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Vertigo / BPPV: Discharge Information

Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. It is a benign (not life-threatening), balance disorder of the inner ear that causes sudden (or paroxysmal) episodes of mild to severe vertigo.

It is positional because it is triggered by changes to your head’s position. These positions include tipping your head up or down, lying down, or when you turn over or sit up in bed. Symptoms come and go and usually last for less than a minute. Episodes can also disappear for some time and then recur. 

Symptoms of BPPV

  • Dizziness - a sense that you or your surroundings are spinning
  • Jumping eyes (known as nystagmus)
  • Loss of balance or unsteadiness
  • Nausea and/or vomiting

BPPV occurs when tiny calcium crystals, called otoconia, dislodge from their normal location in the utricle, a sensory organ in the inner ear. Once dislodged, these crystals float freely in the fluid of the inner ear including into the semicircular canals, which sense rotation of the head. Due to gravity, the crystals usually settle in the posterior semicircular canal as it’s the lowest part of the inner ear. When the crystals are disturbed by head movement, they cause shifts that then cause the symptoms of BPPV.

The most effective treatments for BPPV are physical maneuvers (movements) that reposition and remove the crystals from the semicircular canal. One of the most effective maneuvers is called the Epley Maneuver.

The basic steps of the Epley Maneuver is to start by turning your head to the affected side so the crystals begin to move. Then you turn to the other side to continue to move the crystals through the semicircular canal and back to their normal location.

If your right ear is the affected ear, the steps are as follows:

  1. Sit up in bed, with a pillow set-up behind you, and turn your head to the right side.
  2. Keep your head turned to the right side and lie back. Stay in this position for about 1 minute or until your symptoms stop.
  3. Without lifting your head, turn your head to the left side for about 1 minute.
  4. Turn your whole body to the left side and continue to turn your head so your nose is pointing to the floor for about 1 minute.
  5. Sit up slowly on the left side and tilt your head forward for about 1 minute.

If your left ear is the affected ear, the steps are as follows:

  1. Sit up in bed, with a pillow set-up behind you, and turn your head to the left side.
  2. Keep your head turned to the left side and lie back. Stay in this position for about 1 minute or until your symptoms stop.
  3. Without lifting your head, turn your head to the right side for about 1 minute.
  4. Turn your whole body to the right side and continue to turn your head so your nose is pointing to the floor for about 1 minute.
  5. Sit up slowly on the right side and tilt your head forward for about 1 minute.

Your health care provider will review the Epley maneuver with you on the affected ear. Follow the guidance provided by your care team, which may include the following daily routine:

  • Repeat the maneuver three times a session, for three sessions a day until you have been symptom-free for 24 hours
  • Please see the guides on how to perform the Epley maneuver in the additional resources section

Return to the Emergency Department if you experience any of the following symptoms:

  • New, different or severe persisting dizziness
  • New, different or severe headache
  • Fevers
  • Loss or change in vision
  • Difficulty speaking
  • Numbness or tingling
  • Leg/arm weakness or difficulty walking
  • Loss of consciousness
  • Seizures

These evidence-based resources provide more information about BPPV:

The content on this webpage is to be used as a supplement to the instructions provided to you during your Emergency Department visit. The content, including information and instructions, provided on this website are not to be used as medical advice, diagnosis or treatment. If you are experiencing an emergency, please call 9-1-1 or go to the closest emergency department.