Dizziness and vertigo can happen during pregnancy for many different reasons.
One possible cause is benign paroxysmal positional vertigo, commonly called BPPV. BPPV usually causes short episodes of spinning that are brought on by certain head or body movements.
However, pregnancy does not mean that every dizzy episode is BPPV. New, severe or changing symptoms should be properly assessed rather than diagnosed from a symptom list.
When should you seek emergency help?
Seek emergency medical help if dizziness or vertigo occurs with:
- weakness or numbness of the face, arm or leg;
- facial drooping;
- difficulty speaking or understanding speech;
- new double vision;
- sudden severe imbalance;
- inability to stand or walk;
- fainting or loss of awareness;
- chest pain;
- a sudden severe headache;
- new confusion;
- another new neurological symptom.
Do not wait for a routine appointment or clinic reply.
Call emergency services, such as 108 in India, or arrange urgent transport to the nearest emergency department.
Do not drive yourself.
A sudden loss of hearing in one ear also needs urgent same-day medical or ENT assessment.
Contact your maternity team urgently if you are worried about the pregnancy or have been given specific instructions about symptoms that need immediate review.
What is BPPV?
BPPV is a common inner-ear balance condition.
It can cause a sudden spinning sensation when you:
- roll over in bed;
- lie down;
- sit up from bed;
- look upward;
- bend forward;
- turn your head;
- change position.
The spinning is often brief, but it may be intense. Some people also feel nauseated, unsteady or worried about falling.
The letters BPPV stand for:
- Benign: usually not caused by a dangerous disease;
- Paroxysmal: occurs in sudden episodes;
- Positional: triggered by changes in head position;
- Vertigo: a false feeling that you or the surroundings are moving.
Even though BPPV is usually treatable, similar symptoms can occur with other conditions. A clinician should confirm the cause.
Dizziness during pregnancy can have other causes
Pregnancy can involve physical and hormonal changes, but dizziness should not automatically be blamed on pregnancy.
Possible causes may include:
- BPPV or another balance condition;
- vestibular migraine;
- changes in blood pressure;
- changes in blood sugar;
- medicine effects;
- illness or infection;
- vomiting or reduced intake;
- sleep disruption;
- heart or circulation problems;
- neurological conditions;
- another pregnancy-related or general medical issue.
Sometimes more than one factor may be involved.
Arrange an assessment if the dizziness is new, repeatedly returning, getting worse or different from symptoms you have experienced before.
What information should you give your clinician?
Try to describe exactly what you feel.
Tell your clinician:
- whether the sensation is spinning, faintness, imbalance, floating or something else;
- which movement or position brings it on;
- how long each episode lasts;
- how often it happens;
- whether symptoms occur without movement;
- whether you have nausea or vomiting;
- whether you have a headache;
- whether your hearing changes;
- whether you have ringing or pressure in the ears;
- whether you have blurred or double vision;
- whether you have weakness, numbness or speech difficulty;
- whether you have fainted or nearly fainted;
- whether you have fallen or nearly fallen;
- how the symptoms affect walking and daily activities.
Also provide a complete list of:
- prescribed medicines;
- non-prescription medicines;
- vitamins;
- supplements;
- herbal products.
Tell the clinician how far along you are in the pregnancy and share any advice already given by your maternity team.
How is BPPV diagnosed during pregnancy?
BPPV is diagnosed from your symptoms and a position-based examination.
A trained ENT clinician, vestibular clinician or another appropriately trained healthcare professional may carefully move your head and body into certain positions while watching your eye movements and asking what you feel.
The examination may need to be adapted according to:
- your stage of pregnancy;
- your physical comfort;
- back, neck or mobility problems;
- pregnancy-related concerns;
- how severe your symptoms are.
Feeling dizzy when rolling in bed or looking up can suggest BPPV, but it does not confirm the diagnosis by itself.
There is no reliable home symptom checklist that can prove BPPV or rule out other causes.
How is BPPV treated during pregnancy?
When BPPV is confirmed, a trained clinician may use a carefully chosen repositioning treatment.
This involves moving the head and body through a sequence of positions. The exact approach depends on:
- which ear and balance canal are affected;
- the examination findings;
- your stage of pregnancy;
- your physical comfort;
- neck, back or mobility problems;
- any advice from your maternity team.
The clinician may need to modify the position or choose another approach.
Do not attempt a diagnostic test or repositioning manoeuvre at home to prove that you have BPPV.
Trying the wrong manoeuvre may:
- worsen symptoms;
- increase the risk of falling;
- delay diagnosis of another condition;
- place you in an uncomfortable or unsuitable position during pregnancy.
