Vertigo, the sensation that you or the room around you is spinning, can often be managed at home with specific head maneuvers, exercises, and lifestyle changes. The most common cause is benign paroxysmal positional vertigo (BPPV), which happens when tiny calcium crystals in your inner ear drift into the wrong canal. Other causes include inner ear infections, Meniere’s disease, and, rarely, problems with blood flow to the brain. What you should do depends on what’s triggering your episodes and how severe they are.
What to Do During an Attack
When vertigo hits, your first priority is not falling. Sit or lie down immediately. If you’re near a road, stairs, or uneven ground, move away slowly, keeping your head straight and walking near walls or handrails. Once you’re somewhere safe, lie down and prop your head up with an extra pillow. Focus your eyes on a single fixed spot in front of you.
Bright lights and noise tend to make the spinning worse. Find a quiet, dark space if you can. Close your eyes or use earplugs. Practice slow, deep breathing and sip water. Avoid turning your head to its extreme range in any direction, especially looking straight up or rotating as far as your neck allows. These end-range movements can intensify the sensation.
Most BPPV episodes last under a minute once you stop moving. Vertigo from other causes can persist for hours. Either way, staying still and hydrated helps your brain recalibrate while the worst passes.
The Epley Maneuver for BPPV
If your vertigo is triggered by rolling over in bed, tilting your head back, or looking up, BPPV is the likely cause. The Epley maneuver works by guiding the displaced crystals out of the semicircular canal and back where they belong. A healthcare provider can do this for you in the office, but it’s also possible to perform at home once you know which ear is affected.
The sequence involves five head positions, each held for 20 to 30 seconds. You start sitting upright, then turn your head 45 degrees toward the affected ear. From there, you lie back quickly so your head hangs slightly off the edge of the bed, still turned at that 45-degree angle. Your vertigo will likely spike briefly during this step. Next, you slowly rotate your head to the opposite side, then roll your whole body to match so you’re lying on your side. After holding that position, you sit back up.
Your doctor can confirm which ear is the problem using a test called the Dix-Hallpike maneuver. They’ll guide you from sitting to lying down with your head turned to one side and watch for involuntary eye movements called nystagmus. If your eyes flutter when your right ear faces the floor, the crystals are in your right ear. Getting this diagnosis right matters because the Epley maneuver only works when aimed at the correct side.
Brandt-Daroff Exercises
If the Epley maneuver doesn’t fully resolve your symptoms, or if you’re not sure which ear is affected, Brandt-Daroff exercises offer a gentler alternative. You sit on the edge of a bed, then quickly lie down on one side with your nose pointed toward the ceiling at a 45-degree angle. Hold for about 30 seconds or until the dizziness fades, sit back up, then repeat on the other side. Most recommendations call for several repetitions at least twice a day. These exercises work by gradually habituating your brain to the movements that trigger vertigo, and they can also help reposition crystals over time.
Vestibular Rehabilitation Exercises
For vertigo that lingers for weeks or keeps coming back, vestibular rehabilitation therapy retrains your brain to process balance signals more accurately. A physical therapist typically designs the program, but the exercises themselves are straightforward and done at home.
Gaze stabilization exercises are a core component. You sit about five feet from a wall and fix your eyes on a target at eye level. While keeping your gaze locked on the target, you shake your head side to side (like saying “no”) for one minute. The same exercise works with up-and-down nodding. As your tolerance improves, you progress from sitting to standing, then to walking toward the target and back. The goal is to keep the target in clear focus even as your head moves faster.
Habituation exercises take a different approach. Instead of stabilizing your gaze, they deliberately expose you to the motions that provoke dizziness. You might sit in a chair and slowly turn your head and eyes to the left, hold for two to three seconds, then turn to the right. Starting with 5 to 10 repetitions while seated, you eventually work up to 15 to 20 repetitions with your eyes closed, then progress to turning your head side to side while walking. Over weeks, your brain learns to tolerate these movements without triggering a vertigo response.
A third type involves rotating your head and torso together while tracking your thumbs with your eyes. You sit upright, clasp your hands with thumbs up, and rotate left and right 10 times. Later levels add standing, faster rotations, and standing on a thick pillow to challenge your balance further.
Dietary Changes for Meniere’s Disease
If your vertigo comes with hearing loss, ringing in the ears, or a feeling of fullness in one ear, Meniere’s disease may be the cause. This condition involves excess fluid pressure in the inner ear, and sodium is a major driver of that pressure. Keeping daily sodium intake under 2 grams (about 2,000 milligrams) is the standard dietary recommendation. That’s tighter than the general guideline of 2,300 milligrams for heart health, so it requires real attention to food labels.
Cutting sodium means cooking more from scratch, avoiding canned soups and processed meats, and watching for hidden salt in bread, condiments, and restaurant meals. Caffeine and alcohol can also worsen Meniere’s symptoms for some people by affecting fluid balance in the inner ear. Staying well-hydrated with water, paradoxically, helps your body regulate that fluid more effectively.
Medications That Help
Over-the-counter meclizine (sold as Antivert or Bonine) is the most commonly used medication for vertigo. It suppresses the signals from your inner ear that create the spinning sensation. The typical dose ranges from 25 to 100 milligrams per day, split into smaller doses throughout the day. It works best for acute episodes rather than long-term use, since taking it continuously can actually slow your brain’s ability to compensate for the underlying balance problem.
Prescription options include anti-nausea medications and, for severe episodes, sedatives that calm the vestibular system. These are generally reserved for short-term relief during intense flare-ups. For Meniere’s disease, a diuretic (water pill) is sometimes prescribed to reduce inner ear fluid pressure.
Ginger, despite its reputation as a natural remedy for motion-related nausea, has not been shown to reduce vertigo itself in clinical research.
Warning Signs That Need Emergency Attention
Most vertigo is benign, but it can occasionally signal something serious. Vertigo is actually the most common warning symptom before a stroke affecting the back of the brain. What makes this tricky is that fewer than 20% of these stroke patients have obvious neurological signs like facial drooping or arm weakness.
Get emergency help if your vertigo comes with any of these:
- Sudden, severe headache or neck pain, which may point to a blood vessel problem
- Sudden hearing loss combined with vertigo, which carries a higher stroke risk than either symptom alone
- Difficulty walking, limb coordination problems, or weakness on one side
- Double vision, slurred speech, or difficulty swallowing
- Vertigo after a neck injury, vigorous sports, or neck manipulation, which can be linked to a torn artery in the neck
Heart rhythm problems can also cause spinning sensations that mimic inner ear vertigo. If your episodes come with a pounding or irregular heartbeat, chest pressure, or fainting, that’s a different kind of urgent evaluation.