reassurance are important, as it can be frightening. While recovering, moving the head gently and avoiding triggering positions can help, and BPPV often settles on its own over weeks even without treatment, though the manoeuvres speed this up. It can sometimes come back, and the manoeuvres can be repeated. Medicines for dizziness are generally not helpful for BPPV. The reassuring message is that this common, unpleasant condition is not dangerous and usually responds well to simple treatment.