Vertigo Exercises: The Epley Maneuver and Other Evidence-Based Treatments

Vertigo Exercises: Epley Maneuver and Evidence-Based Treatments

Vertigo — the sensation that you or the world is spinning — affects approximately 40% of adults at some point in their lives. The most common cause, benign paroxysmal positional vertigo (BPPV), can often be effectively treated with specific repositioning exercises.

What Is BPPV?

BPPV occurs when calcium carbonate crystals (otoliths) in the inner ear become displaced into the semicircular canals. When you move your head, these crystals stimulate the fluid in the canals, sending false movement signals to the brain and causing brief but intense vertigo.

Characteristics of BPPV:

• Triggered by specific head movements (rolling over in bed, looking up, bending forward)
• Episodes last less than 1 minute
• May be accompanied by nausea
• Typically resolves spontaneously within weeks to months

The Epley Maneuver (Most Effective Treatment)

The Epley maneuver repositions the displaced crystals from the semicircular canal back into the utricle where they can't cause symptoms. It has a success rate of 80-90% with a single treatment.

Steps (for right-sided BPPV — the most common):

1. Sit on a bed, turn head 45 degrees to the right
2. Quickly lie back with head still turned 45 degrees right; wait 30 seconds
3. Turn head 90 degrees to the left (now 45 degrees left of center); wait 30 seconds
4. Roll body and head together to the left side (head now facing down-left); wait 30 seconds
5. Slowly sit up

If symptoms occur during the maneuver, you've confirmed the diagnosis and the treatment is working. Repeat 1-3 times per session.

Important: Have someone assist you the first time, as vertigo can cause falls.

Brandt-Daroff Exercises

An alternative for patients who can't tolerate the Epley maneuver or for home maintenance:

1. Sit upright on the edge of the bed
2. Quickly lie down on your side (affected ear down), head at 45 degree angle; wait 30 seconds
3. Return to sitting; wait 30 seconds
4. Lie down on the opposite side; wait 30 seconds
5. Return to sitting

Perform 5 repetitions, 3 times daily for 2 weeks.

When to See a Doctor

Seek medical attention if:

• Vertigo is accompanied by severe headache, double vision, difficulty speaking, or weakness (may indicate stroke)
• Vertigo is constant (not positional) — suggests a different diagnosis
• Hearing loss or tinnitus accompanies vertigo (may indicate Meniere's disease)
• Home exercises fail after 2 weeks

Medical Disclaimer

New or severe vertigo requires medical evaluation to rule out serious causes before attempting home exercises.