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I Suffer From Vertigo BPPV

BPPV Treatment Sydney

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common vestibular conditions, diagnosed in 17-42% of patients who experience vertigo symptoms. Diagnosis is often straightforward — after discussing your symptoms and medical history, a physical examination can usually confirm BPPV without the need for further investigation.

BPPV is a balance disorder that affects the otolith organs within your inner ear — the part of the vestibular system responsible for detecting gravity and head movements. These sensory organs help your body stay balanced and upright as you move. When BPPV develops, these organs become disrupted, mistakenly detecting normal head movements as a threat. This leads to BPPV symptoms like vertigo, which can feel sudden and severe.

Our medication-free, non-invasive techniques are designed to treat BPPV safely and gently. We expect most patients to experience positive changes within the first six sessions — a result we see in 85-90% of cases. If you’re ready to address your symptoms and restore your balance, book your initial session today.

Understanding Your Symptoms

What are the common symptoms of Vertigo BPPV?

Amongst patients who seek treatment for vertigo symptoms, 17-42% of them will be diagnosed with BPPV, as will between 11-64/100,000 people in Sydney each year. Benign Positional Paroxysmal Vertigo is easily diagnosed after your medical history is collected and is confirmed with physical tests, ruling out any conditions with similar or overlapping symptoms such as Meniere’s Disease or cervicogenic dizziness. The main BPPV symptoms that our patients experience are:

  • Vertigo
  • Dizziness
  • Light headedness
  • Struggling to control balance
  • Nausea
  • Vomiting
  • Nystagmus (rapid, unidirectional involuntary eye movements, unnoticed by the patient)

 

Scans are most often not required in BPPV diagnosis. These physical tests will assess the balance organs in your inner ear, which are known to be the cause of BPPV.

Chronic Daily Headache - Sydney Headache & Migraine Clinic

Understanding Your Headache

What causes Vertigo BPPV?

Common Causes

Some common known causes of Benign Paroxysmal Positional Vertigo (BPPV) include:

  • Head injury
  • Complications following ear surgery
  • Age-related deterioration of the vestibular system
  • General inner ear issues (such as severe inner ear infections, an inner ear disorder or inner ear disease like vestibular neuritis)

These conditions can displace calcium carbonate crystals inside the inner ear canals resulting in episodes of vertigo. BPPV manifests in various forms depending on the affected semicircular canal

  • Anterior canal BPPV is induced by tilting the head forward 
  • Posterior canal BPPV is elicited by movements that alter head position, such as rolling over in bed with the head turned towards the side of the affected ear. 

Recognising the triggers of vertigo episodes, their underlying causes, and specific types is essential for precise diagnosis and management of BPPV.

BPPV Theory

There are two main theories about the cause of BPPV. These theories both speak about abnormal detections which trigger vertigo symptoms, regarding changes in the endolymph that flows in the semicircular canals of the otolith organs. These two theories are as follows:

The ‘Cupulolithiasis Model’

This model suggests that tiny calcium carbonate crystals become stuck on the cupula (the sensory organ within the otolith) causing abnormal stimulation during head movements.

The ‘Canalithiasis Model’

This theory proposes that free-floating crystals (canaliths) move through the endolymph, triggering vertigo symptoms when they shift position.

 

How is BPPV Diagnosed?

Diagnosing Benign Paroxysmal Positional Vertigo (BPPV) starts with a detailed assessment of your BPPV symptoms, medical history, and potential triggers such as neck injuries or ear infections. At Sydney Headache and Migraine Clinic™, our experienced clinicians perform a range of tests designed to confirm BPPV diagnosis and rule out other vestibular conditions like Meniere’s disease or vestibular neuritis.

The primary focus is on understanding which semicircular canal in the inner ear is affected — the posterior canal, anterior canal, or horizontal canal — as this influences your treatment plan.

Diagnostic Tests We Perform

Dix-Hallpike Test:

This test targets the posterior semicircular canal — the most common site of BPPV. As your head is turned and repositioned, we observe your eye movements for signs of nystagmus, a key indicator of positional vertigo. If posterior canal BPPV is present, vertigo symptoms are typically triggered within a few seconds of head movement.

