Patients suffering from recurrent spells of vertigo, lasting a few minutes per spell, associated with changes in head position (often provoked by rolling over in bed), usually have benign paroxysmal positioning vertigo (BPPV) The term “positioning vertigo” is more accurate than “positional vertigo” because it is provoked by changes in head position rather than by the maintenance of a particular posture The typical symptoms of BPPV occur in clusters that persist for several days There is a brief (10–15 sec) latency period following a head movement before symptoms develop, and the acute vertigo subsides within 10–60 seconds, though the patient may remain imbalanced for several hours Constant repetition of the positional change leads to habituation Since some CNS disorders can mimic BPPV (eg, vertebrobasilar insufficiency), recurrent cases warrant head MRI In central lesions, there is no latent period, fatigability, or habituation of the symptoms and signs

Treatment

of BPPV involves physical therapy protocols (eg, the Epley maneuver or Brandt-Daroff exercises), based on the theory that it results from free-floating otoconia within a semicircular canal