Patient education: Exercises (maneuvers) for benign paroxysmal positional vertigo (The Basics)

What is positional vertigo? — Vertigo is a type of dizziness. One common type is called "benign paroxysmal positional vertigo," or "BPPV." It is sometimes just called "positional vertigo." Vertigo can make you feel like you are spinning, swaying, or tilting, or like the room is moving around you. In BPPV, these symptoms can be caused by changing the position of your head. The symptoms might only last a few minutes, but they can happen again and again.

BPPV is different than feeling dizzy because you stood up too fast. It is often triggered by rolling over in bed or looking up.

BPPV is caused by inner ear problems. Deep inside the ear, there is a small network of tubes filled with fluid. Special calcium deposits float inside that fluid. Together, these tubes and deposits make up the "vestibular system" (figure 1). This system tells the brain what position the body is in. It also helps keep you balanced.

With BPPV, extra calcium deposits form in the inner ear. This can lead to short episodes of vertigo when you move your head in certain ways.

How can exercises help with BPPV? — Certain exercises or "maneuvers" can help move the extra calcium to a part of the inner ear where it will be reabsorbed. Some people feel better right away after these exercises. Others feel better within a few days. You might need to repeat the exercises a few times to help your symptoms. The exercises can also make symptoms like nausea worse while you do them.

It can help to know how to do these exercises at home if your symptoms return. Talk to your doctor or nurse before trying to do these on your own. They can help you figure out which exercises are best for you. If you try to do these without talking to your doctor, you might make your symptoms worse.

What exercises should I do? — Your doctor might show you how to do these exercises or have you work with a physical therapist. They will teach you how often and how long to do the exercises.

●Modified Epley maneuver – This is mostly used if you know which ear has the calcium deposits causing your vertigo.

Hold each position before moving to the next position.

If your right ear has a problem (figure 2):

•Put a pillow toward the end of your bed. Sit far enough away from the pillow that it will be under your shoulders, but not your head, when you lie back.

•Sit on the bed with your legs extended in front of you. Leave room to the side of you so you can roll to your left without falling off of the bed.

•Tilt your head back slightly, and turn your head 45 degrees to the right. This is halfway between looking straight forward and looking over your right shoulder. Hold this position for 30 seconds.

•Lie back quickly with your head in the same position, and hold this position for 30 seconds.

•While on your back, roll your head to the left. Your head should now be tilted slightly back and looking 45 degrees to the left. This is looking halfway between straight ahead and over your left shoulder. Hold this position for 30 seconds.

•Now, hold your head in the same position, and roll onto your left shoulder so you are lying almost face down with your left arm under your body. Your head should still be looking halfway between straight ahead and over your left shoulder. Hold this position for 30 seconds.

•Sit up on the side of the bed.

•Ask your doctor or therapist about when and how often to repeat the exercise.

If your left ear has a problem (figure 3):

•Put a pillow toward the end of your bed. Sit far enough away from the pillow that it will be under your shoulders, but not under your head, when you lie back.

•Sit on the bed with your legs extended in front of you. Leave room to the side of you so that you can roll to your right without falling off of the bed.

•Tilt your head back slightly, and turn your head 45 degrees to the left. This is halfway between looking straight forward and looking over your left shoulder. Hold this position for 30 seconds.

•Lie back quickly with your head in the same position, and hold this position for 30 seconds.

•While on your back, roll your head to the right. Your head should now be tilted slightly back and looking 45 degrees to the right. This is looking halfway between straight ahead and over your right shoulder. Hold this position for 30 seconds.

•Now, hold your head in the same position, and roll onto your right shoulder so you are lying almost face down with your right arm under your body. Your head should still be looking halfway between straight ahead and over your right shoulder. Hold this position for 30 seconds.

•Sit up on the side of the bed.

•Ask your doctor or therapist for instructions about when and how often to repeat the exercise.

●Semont maneuver – This is mostly used if you know which ear has the calcium deposits causing your vertigo.

If your right ear has a problem (figure 4):

•Sit on the edge of the bed, with room on both sides of you. Turn your head 45 degrees to the left. This is looking halfway between straight ahead and over your left shoulder.

•Quickly lie down on your right side with your head still turned to the left so you are looking up at the ceiling. Hold this position for 30 seconds or until any dizziness goes away.

•Quickly sit up and lie down on your left side without stopping in the middle to sit upright. Keep your head turned 45 degrees to the left while changing positions. When you are on your left side, your head will face partly toward the bed or floor. Hold this position for 30 seconds or until any dizziness goes away. Then, sit upright.

•Ask your doctor or therapist for instructions about when and how often to repeat the exercise.

If your left ear has a problem (figure 5):

•Sit on the edge of the bed, with room on both sides of you. Turn your head 45 degrees to the right. This is looking halfway between straight ahead and over your right shoulder.

•Quickly lie down on your left side with your head still turned to the right so you are looking up at the ceiling. Hold this position for 30 seconds or until any dizziness goes away.

•Quickly sit up and lie down on your right side without stopping in the middle to sit upright. Keep your head turned to the right while changing positions. When you are lying on your right side, your head will face partly toward the bed or floor. Hold this position for 30 seconds or until any dizziness goes away. Then, sit upright.

•Ask your doctor or therapist for instructions about when and how often to repeat the exercise.

●Brandt-Daroff exercises – This is mostly used if you are not sure which ear has the calcium deposits causing your vertigo.

For this exercise (figure 6):

•Sit on the edge of the bed in the middle of 1 side.

•Lie down quickly on your left side with your head turned 45 degrees to the right. This is looking halfway between straight ahead and over your right shoulder. Hold this position for 30 seconds or until any dizziness goes away.

•Sit up, and face forward. Wait for any dizziness to go away.

•Lie down quickly on your right side with your head turned 45 degrees to the left. This is looking halfway between straight ahead and over your left shoulder. Hold this position for 30 seconds or until any dizziness goes away.

•Sit up, and face forward. Wait for any dizziness to go away.

•Ask your doctor or therapist for instructions about when and how often to repeat the exercise. Often, they will want you to do this exercise 4 to 6 times, several times each day.

What else should I know? — Some of these exercises are used if you have a problem with only 1 ear. If this is the case, do not do the exercise on the other side. This will not help and can even make the problem worse. Your doctor will tell you if you should do the exercises for both ears or only 1 ear.

Make sure that you understand exactly what you need to do. Ask questions if there is anything you do not understand.

More on this topic

Patient education: Vertigo (a type of dizziness) (The Basics)

Patient education: Vertigo (Beyond the Basics)