Why Vertigo Happens Even When Your Brain MRI Is Normal
July 29, 2026
Positional vertigo is a spinning sensation triggered by certain changes in your head position. BPPV (Benign Paroxysmal Positional Vertigo) is the most common cause of positional vertigo.
Many patients experience this as dizziness when lying down or turning in bed, bending forward, or looking up.
As an ENT and vertigo specialist in Navi Mumbai, I meet many patients who feel confused and scared because they aren’t sure whether it’s vertigo or something more serious.
To know more about causes of dizziness and vertigo you can read this detail post about vertigo causes and treatment.
In this blog, I will explain what positional vertigo really is and how you can feel steady again, often without long-term medication.
Positional vertigo is a specific type of dizziness that occurs when you move your head in certain directions or change THE position of your head.
You may feel as if the room is spinning, or your head is moving, even though you’re completely still.
Many people confuse positional vertigo with BPPV. But not all positional vertigo is BPPV. That’s why an expert diagnosis matters.
BPPV is sudden, lasts for few seconds and triggered by movement.
It is one of the easiest forms to treat. In fact, with the right diagnosis, many people feel better in just one visit.
The key difference is position triggers; vertigo happens with certain head movements.
Positional vertigo can have several causes. The most common is benign paroxysmal positional vertigo caused by a mechanical disturbance inside the inner-ear vestibular system.
Other conditions such as central neurological factors or blood pressure drops can also cause dizziness or vertigo with changes in position.
Small calcium crystals (called otoconia) are supposed to stay in one place called vestibule in the inner ear, normally helping you sense gravity.
But when they move into the wrong area (semicircular canals of inner ear), sends wrong signals to the brain especially when you lie down, turn, or look up.
This mismatch between what your eyes see and what your inner ear senses is what causes that sudden, spinning feeling.
Common Triggers of BPPV
BPPV isn’t the only reason someone might feel dizzy during head or position changes.
Other inner ear, neurological or medical conditions can sometimes mimic positional vertigo though they often come with additional symptoms.
Meniere’s disease may cause spinning vertigo similar to BPPV, but it’s usually accompanied by hearing loss, a sense of fullness in the ear, and ringing (tinnitus).
Vestibular migraine can also mimic vertigo, but episodes are often longer and linked to light or sound sensitivity and headaches.
Postural Hypotension or orthostatic hypotension causes dizziness when changing positions from lying to sitting or standing due to a sudden drop in blood pressure.
POTS (Postural Orthostatic Tachycardia Syndrome) is another non-ear-related cause, where the heart rate increases abnormally when standing up, leading to a dizzy or unsteady feeling.
When you visit my vertigo clinic, I begin by listening to your symptoms carefully – what triggers the spinning, how long it lasts and and whether it occurs with particular head or body movements.
Based on your symptoms, I may check pulse and blood pressure in lying and standing positions.
I then perform simple clinical vestibular tests such as observation of eye movements (nystagmus) and an assessment of balance and gait.
Positional testing such as Dix-Hallpike maneuver or supine roll test, can help identify BPPV.
Sometimes special balance tests such as VNG, VEMP, Posturography, Audiometry, an MRI and a referral to a neurologist or cardiologist may be required.
Understanding the cause and correct diagnosis is the first step in choosing the right treatment.
The right treatment of positional dizziness depends on the root cause and if it is BPPV, identifying which semicircular canal is affected.
For BPPV simple head-positioning maneuvers like the Epley, or Semont, can be performed right in the clinic. It reposits the calcium particles and can bring the relief within minutes.
For head trauma or age-related changes, a combination of vestibular physiotherapy and natural recovery time is often helpful.
When positional vertigo symptoms are part of Meniere’s disease or vestibular migraine, targeted medical management is advised.
To learn about Epley’s maneuver, home maneuvers, exercises, and what to do if it keeps coming back, read my step by step guide on BPPV Treatment.
Over the years, I’ve seen patients struggle while searching for a lasting treatment of vertigo. Here are a few things I recommend avoiding:
Most BPPV episodes are not dangerous but it’s important to see a specialist. Early repositioning avoids unnecessary suffering.
These are the red flags where You should see an ENT specialist immediately if:
If you’re unsure if it is positional vertigo or what is causing your spinning, it’s best to consult a certified vestibular or vertigo specialist early.
Dr. Archana Jhawar - ENT & Certified Vertigo Specialist is trained in BPPV and Balance Disorders under mentorship of Dr Srinivas Dorasala and the American Institute of Balance.
She practices at her ENT and Vertigo clinic-Neoalta Clinic Vashi and Kokilaben Hospital, Koparkhairane, Navi Mumbai and also offers Online video consultations.
Hi, I’m Dr. Archana Jhawar, an ENT & Vertigo specialist with 25 years of experience. I specialize in tinnitus, vertigo, ear, nose and throat care, and ENT surgeries. I practice at Neoalta Clinic, Vashi, and Kokilaben Dhirubhai Ambani Hospital in Navi Mumbai.
I have advanced training in vertigo management and REBT(CBT), combining evidence-based care with a compassionate approach. Beyond medicine, I enjoy reading, writing, music, yoga, and photography.
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