What Is the Best Treatment for Vertigo from BPPV?

Vertigo is a terrible feeling. The world spins around you and you may feel unsteady or nauseated. While there are many possible causes of vertigo, the most common is a condition called benign paroxysmal positional vertigo (BPPV). The condition occurs when the calcium crystals in the posterior canal of the ear come loose and start floating where they do not belong. The best treatment for vertigo from BPPV is to get these calcium particles back in their proper place, usually through a series of head movements. How can you learn what the proper movements are?

What is Vertigo from BPPV?

Vertigo is one of those terrible terms that really doesn’t describe what is going on. Here is how the AMA described it on March 15, 2024 in an article titled:

“What doctors wish patients knew about vertigo”

The author of the article consulted Benjamin Wycherly, MD, an otolaryngologist who has a lot of experience with vertigo:

“Vertigo is a feeling like you’re in motion. Things are moving or you’re moving when you’re really not,” Dr. Wycherly said, noting “we often talk about dizziness, which is more of a broad term. Vertigo is a more specific type of dizziness. It’s that sense that you’re moving.”

I wish I could tell you that Dr. Wycherly’s description is satisfying for me. I have had vertigo from BPPV, and that explanation doesn’t quite do it for me.

An article ion JAMA (April 23, 2026) is a bit more helpful. It is titled:

“Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo”

“Clinical Presentation

“BPPV typically presents with brief (<1 minute) recurrent episodes of vertigo triggered by certain head movements—most specifically lying down or turning over in bed. Some patients with BPPV report nonspinning dizziness (eg, lightheadedness or unsteadiness without vertigo) or continuous dizziness with positional worsening instead of only isolated brief positionally triggered symptoms.”

Is that a bit more helpful?

Misdiagnosis of Vertigo from BPPV

Expert otolaryngologists who frequently treat vertigo from BPPV have confided to us that this condition is frequently misdiagnosed by other healthcare professionals. It is not uncommon for these folks to prescribe the drug meclizine to treat “dizziness” or “vertigo.” Here is the no-nonsense simple response from the JAMA article cited above:

“Meclizine is not an effective treatment for BPPV and may cause unnecessary sedation.”

It is absolutely critical for a patient with vertigo to be diagnosed correctly! Some people with general vertigo or “dizziness” may be experiencing a stroke. If so, that requires immediate emergency treatment.

An article in the Journal of Emergency Nursing (April 22, 2026) describes just such a situation:

“A 76-year-old male with vascular risk factors presented to a satellite emergency department with sudden-onset dizziness described as ‘the room is spinning.’ Without imaging or a structured bedside assessment, he was diagnosed as having benign paroxysmal positional vertigo and transferred for admission.”

An MRI scan revealed a stroke. The author of this article noted that:

“Anchoring on ‘room spinning’ led to a missed opportunity for timely stroke activation.”

How Is Vertigo from BPPV Diagnosed?

Vertigo from BPPV is actually very common, affecting at least 50% of vertigo problems. We wish that all healthcare professionals were trained in performing the Dix-Hallpike test, which is the standard for diagnosing BPPV. There is an instructional video at this link from Michigan Medicine University of Michigan Vestibular Rehabilitation. These professionals also provide a QR code that will take you to a video of the Epley Maneuver to overcome vertigo from BPPV.

The only thing that is not included in this video is assistance from a health professional or a friend or family member. I personally prefer to have someone assist both with the diagnosis and treatment phase of these procedures. When trained professionals perform the Dix-Hallpike test, they will watch for nystagmus, or movement of the eye while the dizziness occurs. It will help determine which ear is affected.

Here are some videos so you can see what the eye movements look like:

Dix-Hallpike Test 1 video

Dix-Hallpike Test 2 video

I do like this video by Dr. Peter Johns:

If all this seems too complex, please have a well-trained health professional perform both the Dix-Hallpike test and the Epley Maneuver.

More Web-Based Instructions for Vertigo from BPPV:

A simple repositioning maneuver has been recommended to correct BPPV. Some audiologists help patients perform this maneuver, but not everyone has access to an audiologist. Korean researchers tested whether they could treat BPPV successfully by providing web-based video instructions (JAMA Neurology, Jan. 17, 2023).

They recruited 585 patients and randomly assigned half to the video instruction. 72 percent of those performing the maneuver and 43 percent of those in the control group resolved their vertigo. The authors concluded that people with recurrent BPPV can benefit from web-guided self-treatment.

An earlier issue of that journal offers a case report from Germany (JAMA Neurology, Jan. 9, 2023). These authors offer video links to the diagnosis and a demonstration of the SémontPLUS maneuver.

I discovered a YouTube video that demonstrates the SémontPLUS maneuver

I have to admit that this technique looks a tad challenging for do-it-yourselfers. If you can find a health professional who knows how to oversee the technique, I would feel more comfortable. I worry that someone might fall while undertaking this approach, and that would be very dangerous.

What Is the Best Treatment for BPPV?

Q. I read in your newsletter that supplements of vitamin D and calcium might prevent recurrences of benign paroxysmal positional vertigo (BPPV). I’ve been taking vitamin D and calcium for years. I still got BPPV, which made my head spin.

My neurologist referred me for PT. The therapist did the Epley maneuver twice on my first visit and repeated it again later. It worked like magic! Now if I think the vertigo is returning, I try to do it myself at home.

The Value of Vitamin D for BPPV:

A. People who are low in vitamin D appear to benefit more from the supplements to prevent BPPV recurrence (Neurology, Aug. 5, 2020). The dose was 400 IU of vitamin D and 500 mg of calcium carbonate twice a day. Those who began the study with adequate vitamin D levels did not take supplements.

What Is the Epley Maneuver?

The Epley maneuver is designed to reposition the calcium crystals in the ears and can be a helpful treatment for BPPV. It is not too hard to do these movements at home. To help you learn how, here is a link to a video in which a PT demonstrates the moves. We do believe that the first time a diagnosis is made and a treatment is attempted, a well-seasoned health professional should be involved.

You can learn more about the diagnosis and treatment of vertigo in our interview with Dr. David Kaylie, medical director of the Duke Vestibular Disorders Clinic. It is Show 992: Overcoming Vertigo. Click on arrow inside the green circle under Dr. Kaylie’s photograph.

How have you overcome BPPV? Please share your experience in the comment section below. Thank you for supporting our work by offering this article to friends and family. You might be surprised how many people suffer from vertigo from BPPV.