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I Suffer From Vertigo BPPV

Benign Paroxysmal Positional Vertigo Treatment Brisbane

Amongst patients who suffer from peripheral vertigo attacks or vestibular migraines, 17-42% will be diagnosed with Benign Positional Paroxysmal Vertigo (BPPV), as will between 11-64 per 100,000 people in Brisbane each year. BPPV is easily diagnosed after a history of your symptoms is collected and is confirmed with physical tests. Further investigation is rarely required for diagnosis of BPPV.

BPPV is a condition affecting the otolith organs inside your inner ear. These otolith organs essentially control balance – they detect the gravitational and acceleration forces in your head during movement so that you can adjust and stay upright.

Vestibular symptoms from BPPV occur when these organs become impaired. The vestibular (inner ear) balance system will detect head movements that are normally fine, and react by causing symptoms of vertigo. This lower threshold for quite severe symptoms of vertigo can be quite debilitating for BPPV sufferers. 

Brisbane Headache and Migraine Clinics™ treat BPPV using world-leading techniques that are safe, gentle, medication-free and non-invasive! Using our methods of vestibular physiotherapy, vestibular rehabilitation therapy, habituation exercises, and more, we expect to see positive results within the first 6 sessions, as we do with 85-90% of our patients. Book a treatment with our Vertigo experts today for the most-effective BPPV treatment Brisbane has to offer!

Understanding Your Symptoms

What are the symptoms of Vertigo BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is characterised by brief episodes of vertigo triggered by changes in head position. These symptoms occur due to displaced calcium carbonate crystals (otoconia) within the semicircular canals of the inner ear, which interfere with normal balance signals sent to the brain. 

Common Benign Paroxysmal Positional Vertigo Symptoms Include:

Vertigo (a spinning sensation)

Dizziness or lightheadedness

Nausea and, in some cases, vomiting

Blurred vision

Nystagmus (rapid, unidirectional involuntary eye movements)

Symptoms may last for seconds to minutes at a time but can recur with repeated head movements. While BPPV itself is not life-threatening, untreated symptoms can increase the risk of falls and significantly impact daily activities. BPPV symptoms may lessen over time, but it is important to seek treatment from a health professional in the early stages to prevent injury or falls.

Headache treatment in Brisbane

Understanding Your Headache

What causes Vertigo BPPV?

Common Causes

Some common causes of BPPV include:

  • Head injury
  • Problems after ear surgery
  • Degeneration of the vestibular system (age-related inner-ear changes)
  • Inner ear disorder or disease (e.g. vestibular neuritis)

These issues can dislodge calcium carbonate crystals, leading to vertigo episodes.

BPPV can occur in different forms depending on the affected semicircular canal:

Anterior Canal BPPV

Triggered by tipping the head forward.


Posterior Canal BPPV

Provoked by movements that change head position (like rolling over in bed with your head turned toward the affected ear).

Understanding triggers, causes and types is crucial for accurate diagnosis and management of BPPV. Common triggers include:

  • Rolling over in bed
  • Tilting the head backward or forward
  • Sudden changes in head position
  • Looking up or down too quickly


BPPV Theory

There are two main theories about the cause of BPPV, both involving abnormal endolymph dynamics in the semicircular canals of the otolith organs:

The Cupulolithiasis Model

Loose particles in the endolymph become stuck in the cupula.


The Canalithiasis Model

Free-floating particles in the endolymph are detected by the cupula.

Two physical tests help confirm a BPPV diagnosis:

  • Dix–Hallpike Test – Detects dysfunction in the affected semicircular canal.
  • Supine Roll Test – Assesses the horizontal semicircular canal.

In a positive test, patients experience vertigo and the clinician observes nystagmus (rapid eye movements). If the superior canal is involved, nystagmus may be horizontal, vertical or rotary.



BPPV Diagnosis

Because vertigo can arise from various causes, BPPV is sometimes misdiagnosed as Meniere’s disease, central vertigo, vestibular neuritis or even anxiety-related dizziness. A thorough assessment—including the Dix–Hallpike and supine roll tests—is key to distinguishing BPPV from other vestibular disorders.

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 treating Vertigo BPPV

Living with Vertigo BPPV

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. In cases where standard treatment for BPPV is ineffective, vestibular dysfunction or increased sensitivity in the brainstem may be the true cause, leading to prolonged dizziness and balance issues. In such cases, when the vestibular nerve sends normal sensory information to an overly sensitised brainstem, the brain misinterprets these signals as a threat, leading to vertigo episodes.

Many individuals find that simple activities such as getting out of bed, bending down, or turning their head can trigger severe dizziness, nausea, and balance issues. Over time, this can lead to anxiety about movement, reduced confidence in daily tasks, and even avoidance of certain activities to prevent symptom flare-ups. Addressing BPPV early with appropriate treatment can help restore normal movement and improve overall quality of life.

Our approach to treating vertigo

Treatment for BPPV

The gold-standard treatment for the most common type of BPPV, posterior canal, is the Epley Manoeuvre. This physical examination technique places the patient’s head in a series of different 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 Brisbane Headache & Migraine Clinic have often had mixed results with the Epley Manoeuvre, have tried various motion sickness medications and some have even tried surgical intervention. They sometimes have mild results, but it is often short-lived. 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 vertigo then we can start treatment for BPPV right away.

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