Prevalence and Factors Associated with Benign Paroxysmal Positional Vertigo and Falls in Hajj: A Cross-Sectional Study

Abstract

Background and Aim: Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder, typically affecting older adults, and is a recognized cause of vertigo and falls. The physically demanding conditions of Hajj may increase dizziness and fall risk, yet BPPV has not been studied in this mass-gathering context. This study aimed to estimate the self-reported prevalence of BPPV and falls among Hajj pilgrims, and to explore self- reported triggers of dizziness.

Methods: A cross-sectional survey was conducted during Hajj 2022–2023 using a validated Arabic questionnaire adapted from published BPPV screeners. Diagnosis of probable BPPV was based solely on self-reported responses to two screening items (brief vertigo episodes <1 minute provoked by specific positional changes). The questionnaire also assessed demographics, comorbidities, falls, and self-reported triggers of dizziness during religious activities.

Results: Of 183 respondents, 144 were eligible for analysis (mean age=36.8 years; range=16–72). Overall, 22.2% (95% CI: 15.7%–29.9%), reported dizziness, but only 1.4% (95% CI: 0.2%–4.9%) met the self-reported criteria for probable BPPV. The incidence of falls during Hajj was 2.1% (95% CI: 0.4%–6.0%), with no significant association with BPPV. Bowing during prayer was the only religious activity significantly associated with BPPV, although this was based on just two BPPV-positive cases

Conclusion: The prevalence of BPPV was low in this predominantly young sample, limiting generalizability to the wider pilgrim population, which usually includes many older adults. Findings highlight the need for age-diverse, clinically confirmed studies to better understand vestibular health risks during Hajj.