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Education And Debate

Fortnightly Review: Benign positional vertigo: recognition and treatment

BMJ 1995; 311 doi: (Published 19 August 1995) Cite this as: BMJ 1995;311:489

This article has a correction. Please see:

  1. Thomas Lempert, neurologista,
  2. Michael A Gresty, scientista,
  3. Adolfo M Bronstein, neurologista
  1. aMedical Research Council Human Movement and Balance Unit, Section of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  1. Correspondence to: Dr Lempert

    Summary points

    • Benign positional vertigo is one of the commonest causes of dizziness

    • It is characterised by short attacks of rotational vertigo that are precipiated by head move-ments such as looking up, lying down, or turning over in bed

    • The diagnosis is confirmed by Hallpike positional testing which shows a characteristic torsional nystagmus when the head is reclined and turned to the affected side

    • Benign positional vertigo is probably caused by otoconial debristhat is trapped in the posterior semicircular canal and starts to move when head position is changed quickly with respect to gravity. The concurrent flow of endolymph stimulates the hair cells of the affected canal, causing vertigo

    • The condition can be treated successfully in most patients by a simple manoeuvre of the head that clears the canal from debris

    • Repeated manoeuvres and self guided positional exercises will increase the success rate in those whose condition does not improve after one treatment session

    Dizziness is one of the most common complaints in general practice, and yet doctors often find it difficult to establish a firm diagnosis in individual patients. Benign positional vertigo accounts for about a fifth of the referrals to specialised vertigo clinics1 and is the most commonly missed treatable condition. Fortunately, it can be readily diagnosed by positional testing. Recent insights into its pathophysiology have provided new means of effective treatment that can be applied in clinics.


    The incidence of benign positional vertigo is conservatively estimated to be 64 per 100000 population per year.2 Therefore a general practitioner is likely to see several new patients every year. Age at onset spans from childhood to senescence, but most patients are over 40.3 4 Women are affected about twice as often as men.5

    Symptoms and natural course

    Most patients report attacks of rotational vertigo of between 10 and 20 seconds that …

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