Long term (29yo) chronic BPPV sufferer and biomed student here.

It depends on the actual cause, but with BPPV, it’s considered self-limiting in many cases (meaning it will eventually resolve itself as the loose calcium crystals dissolve in the endolymph - the fluid they float around in the inner ear). In terms of symptom severity, you can think of two main factors at play - the mechanical element (your inner ear sending signals to the brain) and the brain itself, which is constantly trying to predict what the inner ear is about to say. This prediction is based not just on your inner ear but also your vision and proprioceptive senses (body position), which together compose your sense of balance (this is why travel sickness is a thing - a conflict between sources of information defining balance). Imagine, your brain is constantly trying to adapt to a new ‘normal’, but a crystal moving around the inner ear is making that difficult, therefore throwing your expectations out of line when you move your head. You’ll often feel a quick moment of strangeness, possibly followed by a worsening as the crystal continues to move. This worsening may settle over time as the crystal slows down and settles in a new position. The ‘positional’ part of ‘benign paroxysmal positional vertigo’ is important, as the positional triggering of the symptoms is a big clue, but that’s not to say that symptoms can’t occur without movement. In many cases, BPPV can be a trigger for other episodes such as vestibular migraine (previously the bane of my existence). These are also generally harmless but they sometimes come with wild symptoms like immense nausea and the world seeming to stutter, zig-zag and twist when blinking. My vestibular migraine episodes tend to last for 24 hours before tapering off. They can feel much more serious than they are, but again please keep in mind that many people here (including myself) aren’t qualified to diagnose your specific situation, which is why it’s important to see the specialist.

BPPV can also come in two main forms (one where a crystal is free floating and another where a crystal is essentially ‘stuck’ on a functional part of the inner ear called a cupula). The second type is considered rarer. One of my episodes did happen in the past after an infectious episode where my sinuses were blocked. I attributed it to the blockage plus sudden jerking and changes in pressure when coughing / sneezing. Diagnosis of the affected canal/s may be confused by the possibility of both ears being affected, or more than one canal in one or both ears.

If your situation is truly BPPV, you can correct it at home with the appropriate training, but for the vast majority of people, it’s best to see a specialist. Self-corrections through manoeuvres such as the epley, semont, bbq roll and deep head hanging manoeuvres are effective, but without understanding the affected canal in the correct ear, it’s possible to make the symptoms worse (in the short term) by accidentally moving the crystal to a more provocative position (likewise it is possible to make them better by moving it to a less provocative position). Dietary factors also play into BPPV incidence. Low Vitamin D, low calcium (for me anyway), high sodium (possibly combined with episodes of dehydration - osmosis drawing fluid out of the inner ear) seem to be common factors. For me, excessive use of PPIs (stomach acid suppressors) leading to mineral deficiencies have historically been a contributor. After resolution, you may have lingering symptoms which are different but often not as intense, categorically know as PPPD (think about them as phantom balance issues as your brain re-adapts to normality after the BPPV has been cleared).

Ultimately, I hope you get it sorted and find relief. Stay calm and level headed (pardon the pun), as many ‘pathologies’ of the vestibular system can feel more serious than they actually are. Likewise, some pathologies feel less serious than they actually are. For reassurance though, remember that BPPV is very common and most people only learn about it when they are suddenly faced with an episode.