Previously, I have covered the topic of BPPV in two previous blog posts, BPPV Overview Part 1 and Part 2. In this blog post we will talk about BPPV Symptoms.
I will cover common complaints associated with BPPV symptoms, common positions and activities that trigger BPPV symptoms, and other conditions that BPPV is associated with. People with BPPV do not necessarily have all the complaints, or experience symptoms in all the positions or activities listed below. This is a list of the most common reports that I hear from patients with BPPV.
What common complaints are associated with BPPV?
- Bed spins
- Vertigo when lying down or rolling in bed, triggered by change in head position
- Symptoms worse in the middle of the night or in the morning
- Complaints of intermittent dizziness (can be constant dizziness for a new case)
- Loss of balance, blurry vision, or falls with head turns
- Dizziness looking up or down causes loss of balance
- Feelings of unsteadiness or imbalance, especially in the dark
- Bumping into walls
- Difficulty walking
- Foggy Brain
- Unexplained repeated falls without feelings of vertigo
- Difficulty with short term memory and concentration
- Difficulty reading
- Problems with word finding while talking
- Feel spacey all the time, less in the afternoon
- Fear of falling
- Blurred vision, wavy patterns, or illusion of movement of objects otherwise known to be stationary during high speed or unpredictable head motions. This is called “oscillopsia.”
- Car sickness
- Motion sickness
- Unable to ride roller coasters
Common Positions that Trigger BPPV Symptoms
- Lying down flat on your back
- Rolling over in bed
- Getting up from bed
- Looking up (Ex. putting in eye drops)
- Looking down
- Quick head turns in any direction
- Repetitive head shakes or head nods
Common Activities that Trigger BPPV symptoms
- Reaching into the dryer
- Emptying the lower rack of the dishwasher
- Putting dishes onto an upper cabinet shelf
- Leaning back to look up into a cabinet
- Picking up toys off the floor
- Looking under the bed
- Leaning forward and reaching to make a bed
- Reaching into the back of the closet
- Opening the lower drawer of a dresser and leaning down to get out clothes
- Turning right and left repeatedly, while looking down to vacuum, mop, or clean the floor
- Putting cat food or dog food on the floor
- Picking up after your dog while on a walk
- Working on the computer
- Tipping your head down to check text messages
- Leaning back in the shower to rinse out hair shampoo, especially with your eyes closed
- Painting overhead ceilings
- Hanging curtains
- Hanging up clothes on the clothesline
- Bird watching while hiking
- Twirling and head-banging while dancing
- Star gazing
- Picking fruit from a tree above eye level
What are BPPV Symptoms Commonly Associated with?
- Normal aging!
- Changes in barometric pressure
- Osteoporosis and osteopenia
- Vitamin D deficiency
- Head trauma (ex. jarring sports activity, car accident, whiplash injury, sports concussion, falls with hitting head, blast injuries from road side bombs in war veterans, etc.)
- Sinus infections
- Vestibular neuritis
- Seasonal allergies (in this author’s opinion)
- Hormonal changes (puberty, pregnancy, and menopause)
- Cardiovascular risk factors (high cholesterol, high blood pressure, tobacco smoker due to poor circulation)
- Occupations that have a repeated vibration or impact with the head at an angle (jackhammering, plumber, construction worker, mechanic, bike repair)
- Vestibular Migraines
- Meniere’s disease
- Hearing loss
- Childhood ear infections
- Vestibular Hypofunction
- Neck pain and stiffness
- Clenching jaw and TMJ
- Anxiety issues (due to holding the breath or hyperventilating with panic attack)
- Genetic Predisposition (runs in the family)
- Stroke (CVA)
- Giant cell arteritis
- Ototoxicity from certain medications (oral antibiotics and IV antibiotics)
For more information about BPPV and BPPV symptoms, check out the blog on BetterBalanceInLife.com called “What is the most common vestibular disorder? BPPV.”
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
Good article, just like the others, most of which I’ve now read.
I’ve been suffering from diagnosed right-side BVVP but unable to suffer through the Epley manoeuvre and wondered if you could corroborate what my ENT specialist told me – BVVP does go away on its own?
If you think you have BPPV, I suggest you find someone who is skilled to assess and treat it for you.
You can search for a Vestibular Provider using this article.
This article also has vertigo home remedies.
