Benign paroxysmal positional vertigo


Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo encountered. It is characterised by the sudden onset of dizziness and vertigo triggered by changes in head position. The average age of onset is 55 years and it is less common in younger patients.


  • Incidence: 64.00 cases per 100,000 person-years
  • Peak incidence: 60-70 years
  • Sex ratio: more common in females 3:1
Condition Relative
Benign paroxysmal positional vertigo1
Vestibular neuronitis0.06
Viral labyrinthitis0.05
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

  • vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards)
  • may be associated with nausea
  • each episode typically lasts 10-20 seconds
  • positive Dix-Hallpike manoeuvre


BPPV has a good prognosis and usually resolves spontaneously after a few weeks to months. Symptomatic relief may be gained by:
  • Epley manoeuvre (successful in around 80% of cases)
  • teaching the patient exercises they can do themselves at home, termed vestibular rehabilitation, for example Brandt-Daroff exercises

Medication is often prescribed (e.g. Betahistine) but it tends to be of limited value.


Around half of people with BPPV will have a recurrence of symptoms 3–5 years after their diagnosis