What it is
A short, honest summary.
- —Vertigo is the illusion of movement — most commonly the world spinning around you, or you spinning in the world.
- —BPPV (benign paroxysmal positional vertigo) is the leading cause: tiny crystals dislodge in the inner ear and float into the wrong canal.
- —Other causes: vestibular neuritis, Meniere's disease, vestibular migraine, central causes.
What families notice
The signals worth taking seriously.
- 01Brief, intense spinning triggered by head position (rolling over, looking up)
- 02Nausea and vomiting with episodes
- 03Imbalance between attacks
- 04Sensitivity to motion, scrolling screens, or busy environments
- 05Frequently misdiagnosed as 'cervical' or 'BP problem' in India
My approach
How the work is structured.
- —Proper bedside diagnosis — Dix-Hallpike, Roll Test, Head Impulse — before treating.
- —Repositioning manoeuvres (Epley, Semont, BBQ Roll) for BPPV — often resolving symptoms in one or two sessions.
- —Vestibular rehabilitation exercises for non-BPPV causes: gaze stabilisation, habituation, balance retraining.
- —Education on triggers, recovery rhythm, and what's not vertigo (light-headedness, anxiety-related dizziness).
What recovery looks like
A plain-language picture.
“BPPV resolves in one to three sessions for most people. Other vestibular conditions take weeks to months of targeted exercise, with substantial improvement the rule rather than the exception.”
FAQ
Common questions, answered briefly.
- Why have I been treated for 'cervical vertigo' for months with no improvement?
- Because true cervical vertigo is rare, and most spinning vertigo is BPPV — which is treated very differently. A proper vestibular assessment usually clarifies in 20 minutes.
- Will it come back?
- BPPV can recur in roughly 30% of people. The good news: re-treatment works just as quickly the second time.
For clinicians
Clinical detail, assessment and evidence.
Clinical summary
The picture in clinician register.
Most positional spinning vertigo is BPPV — canalith debris in a semicircular canal — and is resolved by canal-specific repositioning rather than medication. Accurate bedside differentiation (BPPV vs vestibular neuritis vs Meniere's vs vestibular migraine vs a central cause) is the determining step; central red flags are excluded before treating.
Terminology
Terms worth being precise about.
- BPPV
- Benign paroxysmal positional vertigo — displaced otoconia in a semicircular canal.
- Canalith repositioning
- Manoeuvres (Epley, Semont) that return debris to the utricle.
- Dix-Hallpike / supine roll test
- Positional tests that identify the affected canal.
- Direction-changing nystagmus
- A pattern suggesting a central rather than peripheral cause.
Assessment & measures
What the first sessions measure.
- —Dix-Hallpike and supine roll test.
- —Head Impulse Test; the HINTS examination where an acute vestibular syndrome is present.
- —Gait and the Dynamic Gait Index.
Red flags
Signs that need urgent escalation.
- Direction-changing or vertical nystagmus, new headache, or other neurological signs — a central cause; refer or escalate.
- Acute vertigo with a normal head-impulse test — a central-suggestive (HINTS-positive) pattern.
Referral & MDT
When and to whom to refer.
ENT or neuro-otology for refractory or atypical cases. Neurology where central features are present.
Evidence
References and guideline anchors.
- Repositioning manoeuvres for BPPV — PLACEHOLDER — verify against current guidelines before launch.