Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of brief spinning vertigo. The Epley maneuver (canalith repositioning) is a set of head and body movements used to treat the usual form — loose crystals in a semicircular canal, most often the posterior canal.
What BPPV is
Tiny calcium crystals (otoconia) normally sit in a gravity-sensing part of the inner ear. In BPPV, some crystals move into a semicircular canal.
When you change head position — rolling in bed, looking up, lying back — the crystals shift and briefly confuse the balance signal.
Typical pattern:
- Spinning lasts seconds (sometimes up to about a minute), not hours of continuous spinning
- Triggered by position change
- Nausea is common; hearing loss and neurologic deficits are not expected from simple BPPV
Continuous vertigo, new weakness, facial droop, speech trouble, double vision, severe headache, or inability to walk needs urgent evaluation for other causes — including stroke — not a home Epley first.
The office test: Dix-Hallpike
The Dix-Hallpike test helps diagnose posterior-canal BPPV.
In clinic, you sit, turn your head about 45 degrees toward one ear, then lie back quickly with the neck slightly extended so that ear is down. The clinician watches your eyes.
A positive test for posterior-canal BPPV usually shows:
- A short delay, then spinning and characteristic eye movements (nystagmus)
- Symptoms that match the short, fatigable pattern of BPPV
The test tells us which side is involved. That side matters for treatment. Home maneuvers work best after the diagnosis and side are clear.
Epley maneuver (treatment)
The Epley maneuver uses gravity to walk the crystals out of the canal and back where they belong. It is often done in the office. Many people can also do a home version after they have been shown which ear is affected and how to move safely.
Home outline (only after your clinician confirms BPPV and the side)
You will need a bed and a pillow under your shoulders so your head can recline slightly. Someone nearby is helpful the first times, because brief vertigo during the moves is expected.
Example for right-ear posterior-canal BPPV (mirror the turns for the left ear):
- Sit on the bed. Turn your head about 45 degrees toward the affected (right) ear.
- Lie back with the pillow under your shoulders and head reclined, keeping the head turned. Hold about 30 seconds (or until spinning eases).
- Turn your head 90 degrees toward the left (now about 45 degrees toward the good side). Hold about 30 seconds.
- Roll your body and head another 90 degrees onto your left side so your nose points partly toward the bed. Hold about 30 seconds.
- Sit up slowly from that side.
Your clinician may ask you to repeat this several times a day until you have been free of positional spinning for about 24 hours. Follow their schedule. Routine long “sleep upright for a week” restrictions are no longer required for everyone after repositioning — ask what applies to you.
Do not use a home Epley as the first step if
- Stroke warning signs are present
- The diagnosis is unclear (continuous vertigo, new hearing loss, neurologic symptoms)
- You have significant neck or spine disease, unstable neck injury, or high fall risk without help
- You do not know which ear is affected
Wrong diagnosis or wrong-side maneuvers can fail or worsen symptoms. ENT or vestibular physical therapy is the safer next step when the picture is atypical.
Vestibular therapy
Vestibular rehabilitation therapy (VRT) is a physical-therapy approach for dizziness and imbalance. For BPPV it may include repositioning and, when needed, exercises for gaze stability, habituation, and balance.
Referral is useful when:
- Symptoms persist after repositioning
- Balance or fall risk remains
- BPPV recurs often and you need a supervised plan
- The pattern is mixed with other vestibular problems
BPPV often responds well to repositioning. It also recurs in many people over months or years. If it returns and you were previously taught a side-specific home maneuver, you may reuse that plan — or return for re-testing if the pattern changed.
When to seek care now
- Sudden severe headache, weakness, facial droop, speech difficulty, double vision, or inability to walk
- New hearing loss with vertigo
- Vertigo that is continuous rather than brief and positional
- Falls, head injury, or inability to keep fluids down from vomiting
Disclaimer
This is general lifestyle-medicine education. It is not medical advice, diagnosis, or a treatment plan. Supplement use, vertigo maneuvers, and cancer screening decisions depend on your history, medications, and risk. Discuss plans before starting supplements, trying home repositioning, or ordering elective screening tests.
These pages are here to orient you before and after your visit when you review lab results. Your conditions, medications, and overall health all shape how we read the numbers. We'll use the visit to discuss the labs as they apply to you.