Most cases of BPPV (benign paroxysmal positional vertigo) can be treated at home using specific head movements that guide displaced crystals out of your inner ear’s semicircular canals. These repositioning maneuvers resolve symptoms in roughly 64% to 93% of people, often within one or two sessions. The two most effective options for home use are the Epley maneuver and the half-somersault (Foster) maneuver.
Why Home Maneuvers Work
BPPV happens when tiny calcium crystals called otoconia break loose and drift into one of the semicircular canals in your inner ear. These canals detect rotation, so when loose crystals shift around inside them, your brain gets a false motion signal. The result is brief but intense spinning triggered by specific head movements: rolling over in bed, looking up, or bending forward.
Repositioning maneuvers use gravity to float those crystals back out of the canal and into a chamber where they no longer cause problems. You move your head through a sequence of positions, pausing at each one so the crystals can settle and migrate in the right direction. No medication is involved, and the maneuvers take only a few minutes.
How to Do the Epley Maneuver at Home
The Epley maneuver is the most studied treatment for posterior canal BPPV, which accounts for the vast majority of cases. At a two-week follow-up, the Epley has shown a success rate around 93%. You’ll need a bed or flat surface and a pillow placed so it will rest under your shoulders (not your head) when you lie back. Before starting, you need to know which ear is affected. The side that triggers dizziness when you turn toward it during a Dix-Hallpike test is your affected side.
These instructions are for the right ear. Mirror them for the left.
- Position 1: Sit upright on the bed with your legs extended. Turn your head 45 degrees to the right.
- Position 2: Keeping your head turned, quickly lie back so your shoulders land on the pillow and your head reclines, touching the bed. Hold for 30 seconds. You may feel a burst of dizziness here, which is normal and means the crystals are moving.
- Position 3: Without lifting your head, turn it 90 degrees to the left so you’re now looking 45 degrees to the left. Hold for 30 seconds.
- Position 4: Roll your body onto your left side while turning your head another 90 degrees so you’re facing the floor at a downward angle. Hold for 30 seconds.
- Position 5: Slowly sit up on the left side of the bed.
Wait 15 minutes before standing. If dizziness returns, you can repeat the maneuver up to three times in a single session. Many people need two or three repetitions before the crystals fully clear.
The Half-Somersault (Foster) Maneuver
The half-somersault is a good alternative if the Epley is difficult for you, particularly because it doesn’t require you to extend your neck backward over the edge of a bed. Research comparing the two found the half-somersault was equally effective at reducing crystal burden in the canal, and patients were actually less likely to experience treatment failure when using it at home for recurrences. The trade-off is that you may need to perform more repetitions per episode.
For right-sided BPPV:
- Step 1: Kneel on the floor and tip your head back to look at the ceiling briefly.
- Step 2: Place your head on the floor in front of you, tucking your chin toward your knees (like you’re about to do a somersault, but you won’t actually roll). Wait for any dizziness to subside, or hold 15 seconds if there’s none.
- Step 3: Turn your head about 45 degrees toward your right shoulder, so you’re facing your right elbow. Hold until dizziness stops or for 15 seconds.
- Step 4: Keeping that 45-degree turn, raise your head to back and shoulder level (so your head is now level with your spine while you’re on all fours). Hold again.
- Step 5: Keeping the 45-degree angle, raise your head to the fully upright kneeling position.
Wait 15 seconds between each position change. You can repeat the maneuver after a brief rest if symptoms persist.
What to Do After Treatment
The first 24 to 48 hours after a successful maneuver matter. Following a few positioning guidelines helps prevent the crystals from sliding back into the canal before they fully settle.
On the first night, sleep semi-recumbent with your head at roughly a 45-degree angle. A recliner chair works well, or you can prop yourself up with pillows on a couch. During the day, try to keep your head vertical as much as possible.
For at least one week after treatment, use two pillows when sleeping and avoid sleeping on the affected side. Try not to put your head in positions that originally triggered the vertigo: looking straight up, bending far forward, or quickly tilting your head to the affected side. These precautions aren’t permanent. They’re just a buffer while the crystals resettle in a stable location.
When Home Treatment Doesn’t Work
If you’ve done the maneuvers correctly several times over a few days and your vertigo hasn’t improved, a few things could be going on. You might be treating the wrong ear, the crystals could be in a different canal (the horizontal or anterior canal rather than the posterior), or the underlying cause may not be BPPV at all.
Traumatic BPPV, caused by a head injury or whiplash, tends to be more resistant to treatment. It often involves a larger amount of displaced crystals and sometimes affects more than one canal. Multiple treatment sessions over weeks are typically needed.
Certain symptoms suggest the problem is not BPPV and needs prompt medical evaluation: dizziness that lasts minutes to hours rather than seconds, nystagmus (involuntary eye movement) that changes direction without any head movement, double vision, difficulty walking or coordinating movements, severe vomiting, or new hearing loss. These patterns can indicate a problem in the brain rather than the inner ear.
Who Should Avoid Home Maneuvers
The Epley maneuver requires significant neck movement, including backward extension. If you have cervical spine problems such as spondylosis, a herniated disc, previous neck fracture, or rheumatoid arthritis affecting the cervical spine, the maneuver could be harmful. In rare cases, forceful neck manipulation has been associated with a risk of atlantoaxial dislocation. The half-somersault places less stress on the neck but still involves forward flexion and head turning.
It’s also worth noting that dizziness triggered by neck movement isn’t always BPPV. Cervicogenic vertigo, caused by abnormal signals from neck structures or reduced blood flow in the vertebral artery, can mimic it. If your dizziness seems tied to neck position rather than head position relative to gravity, a clinician can help distinguish between the two.
Recurrence and Long-Term Management
BPPV recurs in a significant number of people, sometimes months or years after a successful treatment. The good news is that once you’ve learned the maneuvers, you can treat recurrences immediately at home. Many people who’ve had BPPV keep a printed set of instructions nearby so they can act quickly when symptoms return, often resolving an episode within minutes.
Brandt-Daroff exercises, a series of side-to-side movements done while seated on a bed, are sometimes recommended as a daily maintenance routine for people with frequent recurrences. They’re less effective than the Epley or half-somersault for acute episodes, but they may help dislodge small amounts of debris before it accumulates enough to cause full-blown vertigo.