Supine Roll Test:

Used to detect horizontal canal BPPV, this test involves turning the head while lying down to provoke dizziness and monitor for nystagmus. Observing how symptoms respond to these movements helps us confirm the affected canal and understand the severity of your condition.

Throughout testing, our clinicians assess for common symptoms like nausea, imbalance, hearing loss, and the characteristic sensation of spinning or movement. These tests not only guide us toward the correct BPPV vertigo treatment but also help differentiate BPPV from other causes of dizziness such as cervicogenic dizziness or inner ear disease.

In most cases, imaging or scans are unnecessary. The diagnosis relies on clinical assessment of your vestibular system, balance organ, and how your head movements trigger vertigo — confirming if canalith repositioning manoeuvres will be effective as your first treatment.

About The Assessment Stage

What To Expect During The Assessment


1. Comprehensive and in-depth examination

We instigate an in-depth assessment to identify all possible related factors that could be causing your headaches or migraines. The upper cervical spine, in particular, is thoroughly examined to identify possible issues.



2. Ligamental stability and vertebral arterial tests

We undertake careful examination of neck ligaments and vertebral arteries, ensuring only the highest standards of patient safety and comfort.


3. Temporarily reproduce your headache and migraine symptoms

As a part of the treatment process, we apply gentle and selective stress to the upper cervical spine in order to reproduce headache symptoms, which subside after 20-30 seconds. This helps to identify and treat the cause of your headaches.

More about Vertigo BPPV

Living with Vertigo BPPV

Living with Benign Paroxysmal Positional Vertigo (BPPV) can be unpredictable and exhausting. Simple movements — turning your head, rolling over in bed, or looking up — can unexpectedly trigger a spinning sensation, leaving you dizzy, unsteady, and anxious.

Many people find themselves avoiding activities that once felt routine, like driving, working, or even walking down the street. The fear of triggering vertigo episodes, paired with feelings of imbalance, nausea, and dizziness, often leads to frustration and isolation.

Over time, BPPV symptoms can impact your confidence, quality of life, and ability to stay active. Fortunately, with the right assessment and treatment plan, it is possible to regain control and reduce the impact of BPPV on your daily life.

Brainstem Sensitisation and Persistent BPPV Symptoms

A lot of the patients that we see will experience all of the symptoms of BPPV, but the results of their physical tests are unclear, or treatment isn’t as effective as expected. In these cases, it is likely that increased sensitivity in their brainstem is the true cause of their symptoms. The vestibular nerve will send ‘normal’ information to this hyper-sensitive brainstem that is interpreted as a threat, causing the patient to experience vertigo or other vestibular symptoms such as dizziness or unsteadiness.

I’ve tried it all, is there anything else that can help my BPPV?

BPPV Treatment Sydney

The gold standard physical therapy treatment for the most common type of BPPV, posterior canal, is the Epley Manoeuvre. This benign paroxysmal positional vertigo treatment technique involves manoeuvring the patient into a series of different head positions, placing shifting matter and endolymph through the semicircular canals. This manoeuvre is commonly taught to patients to be performed regularly at home.

The patients that we see at Sydney Headache & Migraine Clinic™ have often had mixed results with the Epley Manoeuvre, have tried various BPPV vertigo treatment options and  medications (such as motion sickness medications), some have even tried surgical intervention. They sometimes have mild results, but it is often short-lived, finding that their BPPV symptoms persist. This is because they often haven’t been thoroughly assessed to determine if a sensitised brainstem is the true cause of their symptoms. 

If we assess you and can determine that, yes, the brainstem and upper cervical spine are the true cause of your BPPV then we can start a treatment plan right away with a tailored solution to your BPPV, including manual therapies, vestibular rehabilitation techniques and much more.

Schedule your initial appointment with us today to discover the BPPV vertigo treatment Sydney residents rely on to truly address the root cause of their condition.

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