Concussion and Benign Paroxysmal Positional Vertigo

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What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is a short-lived episode of mild to intense dizziness, lightheadedness, nausea, and imbalance that comes about rapidly and can be triggered by changes in head position. Those who suffer from BPPV frequently experience the onset of symptoms when lying down and sitting up from bed. Symptoms typically last no more than 30 seconds, but can be experienced multiple times throughout the day.

Figure 1

How is BPPV associated with concussion?

Concussed patients are often inflicted with BPPV. Otherwise sedentary otoconia, “ear rocks”, can be displaced from the utricle of the inner ear to the semi-circular canals from the impact of head trauma (Figure 1). In these canals the otoconia brush across fine hairs of the inner ear creating a false sense of motion. This false sense of motion brings about the BPPV symptoms.

How is BPPV diagnosed?

The Dix-Halpike Test is a diagnostic tool used to diagnose BPPV. This test is performed by the medical provider positioning the patient: lying down, face up, and legs extended with the patient’s head hanging over the edge of the examination table. The head is placed at a 40-degree angle to both the right and left sides to determine if the BPPV is unilateral or bilateral. This is assessed by the provider observing involuntary eye movement know as nystagmus or simply by the patient stating the presence of symptoms such as dizziness or nausea.

How is BPPV treated?

The Epley Maneuver, performed in office, is a therapeutic maneuver that promotes otoconia to move from the semicircular canal (typically the posterior canal: 85-95%) back to the utricle. This is performed much like the Dix-Halpike test, but for longer durations in order for the otoconia to make their way back to the utricle. Many patients discover immediate relief of their BPPV symptoms. For others, noninvasive vestibular rehabilitation is required for otoconia repositioning.


By Lin Ozan and Mo Mortazavi, MD


Benign Paroxysmal Positional Vertigo (BPPV). Mayo Foundation for Medical Education and Research 2017. Accesses on October 28, 2017 at

Benign Paroxysmal Positional Vertigo in the acute care setting. TD Fife, M von Breven. Neurologic Clinics, 2015 Aug; 33(3): 601-617. accessed on October 28, 2017 at http://www.ncbi.nlm.nih/pubmed/26231274.

Image (Figure 1) courtesy of Midwestern University. Accesed on October 28, 2017 at

The Dix-Hallpike test and the canalith repositioning maneuver. Laryngoscope 2005 Jan; 115(1): 184-187. accessed on October 28, 2017 at