Individuals with vertigo incorrectly perceive movement (commonly a rotating motion) in their surroundings. Feelings of vertigo can disrupt your balance and contribute to falls that can be critical among older adults; it might also be coupled with dizziness, sensations of spinning in space, and more infrequently, nausea, vomiting, migraines, visual irregularities including nystagmus, and fainting.

There can be many root causes for vertigo, but one kind of it – benign paroxysmal positional vertigo, or BPPV – is related to hearing. BPPV is attributable to calcium crystals that form naturally in the inner ear. Known as otoliths or otoconia, these crystals typically cause no problems for people. In people who are afflicted with benign paroxysmal positional vertigo, however, these crystals become dislodged from their normal location and migrate into one of the semicircular canals of the inner ear that control our sense of balance. When this happens, and the person with BPPV changes the orientation of their head relative to gravity, these crystals move about, and cause an abnormal displacement of endolymph fluid, which results in vertigo.

Benign paroxysmal positional vertigo can be triggered by such common movements as tilting or turning your head, looking up and down, and rolling over in bed, and is characterized by the brief (paroxysmal) nature of the attacks. The resulting vertigo can be made worse by anxiety, lack of sleep, or changes in barometric pressure (for instance, in advance of a rainfall or snowfall). The condition can present itself at any age, but it most commonly appears in people over 60. The initial trigger for the benign paroxysmal positional vertigo is typically difficult to determine. An unexpected blow to the head (for example in a motor vehicle accident) is among the more well-known causes.

BPPV is differentiated from other types of vertigo or dizziness in that it is almost always prompted by head movements, and in that its symptoms usually subside in under a minute. Health professionals may diagnose it by having the affected individual lie on their back and then tip their head to one side or over the edge of the examination table. There are more rigorous tests that can be used to diagnose BPPV, such as videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, or magnetic resonance imaging (MRI), which is used primarily to rule out other possible causes of the vertigo.

There is no full cure for BPPV, but it can be effectively treated using canalith repositioning (either the Semont maneuver or the Epley maneuver), both of which use bodily movements to guide the crystals to a position in which they no longer cause trouble. Surgery is an option in the rare cases where these treatments are not effective. If you suspect BPPV or have been suffering from vertigo or dizziness for over a week, consult a specialist familiar with balance and vertigo disorders.