You can read for yourself about the likelihood of BPPV going away on its own, by checking out this article.
That article specifically says this:
“Furthermore, despite the fact that the natural history of BPPV includes a spontaneous resolution rate ranging from 27% to 50%, this often takes a significant amount of time, and almost 86% of patients with BPPV will suffer some interrupted daily activities and lost days at work due to BPPV. In addition, 68% of patients with BPPV will reduce their workload, while 4% will change their job and 6% will quit their job as a result of the condition.”
I hope that answers your question.
Kim Bell, DPT
Have you ever heard of someone not being able to use their legs due to BPPV? A Friend’s Relative was life flighted, because she couldn’t move her legs. She was told that it was due to BPPV. She is now home and has to do PT. Thank you for any help you can give. I can’t find any article mentioning, losing use of your legs.
“Not being able to use your legs” is not a common symptom of BPPV. That severe symptom definitely indicates the need for a full work up to rule out other possible causes of dizziness or vertigo.
I hope your friend feels better soon!
Kim Bell, DPT
I was diagnosed with BPPV in both ears 4 or 5 years ago, worse in the left ear and two years ago with Meniere’s in the right ear. I had some violent Meniere’s episodes two years ago but hadn’t had any BPPV episodes since 2016. However, I’ve recently had some reasonably short severe vertigo attacks (less than a minute) followed by the room spinning for an hour or so and by vomiting. After each of these I’ve experienced constant bouts of dizziness for days afterwards. is this consistent with BPPV?
I’d like to do the Epley Maneuver but am not sure which ear might be causing the current problems. If I do it for the left ear and the problem is not the left ear, will this aggravate either the BPPV or the Meniere’s in the right ear?
Short severe vertigo attacks that last for less than a minute, but can make you feel horrible for a few hours or a whole day afterwards is consistent with BPPV.
Vertigo from Meniere’s typically lasts for 20 minutes to hours. Also Meniere’s episodes usually have co-occuring ear symptoms of rushing, roaring or ringing sounds in your ear and hearing loss during the episode.
This article details Meniere’s disease. You may want to learn more about triggers for Meniere’s attacks by clicking here.
This article talks about why the Epley may not work.
This article discusses pitfalls of trying to treat yourself.
Yes, treating BPPV in one ear can aggravate BPPV in the other ear.
This article shares how to find a vertigo doctor or vestibular physical therapist in your area.
This article has home remedies that may help.
I hope you can find competent vestibular provider to help you sort through this!
Kim Bell, DPT
Can it still be BPPV if you never had true vertigo? Just dizziness? And does it have to be a specific head position or movement or can it be any? It seems whenever I turn my head side to side, look up or down I feel off balance and get very quick dizzy spurts( like it almost wants to spin but stops short of doing so). And this happens whether I be lying down or standing,sitting,walking,etc.
Yes, this blog may help you.
This blog can help you find a vestibular physical therapist.
This article will help you document your symptoms.
Kim Bell, DPT
I had my first ever episode of vertigo on my 3rd day with Covid. It was when I had been lying down and then sat up quickly, it lasted less than a minute but I was nauseous for the rest of the day and felt an overall dizziness for a couple weeks. No tinnitus and no change in my hearing. The dizziness seemed better when I didn’t move my head and focused on something up ahead while walking. I went to an ENT, he suspected BBPV and proceeded with the Epley maneuver, which triggered another vertigo attack as expected. It helped and I haven’t had any vertigo since (a month later).
I went in for a follow up and a hearing test, which showed a mild low frequency loss in one ear. My ENT did not realize this was the same result from a previous hearing test a couple years prior. He then told me he suspected meniere’s. However, I don’t agree! I’ve had one short episode of positional vertigo, along with Covid, and felt better after the Epley maneuver and antibiotic (I also had a sinus infection).
Is a long term, mild low frequency hearing loss a red flag for Ménière’s disease? The previous audiologist two years ago had no concerns with the same findings, and that appointment was focused on a diagnosis of Eustachian tube dysfunction. I feel that this new ENT is jumping the gun even mentioning meniere’s. I feel I had BPPV that was successfully treated. I haven’t been diagnosed but I’m planning on getting a second opinion. Your input would be greatly appreciated!
In order to diagnose Meniere’s, you will technically need a series of three hearing tests.
First hearing test establishes a baseline.
