Positional vertigo: Info & doctors for positional vertigo

Leading Medicine Guide Editors
Leading Medicine Guide Editors

Dizziness is a common symptom that can indicate various diseases. The best-known and most widespread form of vertigo is benign paroxysmal positional vertigo, or BPLS.

In this guide, you can get more information about positional vertigo and find selected doctors

ICD codes for this diseases: H81.1

Selected doctors for positional vertigo

Brief overview:

  • What is positional vertigo? If the patient suffers from recurring attacks of dizziness as soon as he or she changes position, for example turns or lifts the head, this is called positional vertigo.
  • Symptoms: The rotary vertigo that occurs can last from a few seconds to a maximum of two minutes. This is often accompanied by nausea, vomiting and, in the case of positional vertigo during movements in bed, also sleep disturbances.
  • Causes: With advancing age, the organ of balance in the ear sends conflicting signals to the brain in some people, so that it cannot reconcile the information from the different sensory organs.
  • Diagnosis: An ENT doctor detects the disease through a detailed conversation and a subsequent examination by means of a hearing test and test of the organ of equilibrium.
  • Treatment: During treatment, the patient learns techniques to avoid dizziness and to react to dizziness attacks.
  • Prognosis: The disease can be completely reversed as long as the patient engages in the treatment and consistently follows the doctor's instructions.

Article overview

Definition: What is positional vertigo?

In positional vertigo, sufferers suffer from recurrent attacks of vertigo. They occur whenever the affected person changes his or her position - for example, when lying down, turning, raising or lowering the head.

Positional vertigo is only caused by rapid changes in position. Sitting, lying down or walking, patients are free from vertigo.

It is particularly characteristic that the dizziness occurs with a short time delay after the movement. The dizzy spell lasts on average 30 seconds to a maximum of 2 minutes.

It is a harmless condition, but can severely affect everyday life and quality of life. It is therefore all the more important that those affected learn to live with the symptoms. Acute attacks of dizziness can be significantly alleviated by certain manoeuvres.

Typical symptoms of positional vertigo

In most cases, episodic rotary vertigo occurs, which can last from a few seconds to a maximum of two minutes.

Like other forms of vertigo, positional vertigo is often accompanied by symptoms such as

einher. Older patients in particular also have an increased risk of falling.

Untreated positional vertigo can also lead to avoidance behaviour. This in turn has a negative effect on posture. Last but not least, untreated sufferers are more likely to have depressive moods.

What causes positional vertigo?

In the inner ear , there are small crystals that reinforce the force of gravity on the sensory cells, called otholites (ear stones). Under certain circumstances, they can detach from their original location and migrate into the fluid-filled archway.

The following now happens when the head is moved: The otholites move along and send signals to the brain. However, this cannot compare the incoming information with that of the other organs, such as the eyes. This causes dizziness and balance problems.

Gleichgewichtsorgan im InnenohrThe organ of balance in the inner ear © Henrie - Adobe Stock.

  • The detachment of the otholites is a completely natural ageing process. Positional vertigo therefore usually occurs in older people between the ages of 60 and 80. Lebensjahr auf. Women are affected more often than men.

    Furthermore, the development of benign paroxysmal positional vertigo is promoted by the following factors:

Investigation & diagnosis: What does the doctor do?

If dizziness attacks recur, it is advisable to consult an ear, nose and throat specialist. The family doctor can also be the first point of contact. If necessary, he refers the patient to an ENT specialist or a neurologist.

At the beginning of the examination, a detailed doctor-patient discussion takes place, the so-called anamnesis. This conversation can already give the doctor important clues about the cause of the vertigo.

He then carries out a hearing test and also tests the balance and hearing organs. In this way, he can rule out certain diseases – for example, acute hearing loss.

If he suspects positional vertigo, he can confirm this, for example, with the so-called Dix-Hallpike positional test. He asks the patient to sit upright on the examination couch, turn his head 45 degrees to the side and then lie down.

In benign paroxysmal positional vertigo, the patient now suffers a vertigo attack. It is often accompanied by involuntary, rapid eye movements (nystagmus). The dizziness subsides within a maximum of two minutes.

How is positional vertigo treated?

Treatment with medication or surgery is not an option for benign paroxysmal positional vertigo. Instead, the patient learns techniques to help prevent dizziness or effectively relieve acute attacks of dizziness.

The patient may also receive instructions from the doctor to perform so-called rescue manoeuvres. Two manoeuvres were developed for this purpose: the Eplay manoeuvre and the Brandt-Daroff manoeuvre. This can be used to move the crystals from the archways back into the correct organ (the utricle). 

When carrying out the manoeuvres, there are some instructions to be followed. Therefore, patients should be thoroughly instructed in these exercises by their ENT doctor or by a physiotherapist. There are special positioning trainings for this.

These manoeuvres are very easy to perform, even for non-professionals, and in about 80 % of cases the patients are also completely free of symptoms after the first treatment.

With positional vertigo, it is not a matter of habituation, but rather one eliminates the cause through these exercises.

Progression and prognosis

The prognosis for positional vertigo is good, provided patients are committed to treatment. They must consistently perform the exercises prescribed by the doctor.

Benign paroxysmal positional vertigo can thus regress completely.

In many cases, however, it occurs intermittently over and over again. The affected person can then effectively alleviate or shorten the attacks of dizziness through previously learned relief manoeuvres.


Although positional vertigo is usually harmless, sufferers should not simply ignore the symptoms. In any case, you should consult a specialist to rule out other diseases.

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