Vestibular
Positional Dizziness & BPPV | North Vancouver
The room spins when you roll over in bed or tip your head back at the sink. Most of the time the cause sits in the inner ear, and the right manoeuvre can settle it in a session or two.
What it is
Understanding your positional dizziness / bppv.
Positional dizziness is vertigo, the sense that you or the room is spinning, set off by a change in head position. Rolling over in bed, lying down, looking up to a high shelf, or bending to tie a shoe is enough to trigger it. The single most common cause is benign paroxysmal positional vertigo, or BPPV. At Medstar Sport Physio in North Vancouver, we assess and treat this through a one-on-one physiotherapy appointment, confirming the pattern and building a plan from there. We see patients from across Vancouver and the North Shore, many of whom cross Lions Gate Bridge or take the SeaBus for treatment here.
Inside the inner ear are tiny calcium crystals that normally sit in one spot and help register gravity. In BPPV they come loose and drift into one of the semicircular canals, the looped tubes that detect head rotation. Once they're in the wrong place, ordinary head movements send the brain a burst of false motion signals, and you get a short, intense spin that usually fades within a minute.
Not every spinning sensation is BPPV. Inner-ear inflammation (vestibular neuritis or labyrinthitis), a recent head injury or concussion, vestibular migraine, and age-related changes can produce similar episodes. The pattern of what triggers it, how long it lasts, and what your eyes do during a positional test is how we tell them apart.
What to expect
Classic BPPV often resolves in one or two visits once the right canal is identified and the manoeuvre is performed. Some people need a repeat the following week, and a small number have it recur months later, which is easy to re-treat. If the dizziness doesn't fit the BPPV pattern, your physiotherapist will say so and point you toward the right next step rather than repeating manoeuvres that won't help.
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Common questions
About positional dizziness / bppv.
How is BPPV different from feeling lightheaded?
Lightheadedness, the about-to-faint, woozy feeling, is usually about blood pressure or hydration and isn't position-specific. BPPV is true vertigo: a spinning sensation that fires when you move your head a particular way and settles within seconds to a minute. The trigger pattern is the giveaway, and it's what the positional tests confirm.
Will the Epley manoeuvre make me dizzy during the appointment?+
Briefly, yes. Moving the crystals out of the semicircular canal provokes a short burst of the vertigo you came in with. It's expected, it's a sign we're in the right canal, and it passes quickly, usually within a minute like the spins BPPV normally causes. Most people leave noticeably better than they arrived, and classic BPPV often resolves in one or two visits once the right canal is identified.
Do I need an MRI or to see an ENT first?+
Usually not for straightforward BPPV. We assess first, using Dix-Hallpike and roll testing to confirm BPPV and identify which ear and canal the crystals are in. If the presentation has red flags such as constant dizziness, hearing loss, double vision, severe headache, or neurological signs, that points to a cause other than BPPV, such as vestibular neuritis or labyrinthitis, and we'll refer you to your physician or an ENT rather than treating it as BPPV.
It keeps coming back. Is something seriously wrong?+
Recurrence is common and rarely sinister, because the calcium crystals in the inner ear can dislodge again and drift into a semicircular canal, particularly after a cold, a period in bed, or a knock to the head. A small number of people have BPPV recur months after the first episode, and it is easy to re-treat. Re-treatment works just as well the second time, and we'll show you a home manoeuvre for early episodes.
I got dizzy after a car accident: is this covered by ICBC?+
Yes. Vestibular symptoms after a crash, including BPPV and dizziness tied to a concussion, are covered under ICBC's Enhanced Care model. A recent head injury is itself one of the causes that can produce a spinning sensation similar to BPPV, so the first assessment sorts out which pattern you have and confirms it with the Dix-Hallpike or roll test before treatment starts. Bring your claim number to the first visit and we'll handle the billing.
What actually causes BPPV?+
BPPV happens when tiny calcium crystals in the inner ear, which normally sit in one spot and help register gravity, come loose and drift into one of the semicircular canals that detect head rotation. Once they're in the wrong place, ordinary head movements send the brain a burst of false motion signals, producing a short, intense spin that usually fades within a minute.
Could my dizziness be something other than BPPV?+
Yes. Not every spinning sensation is BPPV. Inner-ear inflammation such as vestibular neuritis or labyrinthitis, a recent head injury or concussion, vestibular migraine, and age-related changes can all produce similar episodes. We tell them apart by the pattern of what triggers your dizziness, how long it lasts, and what your eyes do during a positional test.
Does treatment help my balance in general, or only the spinning episodes?+
Both. Alongside the repositioning manoeuvre that clears the crystals causing positional dizziness, we use balance and gaze-stability retraining to rebuild confidence and cut fall risk, which matters especially for older adults. We also add habituation exercises when motion sensitivity lingers after the spinning itself has stopped, and give you clear home instructions to support the recovery.
Reviewed by Amir Ahmadi, PhD, MSc PT, Registered Physiotherapist, Certified IMS Therapist, College of Physical Therapists of British Columbia (CPTBC). Last reviewed July 2026.
This page is for general information only and does not constitute medical advice, diagnosis, or treatment. Individual presentations vary, and assessment findings and treatment plans differ from person to person. If you are experiencing severe symptoms, neurological changes (numbness, weakness, bowel or bladder changes), or a significant trauma, contact your physician or emergency services. Physiotherapy at Medstar Sport Physio & Health is provided by physiotherapists registered with the College of Physical Therapists of British Columbia (CPTBC).