Benign paroxysmal positional vertigo (BPPV)

The leading symptom of BPPV are recurrent short attacks of spinning vertigo, which are induced by changes of head or body position relative to gravity. Typically this occurs when patients get up in the morning. It is the most frequent cause of vertigo. In most patients it is cause by a so-called canalolithiasis (freely moving clot of otoconia) of the posterior canal (>95%), rarely of the horizontal canal.

Signs and Symptoms

BPPV is characterized by recurrent attacks of spinning vertigo. The diagnostic positional maneuvers induce a transient vertical torsional nystagmus in posterior canal BPPV and a linear horizontal nystagmus in horizontal canal BPPV.


A diagnosis can often be reached based on patient history. The diagnostic positioning maneuvers confirm the diagnosis. Thereby the affected side, canal and underlying mechanism can be determined.

Observable ocular motor disorders

  • Posterior canal BPPV: vertical torsional nystagmus
  • Horizontal canal canalolithiasis: geotropic horizontal linear nystagmus, higher intensity on the affected side
  • Horizontal canal cupulolithiasis: ageoptropic linear nystagmus, lower intensity on the affected side


Thomas Brandt, Marianne Dietrich, Michael Strupp, Vertigo and Dizziness – Common Complaints, 2nd edition, 2014, Springer Verlag London. ISBN: 978-0-85729-590-3. Springer