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Ears & Hearing Procedures

Vertigo Maneuvres

Medically reviewed by Prof. Dr. Tamer Fawzy, Consultant ENT Surgen

Treatment for benign paroxysmal positional vertigo (BPPV)

What is BPPV?

BPPV is a common reason for dizziness. It can make you feel like you’re spinning, nauseated, and off-balance. This dizziness is most often triggered by changes in your head position, including lying down, rolling over in bed, bending over, or looking up.

BPPV is usually caused by tiny calcium crystals, also called otolith crystals. They get loose in the canals of your inner ear. In your case, the crystals are in your right ear canal in the back, also known as the right posterior canal.

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How do you fix this?

To treat BPPV, you’ll do specific head movements to clear the crystals out of the canal. One of these movements is called the Epley maneuver. The movements may make you feel worse while you’re doing them. Don’t worry! Feeling worse doing the movement is a good sign – it means the crystals are moving. The movements work very well to put the crystals back in place when you do them correctly.

When will I feel better?

After you do the Epley maneuver, you should no longer feel intense dizziness or spinning with certain head movements or body positions. You may still feel mild dizziness, nausea, or imbalance for a few hours to days.

Once your dizziness has improved, it’s OK to go back to your normal activities. If your dizziness doesn’t completely go away or comes back later, you may need to do the Epley maneuver a few more times. Try doing it once every morning until it no longer makes you feel dizzy. Work with a specially trained professional, called a vestibular physical therapist, to try some other maneuvers if these home exercises are not helping enough.

Right Emplay Maneuver

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Sit up in bed with a thick pillow right behind your back. Turn your head Halfway to the right side.

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Keeping your head turned to the right, lie back so your head hangs down slightly beyond the pillow.  Stay in this position until the dizziness stops, and for an extra 30 seconds

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Roll your head to the left side. Be careful not to lift your head up while you do this. Stay in this position for 30 seconds.

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Roll onto your left side and turn your head until you’relooking down into the bed. Stay in this position until the dizziness stops, and for an extra 30 seconds.

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Without turning your head, use your right arm to push yourself back to a sitting position. You may still feel dizzy, which is OK.   

Conditions treated

This procedure can treat the following conditions.

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Frequently asked questions

  • Try doing the exercises once every morning for a week, or until the dizziness goes away. You don’t need to do them several times a day.
  • They are best in the morning since the crystals settle overnight and get easier to move.
  • Once the dizziness is gone, you don’t need to keep doing the exercises. They won’t prevent vertigo from happening again

  • After you do the maneuver, it’s a good idea to keep your head upright for the next few hours to help the crystals settle back in place.
  • After that, you should start moving so your brain can get used to motion again.

  • Some motion sickness medicines, like meclizine (Antivert) or dimenhydrinate
    (Dramamine), can ease your dizziness temporarily, but you still need to do maneuvers to get the crystals back in place.
  • Using these medicines for too long can actually make you dizzier because they don’t allow your brain time to adapt.

  • Most people will clear their crystals after doing these maneuvers two times and feel better within a few days. If you’re still having a lot of dizziness with head movements after a few days, the crystals may not be completely cleared yet, and you may need to do the maneuver some more.
  • Some people have some dizziness that lasts even after that, particularly those who’ve had migraine or motion sickness before.
  • It’s also possible that something other than BPPV is making you dizzy. If your dizziness doesn’t improve with these exercises, we can do tests to check for other causes.

  • These crystals are made from calcium, like your bones. If you have a low vitamin D level, it can make these crystals more likely to fall out of place and get loose. Ask your doctor to check your vitamin D level. We recommend a level above 40.
  • If you have migraine, treating your headaches may also improve your dizziness. You can ask your doctor about taking some supplements every day. Magnesium glycinate (400 mg), riboflavin (400 mg), or CoQ10 (300 mg) may be helpful.
  • A physical therapist who specializes in dizziness, called a vestibular physical therapist, may be helpful. You can go to www.vestibular.org and click on “Find a clinician” to find a therapist near you.

  • Feeling dizzy is scary! Your brain gets tricked into thinking the world is moving or your body is tumbling through space. That triggers fear that you’re going to fall. Feeling scared is your brain’s way of trying to protect you from getting hurt.
  • If the dizziness is getting better but you’re still feeling fear or anxiety, then you may need other treatment. You can ask your primary care doctor for some strategies to deal with anxiety.
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