Positional vertigo
Michael von Brevern MD (
Dr. von Brevern of Charité University Hospital has no relevant financial relationships to disclose.
Thomas Lempert MD (Dr. Lempert of Charité University Hospital has no relevant financial relationships to disclose.)
Douglas J Lanska MD FAAN MS MSPH, editor. (
Originally released July 12, 2001; last updated November 11, 2019; expires November 11, 2022
This article includes discussion of positional vertigo and positioning vertigo. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
Positional vertigo is triggered by and occurs after a change of head position in space relative to gravity. The most common cause is benign paroxysmal positional vertigo, which can be cured highly effectively with positioning maneuvers. The differentiation from central positional vertigo is discussed by the authors. This article includes a rare differential diagnosis to positional vertigo: light cupula. Patients with this condition present with persistent geotropic positional nystagmus in both lateral head positions. Alcohol consumption and vestibulocerebellar lesions need to be ruled out. This type of nystagmus can be best explained by changes of the density of the cupula that render this organ sensitive to head changes with respect to gravity.
• Positional vertigo is triggered by and occurs after a change of head position in space relative to gravity.
• The most common cause of positional vertigo is due to canalolithiasis of the labyrinth.
• Central positional vertigo should be suspected when features of nystagmus differ from those of benign paroxysmal positional vertigo, or when brainstem and cerebellar signs are present.
By definition, positional vertigo is triggered by and occurs after a change of head position in space relative to gravity (Bisdorff et al 2009). Some authors distinguish between positional and positioning vertigo. The former term has been used for vertigo that continues as long as the head is kept in the provocative position, whereas the latter term is used for vertigo that subsides when the head remains in the critical position (Brandt 1990); however, this nomenclature has not been widely accepted, as it does not reliably allow to separate peripheral from central vestibular disorders.