Treatment should be chosen after an individual assessment.
Do not change medicines or supplements yourself
Do not start, stop, delay or change a medicine, vitamin, supplement or herbal product without advice from an appropriate clinician or pharmacist.
Pregnancy-related decisions need to consider:
- your current health;
- the stage of pregnancy;
- why the medicine or supplement is being used;
- your full medicine list;
- possible interactions;
- advice from your maternity team.
Do not follow medicine or supplement advice simply because it appears online or helped another person.
Speak to the prescriber, pharmacist or maternity team before making a change.
How can you stay safe while waiting for assessment?
Dizziness and imbalance can increase the risk of falling.
While symptoms are active:
- move slowly and carefully;
- sit down if you feel unsteady;
- use support when standing up;
- keep walking areas clear;
- use good lighting;
- wear stable footwear;
- ask for help with activities that feel unsafe;
- avoid carrying a child or heavy object while dizzy;
- avoid locking yourself alone in a bathroom;
- keep a phone nearby when possible.
Do not force yourself into a position that causes severe dizziness.
Avoid:
- driving;
- riding a motorcycle or scooter;
- climbing ladders;
- working at height;
- operating machinery;
- bathing alone if you are at risk of falling;
- remaining alone in an unsafe setting.
Return to these activities should be based on your recovery and individual medical advice.
What should you do if dizziness starts while driving?
Do not continue driving simply because you are close to your destination.
When it is safe to do so:
1. Slow down carefully.
2. Move the vehicle to a safe place.
3. Stop the vehicle.
4. Ask someone for help.
5. Arrange another way to travel.
Do not drive yourself to a clinic or hospital while dizziness, poor balance, visual disturbance or faintness could affect control of the vehicle.
Keep a simple symptom record
A brief record can help during your appointment.
Write down:
- when the episode happened;
- what you were doing;
- which position triggered it;
- how long it lasted;
- whether the room appeared to spin;
- whether you felt faint or unsteady;
- whether you had nausea or vomiting;
- whether you had headache, hearing or vision symptoms;
- whether you fell or nearly fell;
- whether the episode was different from earlier ones.
You do not need to record every small sensation.
Do not use a diary to delay urgent medical care when warning signs are present.
When should you arrange a clinical review?
Arrange an assessment if dizziness:
- is new during pregnancy;
- repeatedly returns;
- continues for a prolonged period;
- is getting worse;
- happens without warning;
- makes walking or normal activities difficult;
- causes a fall or near-fall;
- does not fit a previous diagnosis;
- begins after a medicine or supplement change;
- occurs with headache, hearing or vision changes.
Also arrange another review if symptoms return after treatment or begin to feel different.
Coordinating ENT and maternity care
Tell both the clinician assessing your dizziness and your maternity team about:
- your symptoms;
- test findings;
- planned examinations;
- treatment recommendations;
- medicines and supplements;
- concerns about positioning or comfort.
When one clinician recommends a treatment, medicine, supplement or examination position that concerns you, ask how it fits with your maternity care before making a change.
Good communication between your ENT or balance clinician and maternity team can help ensure that the plan is appropriate for both your symptoms and pregnancy.
Questions to ask at your appointment
You may wish to ask:
- Does my pattern suggest BPPV?
- Could another condition be causing the dizziness?
- Is the position-based examination suitable for me?
- Can the examination or treatment be modified for pregnancy?
- What should I do if the vertigo returns?
- Which activities should I temporarily avoid?
- What symptoms mean that I need urgent help?
- Should my maternity team be informed about the treatment plan?
- When should I arrange follow-up?
Write down the answers so that you and your family understand the plan.
Clinical source and limits
General BPPV assessment and treatment principles in this guide are aligned with the American Academy of Otolaryngology–Head and Neck Surgery BPPV clinical practice guideline. The guideline supports position-based assessment and clinician-directed repositioning when BPPV is confirmed, while also stressing that clinicians should distinguish BPPV from other causes of dizziness and consider fall risk.
Pregnancy can affect comfort, positioning and the appropriate care pathway. This guide cannot determine whether an examination or manoeuvre is suitable for you. Discuss that decision with your maternity team and the clinician assessing your dizziness.
Important medical information
General information cannot diagnose BPPV or provide an individual pregnancy treatment plan.
Do not perform home diagnostic tests or repositioning manoeuvres without guidance from an appropriately trained clinician.
Seek advice from the appropriate ENT or balance clinician, pharmacist and maternity team for decisions about assessment, treatment, medicines and supplements.