BPPV and Cawthorne’s Exercises

Benign positional vertigo

Benign positional vertigo is the most common type of vertigo. Vertigo is the feeling that you are spinning or that everything is spinning around you. It may occur when you move your head in a certain position.


Benign positional vertigo is also called benign paroxysmal positional vertigo (BPPV). It is caused by a problem in the inner ear.

The inner ear has fluid-filled tubes called semicircular canals. When you move the fluid moves inside these tubes. The canals are very sensitive to any movement of the fluid. The sensation of the fluid moving in the tube tells your brain the position of your body. This helps you keep your balance.

BPPV occurs when a small piece of bone-like calcium breaks free and floats inside the tube. This sends confusing messages to your brain about your body's position.

BPPV has no major risk factors. However your risk for developing BPPV may increase if you have:

  • Family members with BPPV

  • Had a prior head injury (even a slight bump to the head)

  • Had an inner ear infection called labyrinthitis


BPPV symptoms include:

  • Feeling like you are spinning or moving

  • Feeling like the world is spinning around you

  • Loss of balance

  • Nausea and vomiting

  • Hearing loss

  • Vision problems such as a feeling that things are jumping or moving

The spinning sensation:

  • Is usually triggered by moving your head

  • Often starts suddenly

  • Lasts a few seconds to minutes

Certain positions can trigger the spinning feeling:

  • Rolling over in bed

  • Tilting your head up to look at something

Exams and Tests

To diagnose BPPV your health care provider may perform a test called the Dix-Hallpike maneuver.

  • Your provider holds your head in a certain position. Then you are asked to lie quickly backward over a table.

  • As you do this your provider will look for abnormal eye movements and ask if you feel like you are spinning.

If the Dix-Hallpike test doesn't show a clear result you may be asked to do other tests.

Your provider will do a physical exam and ask about your medical history. You may have brain and nervous system (neurological) tests to rule out other causes. These may include:

  • EEG

  • Electronystagmography (ENG)

  • Head CT

  • Head MRI

  • Hearing test

  • Magnetic resonance angiography of the head

  • Warming and cooling the inner ear with water or air to test eye movements. This is called caloric stimulation.


Your provider will do a procedure called Epley's maneuver. It can move the small piece of calcium that is floating inside your inner ear. This treatment works best to cure BPPV. Other exercises don't work as well.

Some medicines can help relieve spinning sensations.

  • Antihistamines

  • Anticholinergics

  • Sedative-hypnotics

However these medicines often do not work well for treating vertigo.

To keep your symptoms from getting worse avoid the positions that trigger it.

Outlook (Prognosis)

BPPV is uncomfortable but it can usually be treated with Epley's maneuver. It may come back again without warning.

Possible Complications

People with severe vertigo may get dehydrated due to frequent vomiting.

When to Contact a Medical Professional

Call your health care provider if:

  • You develop vertigo

  • Treatment for vertigo doesn't work

Get immediate medical help if you also have symptoms such as:

  • Weakness

  • Slurred speech

  • Vision problems

These may be signs of a more serious condition.


Avoid head positions that trigger positional vertigo.

Alternative Names

Vertigo – positional; Benign paroxysmal positional vertigo; BPPV: dizziness- positional


  • Exercises are to be carried out for 4-5 minutes 10-12 times a day. You can expect dizziness to occur when first beginning the exercises. Please be seated while doing them.

  • Eye Exercises Looking up then down – at first slowly then quickly 20 times Looking from one side to the other – at first slowly then quickly 20 times.

  • Head Exercises Bend head forward – then backward with eyes open – slowly then quickly 20 times.

  • Turn head from one side to the other – slowly then quickly 20 times. As dizziness improves these exercises should be done with eyes closed.

  • Sitting While sitting shrug shoulders -20 times.

  • Turn shoulders to the right then left – 20 times

  • Bend forward and pick up objects from group and sit up -20 times

  • Standing Change from sitting to standing and back again -20 times with eyes open

  • Repeat with eyes closed.

  • Throw a small rubber ball from hand to hand above eye level

  • Throw ball from hand to hand under one knee.

  • Moving About Walk across the room with eyes open then closed -10 times Walk up and down a slope with eyes open the closed – 20 times Any game involving stooping or turning is good.

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