Positional Vertigo

What Is Positional Vertigo?

Vertigo is the sensation that you or your surroundings are moving when they are not. It is different from general dizziness or lightheadedness. In positional vertigo, symptoms are triggered specifically by changes in head position.

Benign Paroxysmal Positional Vertigo (BPPV) is a mechanical issue within the inner ear. The inner ear contains structures that help your brain determine head movement and balance. When this system functions normally, your brain accurately interprets motion and position.

In BPPV, small calcium crystals inside the inner ear become dislodged and move into areas where they interfere with normal balance signals. This disruption causes the brain to mistakenly perceive movement – leading to spinning sensations.

Understanding the Inner Ear and Balance

Your balance system relies on coordination between:

• The inner ear (vestibular system)
• Your eyes
• Sensory feedback from muscles and joints

Inside the inner ear are three semicircular canals filled with fluid. These canals detect rotational head movement. When you move your head, fluid shifts within the canals and sends signals to the brain via the vestibulocochlear nerve.

In BPPV, loose calcium crystals (otoconia) float into one of these canals. When you change head position, the crystals shift, disturbing the fluid movement and sending incorrect signals to the brain. The result? A sudden spinning sensation.

Common Symptoms of BPPV

Positional vertigo typically causes short, intense bursts of dizziness triggered by specific movements. Symptoms may include:

• Spinning sensation when rolling over in bed
• Vertigo when looking up or bending forward
• Nausea
• Lightheadedness
• Brief balance disturbance
• Feeling unsteady after an episode

Episodes usually last less than a minute but can feel much longer due to their intensity. Between episodes, many people feel completely normal.

What Triggers Positional Vertigo?

BPPV can sometimes occur without an obvious cause. However, it is more commonly seen after:

• A recent head knock or trauma
• Respiratory infections
• Prolonged bed rest
• Air travel
• Age-related inner ear changes

The condition is more common in adults over 50 but can occur at any age.

How Is Positional Vertigo Diagnosed?

Accurate diagnosis is essential because many other conditions can cause dizziness.

A trained physiotherapist or doctor will:

• Ask detailed questions about your symptoms
• Assess when and how dizziness occurs
• Perform specific positional tests (such as the Dix-Hallpike test)
• Observe eye movements (nystagmus), which indicate inner ear involvement

These tests help determine which ear and which canal are affected so that treatment can be targeted precisely.

Treatment: How Physiotherapy Can Help

The good news is that BPPV is usually very responsive to treatment.

Repositioning Manoeuvres

Treatment involves a series of guided head and body movements designed to move the displaced calcium crystals back to their correct position in the inner ear.

The most common technique is the Epley manoeuvre. These movements:

• Are safe and controlled
• Usually take only a few minutes
• Often provide rapid symptom relief
• May resolve symptoms within one or two sessions

Vestibular Rehabilitation Exercises

In some cases, you may be given exercises to:

• Reduce residual dizziness
• Improve balance
• Prevent recurrence
• Restore confidence in movement

Most people experience significant improvement quickly, although some cases require repeat treatment.

What to Expect After Treatment

After repositioning treatment:

• You may feel slightly off-balance for 24-48 hours
• Mild nausea can occur temporarily
• Symptoms usually reduce dramatically

Your physiotherapist may provide advice on sleeping positions or movements for the first day after treatment.

While recurrence is possible, it is manageable and often responds well to repeat treatment.

When to Seek Urgent Medical Attention

Although BPPV is benign, dizziness can sometimes indicate more serious conditions. Seek urgent medical care if vertigo is accompanied by:

• Severe headache
• Double vision
• Difficulty speaking
• Weakness or numbness
• Chest pain
• Fainting

These symptoms require immediate medical evaluation.

Living Confidently After Vertigo

Experiencing vertigo can reduce confidence in movement and increase fear of falling. Regaining trust in your balance system is an important part of recovery.

Physiotherapy not only treats the mechanical cause of BPPV but also helps restore:

• Safe movement patterns
• Balance control
• Confidence in daily activities

Early assessment prevents unnecessary anxiety and prolonged discomfort.

How Masnad Health Clinic Can Support You

At Masnad Health Clinic, our physiotherapists are trained in vestibular assessment and treatment.

We focus on:

• Accurate diagnosis of positional vertigo
• Safe and effective repositioning manoeuvres
• Balance rehabilitation where needed
• Individualised guidance to reduce recurrence

If you are experiencing dizziness when changing positions, early assessment can provide clarity and fast relief.

Book an Appointment

If you suspect positional vertigo or are unsure about your symptoms:

Book your appointment online today
Or call us on (02) 9793 8840

Early treatment can often resolve symptoms in just one or two sessions.