Second hearing test needs to occur during a vertigo episode, which is difficult for most patients.
Third hearing test occurs after the vertigo episode is resolved.
The hearing loss associate with Meniere’s disease is in certain predictable ranges during a vertigo attack.
I wrote this article on Meniere’s and this glossary term may help also.
Otherwise, it may be more of an educated guess.
Many patients I am seeing with post COVID vertigo are either having a vestibular neuritis (bacterial or viral infection) and/ or BPPV onset.
If you are still having symptoms, I suggest you find a vestibular physical therapist. You can search using this article.
You can also look for an Otoneurologist, an Otologist, or a Neurotologist, who are vestibular specialty doctors – to get your second opinion.
Kim Bell, DPT
This is a wonderful blog. Thank you for sharing your expertise. Does this sound like BPPV: feeling off balance specifically when walking, turning, in the supermarket, in dark spaces, or in spaces where the light fluctuates? The dr can’t figure it out because there’s no nystagmus but you indicate in another post that nystagmus isn’t required for BPPV. Any feedback is appreciated.
This could be symptomatic BPPV. The only way to know is to have a provider treat you as if it is BPPV, and see if it helps.
You could also have another type of vestibular problem, besides symptomatic BPPV.
It is also possible that nystagmus might show up if you are retested for BPPV on another day, because the BPPV testing is not 100% sensitive.
Either way, a vestibular PT, an Otologist, Otoneurologist, or Neurotologist are probably the best type of specialist you can find.
You can use this article to search for that type of specialty provider near you.
This article may also shed some light.
I suggest you organize your story using the questions I ask in this blog, before you consult with the next specialist.
Kim Bell, DPT
I have suffered on and off since my teens and I am now 42. It was so much worse the year I had bad workplace stress and can get bad if I am generally unwell. I seem to have suffered much less over recent years. The main way I suffer now is spinny rides (had to embarrassingly ask them to stop the teacup rides when on with my kids!) Swimming baths slides can be a trigger and I can no longer go upside down on roller coasters. My friends and family try to understand but unless you suffer it is hard to explain just how horrible it feels. If I get it now I just sleep or stay on my good side. My Dad suffers too is this possibly genetic?
Yes BPPV tends to run in families.
I have recently been diagnosed with BPPV and undergoing PT.
I have suffered with an unknown ailment for a year and a half that all started after a flight.
Symptoms are body constriction in the mornings only upon waking. Feels like a piece of plastic that is heated and shrinks. My whole body feels this way. It can last several minutes up to an hour. No pain just body is very tense. Extreme fatigue follows. Also can have vomiting and diarrhea. Brain fog, appetite loss.
I have had 8 episodes over that last year and half. Have ruled out all kinds of things: Heart disease, auto immune, tick disease, hormonal issues, eye issues, mental issues…you name it I have probably been checked for it.
The last few episodes have started with weird eye movements. When I move my eyes I get very dizzy.
Neurologist days I have bppv. Pt has made the dizziness worse and have had to take a leave of absence from work.
They say it will get better but will take longer to heal because I have had it for so long.
I am still having the body constriction. Have you heard of this with bppv?
I have seen other patients who get BPPV after a flight and experience tension in their nerves from the BPPV.
I hope you get relief with the vestibular physical therapy!
I am a 52 year old female. I had a very frightful experience this morning about 530am.
I got up to let my dogs out, put laundry in the dryer, puttered around, then went back to bed, all the while feeling fine.
As I was lying down, I turned to my right slightly to put my phone on the nightstand, and I immediately saw stars, flashing lights, the room spinning, and panic.
I grabbed my bed frame with one hand and felt for edge of bed with other in my panicked freak out and kept telling myself “you are on the bed, just keep holding on to the frame, don’t move”.
My head felt like it was going to explode, but there was no pain, only extreme spinning and flashing lights, think digital NYE fireworks.
I then went on to have 3 more of these episodes during the next hour and a half.
After the second one, I started searching online and discovered BPPV, which did help me get through the rest of the episodes, and I am still feeling the after-effects of this at almost 4pm the same day.
I tried the hallmark test of hanging tilted head off edge of bed (guessing which side) and that didn’t work until rolling over, immediate spinning and nausea.
After that calmed some, I tried again this time intending to do the full maneuver as a treatment and before even getting fully into position, the reaction was immediate- it felt like I had someone deliver a defibrillator jolt to my entire body and again more spinning and nausea.
