Benign Paroxysmal Positional Vertigo (BPPV)

The diagnosis of BPPV is based on certain characteristic clinical findings. Patients with BPPV experience vertigo when moved rapidly into a supine position .The supine position is a position of the body; lying down with the face up, as opposed to the prone position, which is face down.

Typically, these patients experience a sudden onset of Vertigo when rolling over in bed. The duration of the vertigo often cannot be described because the patient quickly moves out of the provoking position and then avoids that position for fear of initiating that other movements precipitate the vertigo, such as straightening up after bending over or looking up suddenly as when reaching for an object on a high shelf. Patients may describe a single occurrence of vertigo, or they may have a long history of episodic vertigo intermixed with periods in which they are symptom-free. Patients with BPPV typically have periods of remission lasting from months to years during which they experience no episodes of vertigo.

Causes of BPPV

The exact etiology of BPPV is often unknown. Many theories exist. One of the most popular theories is forming calcium crystals in the inner ear. Cupulolithiasis. This theory proposes that degenerative debris from the utricle (probably fragments of otoconia-calium crystals- fall onto the copula of the posterior canal, making the ampulla a flask-like dilatation of a tubular structure, especially of the expanded ends of the semicircular canals of the ear gravity-sensitive.

Treatment in Acute attack

Vestibular sedatives.

Once the acute attack is over, one can start doing certain exercise.

Cawthorne Cooksey Exercises in detail

1. In bed or sitting

1. Eye movements — at first slow, then quick

1. up and down

2. from side to side

3. focusing on finger moving from 3 feet to 1 foot away from face

2. Head movements at first slow, then quick, later with eyes closed

1. bending forward and backward

2. Turning from side to side.

2. Sitting

1. Eye movements and head movements as above

2. Shoulder shrugging and circling

3. Bending forward and picking up objects from the ground

3. Standing

1. Eye, head and shoulder movements as before

2. Changing from sitting to standing position with eyes open and shut

3. Throwing a small ball from hand to hand (above eye level)

4. Throwing a ball from hand to hand under knee

5. Changing from sitting to standing and turning around in between


1. Circle around center person who will throw a large ball and to whom it will be returned

2. Walk across room with eyes open and then closed

3. Walk up and down slope with eyes open and then closed

4. Walk up and down steps with eyes open and then closed

5. Any game involving stooping and stretching and aiming such as bowling and basketball

Yoga Neck Exercise

Do these exercise regularly each morning and each evening. Take this exercise regularly for six months and you will see a great deal of difference: Sitting erect, bend the head forward three times, to the back three times, to the right side three times, to the left side three times, and then circle the head each way three times.

Move the head and neck in a figure of 8 movements, slowly.

Don’t hurry through with it but take the time to do it. You will get results.

Don’t do this………………


Don’t do these exercises while you have acute attack of vertigo.