[3] Symptoms are repeated, brief periods of vertigo with movement, characterized by a spinning sensation upon changes in the position of the head.

[3] When found, the underlying mechanism typically involves a small calcified otolith moving around loose in the inner ear.

[3] Diagnosis is typically made when the Dix–Hallpike test results in nystagmus (a specific movement pattern of the eyes) and other possible causes have been ruled out.

Short-term self-resolution of BPPV is unlikely because the effective cure maneuvers induce strong vertigo which the patient will naturally resist and not accidentally perform.

According to the Barany Society's International Classification of Vestibular Disorders (ICVD), the diagnostic criteria for BPPV include[12] Many people will report a history of vertigo as a result of fast head movements.

The spinning sensation experienced from BPPV is usually triggered by movement of the head, will have a sudden onset, and can last anywhere from a few seconds to several minutes.

The most common movements people report triggering a spinning sensation are tilting their heads upward in order to look at something and when rolling over in bed.

When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially "ear rocks") within the affected semicircular canal causes abnormal (pathological) endolymph fluid displacement and a resultant sensation of vertigo.

In rare cases, the crystals themselves can adhere to a semicircular canal cupula, rendering it heavier than the surrounding endolymph.

Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles, thereby inducing an immediate and sustained excitation of semicircular canal afferent nerves.

BPPV is one of the most common vestibular disorders in people presenting with dizziness; a migraine is implicated in idiopathic cases.

The vestibular labyrinth includes three semicircular canals, which contain fluids and fine hairlike sensors that act as a monitor to the rotations of the head.

Other important structures in the inner ear includes the otolith organs, the utricle and saccule, that contain calcium carbonate crystals(otoconia) that are sensitive to gravity.

[25] It involves a reorientation of the head to align the posterior semicircular canal (at its entrance to the ampulla) with the direction of gravity.

Such people include those who are too anxious about eliciting the uncomfortable symptoms of vertigo, and those who may not have the range of motion necessary to comfortably be in a supine position.

The modification involves the person moving from a seated position to side-lying without their head extending off the examination table, such as with Dix–Hallpike.

Assessment of BPPV is best done by a medical health professional skilled in the management of dizziness disorders, commonly a physiotherapist, audiologist, or other physician.

[1] Vertigo, a distinct process sometimes confused with the broader term, dizziness, accounts for about six million clinic visits in the United States every year; between 17 and 42% of these people are eventually diagnosed with BPPV.

[5][29] The HSM can have better long-term success than the Epley, is more comfortable to experience, and has less risk of causing subsequent horizontal canal BPPV (H-BPPV).

All the maneuvers consist of a series of steps in which the head is held in a specific position, typically for 30 to 60 seconds until any nystagmus stops.

A position has to be held until any nystagmus has completely resided, which indicates that the particles have stopped moving, before one proceeds to the next step.

The Epley maneuver[31] employs gravity to move the calcium crystal build-up from the posterior semicircular canal (resulting in diagonal nystagmus) that causes the condition.

[39] The Half Somersault Maneuver (HSM) is a patient-performed alternative to the Epley for posterior canal BPPV (PC-BPPV).

Compared to the Epley, HSM has better long-term success, with less discomfort, and less risk of causing subsequent horizontal canal BPPV (H-BPPV).

[1][41] This maneuver is generally performed by a trained clinician who begins seated at the head of the examination table with the person supine.

[42] For the superior (also called anterior) semicircular canal, resulting in vertical nystagmus, the Deep head hanging maneuver[33] is used.

These primarily include drugs of the antihistamine and anticholinergic class, such as meclizine[9] and hyoscine butylbromide (scopolamine), respectively.

More dose-specific studies are required, however, in order to determine the most-effective drug(s) for both acute symptom relief and long-term remission of the condition.