I decided immediately that this is not a tolerable treatment for me.
I eventually felt well enough to get all my “flu gear” in the bed with me, and then slept for a few hours, which helped, but I am still very much feeling the effects of this very frightening experience.
This was so sudden and seemingly unprovoked that I’m now very anxious about it happening again, especially while I am driving?
I will note that in my research of BPPV, there have been a lot of things in my past that now make perfect sense and fit right in with BPPV.
My grandmother was very often laid up with inner ear trouble, as well.
In retrospect, I believe that I have had multiple forms of vertigo over the years, such as inability to ride roller coasters, car sickness, and even motion sickness while watching movies at a theatre.
The one thing I am unsure of, as I haven’t seen it discussed anywhere, is all the bright lights that I experience- it is similar to migraine auras that I do get from time to time, but this time it was very overwhelming and debilitating.
Is today’s experience something that I should expect for the rest of my life now?
Oh my! That sounds terrible.
You are on to something with the genetic predisposition to spontaneous vertigo that can run in families.
I would say that you cannot speculate on whether this should be expected for the rest of your life or not until you know the root cause.
BPPV is certainly a possible root cause as I discuss in this blog.
However, the key to determining the proper treatment plan and the prognosis (which you are asking about) is to find the root cause.
This is best done by providing a full medical history and having a physical exam by a skilled provider who treats dizziness and vertigo.
You may also be referred for some diagnostic tests.
I suggest you start with your primary doctor and ask for a referral to vestibular physical therapy or a specialty doctor who treats vertigo.
You can use this article to hopefully find a vertigo professional near you.
This article has home remedies that may help.
I believe your case is likely complex and will require professional attention, since you have a history of vertigo symptoms.
I do not recommend testing yourself or attempting to treat yourself for BPPV (without professional instruction) for the reasons I describe in this blog.
I think you naturally found out pretty fast that it is difficult to do any treatment correctly while you are the patient!
For more learning, I talk about the link between vertigo and anxiety in this blog.
I discuss dizziness while lying down and rolling over in bed in this blog.
I hope you find a professional who can assess and treat you soon!
I had labyrinthitis about 20 years ago.
Since then I’ve had issues with being off balance, BPPV, all the classic vestibular symptoms over the years.
Recently my anxiety has exasperated the condition including panic attacks.
I’m taking sertraline and seeing a vestibular therapist who is excellent and doing cognitive behavioral therapy (cbt).
My doctor has taken me down the heart route and an ECG indicated bradycardia and first degree heart block.
The heart investigations I have found very difficult as I thought it was my vestibular system not functioning correctly.
My dr also feels I should try hormone replacement therapy (HRT). I’m 58 and had early menopause.
I’m at a loss of what to do next – go back to ENT, Cardiology?
I feel the heart issue is something probably not related and it’s stressing me going down that route of investigation and is a block to my recovery.
I do have lightheaded feelings when I get up in the morning after 10 mins and after standing still over 5 mins.
I’m fit, love walking and mountaineering and sometimes when I climb a hill I get a throbbing head and ear fullness.
Thank you for any help you can give me it’s much appreciated.
I’m so sorry to hear all this! Menopause is a difficult time for many women, with so many changes to your body.
I love that you already have a vestibular PT and are doing CBT.
There is some research to show that combination of VPT and CBT pairs up nicely with an SSRI or SNRI medication (taken for about 8-10 months)for patients with high anxiety and dizziness.
So you may want to talk to your doctors about if adding an anti-anxiety medication might help you with this current exacerbation.
I have articles on the link between anxiety and dizziness here and here.
I think it’s always a good idea to follow through with the cardiology consult and stick to their plan of care for you.
Our hearts are vital organs, so it’s important to find a cardiologist you trust to stick with for the duration of any testing series and treatment plan.
You can also ask your cardiologist to send you for tilt table testing to rule out any type of dysautonomia, if you are getting fairly consistent symptoms with standing.
If you try HRT, I typically suggest working with a provider who specializes in that type of care within their practice. Hormones can be very powerful so you want to work with an experienced provider.
Your case sounds complex with many possible contributing factors, so it will be important for you to describe your symptoms clearly to your providers.
I suggest you create a case summary describing your symptoms as I have guided in this blog.
I hope you feel better soon!