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Dr. Dr. Jitendra Prasad Yadav • Consultant Neurologist & Headache Specialist • NMC 8029
Vertigo when rolling over in bed, looking up or bending forward? You may have BPPV (Benign Paroxysmal Positional Vertigo) — the #1 cause of vertigo, treatable with the Epley maneuver (canalith repositioning). Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), provides BPPV diagnosis and treatment at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu.
Nepal Medical Council Reg. No. 8029 • 15+ years National Trauma Center, NAMS • Part of Clinics Tree Healthcare Network
What is BPPV?
BPPV causes brief spinning sensations triggered by head position changes. It's the most common vestibular disorder and highly responsive to office-based repositioning treatment.
Inside your inner ear, calcium carbonate crystals (otoconia) normally sit in the utricle. When these crystals dislodge — often after head trauma, prolonged bed rest, or spontaneously with age — they migrate into one of the three semicircular canals (most often the posterior canal). When you move your head into certain positions, these displaced crystals shift, bending the canal's sensory hair cells and sending false "spinning" signals to your brain.
The result: brief (under 1 minute), intense vertigo triggered by specific head movements — typically rolling over in bed, looking up at a shelf, or bending forward. Between episodes, you feel normal or mildly off-balance.
Diagnosis is clinical and bedside. The Dix-Hallpike maneuver is performed: you sit upright, head turned 45° to one side, then lie back quickly with head hanging slightly off the exam table edge. If BPPV is present, this reproduces vertigo and triggers characteristic rotating eye movement (nystagmus) after a brief delay. The direction and timing of nystagmus tells the clinician which canal is affected (usually posterior canal).
No MRI or CT is needed for typical BPPV. Imaging is reserved for atypical presentations: continuous vertigo, hearing loss, neurological deficits, or negative Dix-Hallpike despite strong suspicion.
The gold-standard treatment is the Epley maneuver (also called canalith repositioning procedure). This is a series of slow, deliberate head and body position changes that use gravity to guide the displaced crystals out of the affected semicircular canal and back into the utricle, where they belong and no longer cause symptoms.
How it works:
Each position is held 30-60 seconds. Vertigo may intensify briefly during the maneuver — this is expected and indicates the crystals are moving. The entire procedure takes 5-10 minutes.
Evidence: The Epley maneuver has a 70-90% success rate within 1-3 sessions for posterior canal BPPV. If symptoms persist after one session, repeat repositioning at a follow-up visit (usually 1 week later) is standard. For lateral (horizontal) canal BPPV, different maneuvers (e.g., barbecue roll) are used.
Post-treatment instructions: Avoid lying flat for the rest of the day; sleep semi-upright (45°) the first night if possible. Mild imbalance or residual dizziness for 24-48 hours is common and not a sign of treatment failure.
BPPV recurs in 15-50% of patients over months to years. Recurrence is more likely after head trauma, prolonged bed rest, or in older adults. Brandt-Daroff exercises (home habituation exercises) may be prescribed for recurrent BPPV to reduce future episodes, but are only introduced after initial repositioning succeeds — attempting them during active BPPV can worsen symptoms.
If vertigo returns with the same positional pattern, return for re-evaluation and repeat Epley maneuver. If the pattern changes (continuous vertigo, hearing loss, headache, neurological signs), re-assessment for other vestibular or central causes is needed.
Not all vertigo is BPPV. Seek urgent evaluation if vertigo occurs with:
These symptoms suggest central nervous system causes (stroke, brainstem lesion) or cardiovascular emergencies, not BPPV, and require emergency care.
Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS), evaluates and treats BPPV at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu. The clinic provides:
No reflexive MRI for typical BPPV. Imaging is discussed only when clinical features suggest alternative diagnoses.
Book BPPV Treatment
Kathmandu Neurology Clinic & Cognitive Center
Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600, Nepal
Phone: 974-7736624 • +977 9747978200
Sun-Sat 9AM-7PM • By Appointment • Near Narayanhiti Palace Museum • 27.7172, 85.3240
Book BPPV Evaluation NowRelated Vertigo & Vestibular Pages
Emergency Red Flags
Seek emergency care immediately if vertigo occurs with sudden severe headache, slurred speech, double vision, facial droop, arm/leg weakness, inability to walk, chest pain, or after head injury — these suggest stroke or cardiovascular emergency, not BPPV.
Page Information
BPPV (Benign Paroxysmal Positional Vertigo) is the most common cause of vertigo, triggered by calcium crystal debris in the inner ear semicircular canals. When you change head position — rolling over, looking up, bending forward — the crystals move and send false motion signals to the brain, causing brief spinning sensations typically lasting seconds to under one minute.
Diagnosis is clinical via Dix-Hallpike positional testing, which reproduces vertigo and characteristic nystagmus (eye movement). At Kathmandu Neurology Clinic & Cognitive Center, Dr. Jitendra Prasad Yadav (NMC 8029) performs this bedside maneuver safely. No MRI or lab is needed for typical BPPV; imaging is reserved for atypical presentations or neurological red flags.
The Epley maneuver (canalith repositioning) is a series of head and body position changes that guide displaced crystals out of the affected canal back into a neutral area where they no longer cause symptoms. Evidence shows 70-90% success within 1-3 sessions. It is performed by a trained clinician — attempting it incorrectly at home can worsen symptoms or affect the wrong canal.
Yes; recurrence occurs in 15-50% of patients over months to years, often triggered by head trauma, prolonged bed rest, or spontaneously. Recurrent episodes warrant re-evaluation and repeat repositioning; some patients benefit from home exercises (Brandt-Daroff) as maintenance, which are prescribed only after initial repositioning succeeds.
No. Vestibular migraine, Meniere disease, vestibular neuritis, central causes including stroke, and medication side effects can all cause vertigo. BPPV is distinguished by brief (under 1 min) position-triggered spinning, absence of hearing loss, and positive Dix-Hallpike. Prolonged vertigo, hearing change, slurred speech, double vision, or limb weakness requires urgent neuro-otologic evaluation.
Seek emergency care immediately if vertigo occurs with sudden severe headache (thunderclap), slurred speech, double vision, facial droop, arm or leg weakness, inability to walk, chest pain, or after head injury. These suggest central causes including stroke, not BPPV.
Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600 — led by Dr. Jitendra Prasad Yadav (NMC 8029), Consultant Neurologist with 15+ years at National Trauma Center (NAMS). Book via /book-appointment or call 974-7736624, Sun-Sat 9AM-7PM by appointment. Bring prior reports if you have vestibular testing or imaging from another center.
Most BPPV resolves with repositioning alone. Vestibular rehabilitation (balance retraining exercises) is considered for residual imbalance after repositioning, recurrent BPPV, or when mixed vestibular disorders coexist. Dr. Jitendra coordinates referral to vestibular physiotherapy when indicated.
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