Introduction
Vertigo is one of the most common reasons people seek help from a healthcare provider, and Benign Paroxysmal Positional Vertigo (BPPV) is often suspected first—and for good reason. It’s common, easy to diagnose, and highly treatable. But here’s the problem: not all vertigo is BPPV, and many people spend weeks, months, or even years doing the wrong exercises, getting the wrong treatment, or being dismissed because their symptoms don’t fit the classic pattern.
As a Vestibular Physiotherapy clinic, we see countless patients who arrive convinced they have BPPV—only to discover they actually have a completely different vestibular or Neurological condition.
And the sooner you identify when vertigo is not BPPV, the sooner you can get on the right treatment pathway.
Below are the 10 most important clues that your vertigo may not be BPPV, and what you can do next.
1. Important Clue #1: Your Vertigo Lasts Longer Than 60 Seconds
BPPV typically causes brief, position-triggered vertigo lasting 5–30 seconds.
If your spinning lasts:
- Minutes
- Hours
- Days
- Or is constant
…this strongly suggests another vestibular condition, such as Vestibular Migraine, Vestibular Neuritis, or PPPD for example.
What to do:
Seek an assessment with a Vestibular Physiotherapist—long-duration dizziness is never BPPV.
2. Important Clue #2: You Feel Vertigo Even When You’re Completely Still
BPPV is triggered by movement, especially:
- Getting out of bed
- Rolling in bed
- Looking up
- Bending over
- Lying flat
If you feel dizzy at rest, this points to disorders of the inner ear or brain that are not crystal-related, including Vestibular neuritis, or Vestibular migraine for example.
What to do:
If rest doesn’t relieve symptoms, get a Vestibular Physiotherapist to assess your symptoms .
3. Important Clue #3: You Have Severe Headache, Pressure, or Migraine Symptoms
BPPV does not cause:
- Headaches
- Visual aura (flickering lights in your vision)
- Sensitivity to light or sound
- Brain fog
- Motion sensitivity
If these accompany your dizziness, vestibular migraine becomes far more likely.
What to do:
A migraine-focused treatment plan (not an Epley) is required.
4. Important Clue #4: Your Balance Is Poor Even When You’re Not Dizzy
People with BPPV often feel:
- Normal between episodes (however often people can have balance impairment with and immediately post BPPV)
- Only dizzy with positional triggers
If you feel unsteady walking, veering, or rocking/swimming sensations, something else is driving your symptoms—likely a vestibular hypofunction or PPPD.
What to do:
Request a full balance and vestibular function assessment with a Vestibular Physiotherapist.
5. Important Clue #5: You Feel Worse in Busy Environments (Supermarkets, Screens, Traffic)
This is one of the strongest clues of:
- Vestibular Migraine
- PPPD
- Visual Vertigo
BPPV does not get worse in Woolworths, Coles, ALDI, scrolling on your phone, or watching TV.
What to do:
Treatment will require vestibular rehabilitation—not repositioning manoeuvres alone.
6. Important Clue #6: You Have Ear Symptoms (Hearing Loss, Fullness, or Tinnitus)
BPPV affects balance crystals only, not the hearing organs.
If you experience:
- Aural fullness
- Fluctuating hearing
- Persistent tinnitus
- Sound sensitivity
…conditions like Ménière’s Disease, Vestibular Migraine, or Menieres Disease may be the true cause.
What to do:
Request an assessment with a Vestibular Physiotherapist or a Vestibular Audiologist to complete Vestibular Function Testing (VFTs).
7. Important Clue #7: You Recently Had a Virus, Illness, or Stressful Event
If your dizziness started after:
- A viral infection
- A big life stressor
- Hormonal changes
- A concussion
- A panic episode
…it could points to Vestibular Neuritis, PPPD, or Vestibular Migraine.
What to do:
These conditions require early vestibular rehabilitation to prevent chronic dizziness.
8. Important Clue #8: You Don’t Respond to the Epley Manoeuvre
A true BPPV case typically improves:
- Immediately
- Within 1–3 treatments or so
- Or dramatically over a few days
If you’ve had:
- Weeks of Epleys
- YouTube manoeuvres
- GP-guided Brandt-Daroff exercises
…and no change, this is a strong clue it isn’t BPPV.
What to do:
Stop repeating manoeuvres—they can worsen non-BPPV dizziness.
9. Important Clue #9: You Feel Rocking, Swaying, Floating, or Like You’re On a Boat
These sensations are not typical of BPPV and instead suggest:
- PPPD
- Mal de Débarquement Syndrome
- Vestibular migraine
If it feels like the ground moves under you, it isn’t caused by dislodged crystals.
What to do:
Seek a vestibular physiotherapist familiar with central and chronic dizziness conditions.
10. Important Clue #10: Your Symptoms Come With Anxiety, Panic, or Feeling “Out of Body”
Lightheadedness, depersonalisation, derealisation, or panic are common in:
- Vestibular migraine
- PPPD
BPPV does not cause these symptoms, although dizziness can understandably make you worried.
What to do:
You need a combined vestibular and cognitive behavioural management approach.
So What Should You Do If Your Vertigo Isn’t BPPV?
If any of these clues resonate with you, the next steps are clear:
1. Stop assuming it will “go away” on its own.
Non-BPPV vertigo often becomes chronic without treatment.
2. Get a proper vestibular assessment.
A specialist vestibular physiotherapist can diagnose the correct condition within one session.
3. Follow a tailored rehabilitation plan.
Different disorders require different exercises—not all dizziness is treated the same.
4. Consider referral to a Neuro-Otologist if needed.
Conditions like Vestibular Migraine, PPPD, and Ménière’s disease often require medical co-management.
When to See The Vertigo Co
Book an assessment if you:
- Aren’t improving
- Aren’t sure if you have BPPV
- Feel worse in busy environments
- Have hearing or migraine symptoms
- Feel “foggy,” “off,” or “not yourself”
- Have dizziness triggered by anything other than rolling in bed
The earlier we treat the correct diagnosis, the faster you recover!
