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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. BPPV is recognised from your story by video, and exercises can be taught; the positional test and the Epley manoeuvre done by a clinician are in person.
- What it is: tiny calcium crystals that have come loose inside the inner ear and moved into a balance canal, so certain head movements set off spinning.
- How long a spin lasts: usually less than a minute. Without treatment, episodes can go on for several weeks.
- How well treatment works: the Epley manoeuvre stops BPPV in about 70% of people at the first attempt, and in nearly all with repeat attempts.
- Emergency: call 112 for spinning with double vision, slurred speech, weakness, numbness, sudden hearing loss, trouble walking or a sudden, severe headache.
Do not book a video appointment if your dizziness came on with double vision or loss of vision, slurred speech, weakness, numbness or tingling, trouble walking, sudden hearing loss, a sudden, severe headache or fainting. These are not BPPV. Call 112 or go to an emergency department.
Can an online doctor treat BPPV?
Partly. BPPV has a typical story: brief spins, set off by lying down, rolling over or looking up, with no hearing loss and no other symptoms. A doctor can recognise it by video, work out the likely side, and teach exercises or a home version of the Epley manoeuvre when it is safe for you. The positional test that confirms BPPV and the Epley manoeuvre done by a clinician need in-person care, and so does dizziness that does not fit the pattern.
How an online consultation helps with BPPV
- BPPV, or something else?: Constant dizziness, hearing loss, fainting, headache or numbness are not BPPV, and the doctor checks for them first.
- The likely side worked out: Which movements set off the spinning point to the ear, and the canal, that needs treating.
- Exercises you can do at home: A home routine when it suits you, and where to have the Epley manoeuvre done when it does not.
- No tablets that slow recovery: BPPV is a mechanical problem, and the doctor explains why manoeuvres, not medicines, fix it.
What the doctor checks in an online BPPV consultation
The doctor rules out the signs that do not fit BPPV first, then goes through the spins themselves. The doctor asks about:
- Warning signs: double vision, slurred speech, weakness, numbness, trouble walking, hearing loss, fainting, or a new or severe headache.
- The trigger: lying down, sitting up, rolling over in bed, looking up or bending down, and which side you roll to when it starts.
- How long each spin lasts: BPPV spins usually stop within a minute; constant dizziness points elsewhere.
- What started it: a head injury, a recent inner ear infection, a long spell in bed, migraine or an operation.
- Your health: neck or back problems, which change which manoeuvre is safe, falls, and your medicines.
Before the call, note which movements bring the spinning on and how long it lasts. If the doctor suggests trying a manoeuvre, have someone with you and a bed or sofa you can lie back on.
What is BPPV, and what causes it?
Benign paroxysmal positional vertigo is an inner ear problem that causes brief bouts of spinning when your head moves into certain positions. The name describes it: benign because it is not caused by serious disease, paroxysmal because it comes in short bursts, and positional because moving into or out of a position sets it off.
Your inner ear contains tiny calcium carbonate crystals that help it sense gravity and the position of your head. In BPPV, some of them come loose and drift into one of the fluid-filled semicircular canals, which sense rotation. When you move your head, the crystals move through the fluid and send false signals of spinning to the brain, which makes the eyes flick (nystagmus) and the room seem to spin.
What causes BPPV?
Often there is no clear cause. When there is one, it is most often:
- a blow to the head or a whiplash injury
- an inner ear infection, such as labyrinthitis or vestibular neuritis
- migraine or Ménière’s disease
- lying on your back for a long time, for example during an operation or a long spell in bed
- getting older, with wear on the inner ear
Osteoporosis, diabetes and low vitamin D are linked with BPPV too.
Who gets BPPV?
BPPV is one of the most common causes of vertigo. In a German population survey, 2.4% of adults had had it at some point and 1.6% in the past year, rising to 3.4% of people over 60, and by the age of 80 almost 10% had had it. It most often starts between the ages of 40 and 70, and women are affected more often than men.
What does BPPV feel like, and how long does it last?
The main symptom is a brief, often intense spin, usually lasting less than a minute, set off by a change in head position. Common triggers are:
- lying down, or sitting up from lying down
- rolling over in bed
- looking up, for example to hang washing, or bending down
- tilting your head back or to the side, and holding it there
Many people also feel sick or are sick, sweat, notice blurred vision, or feel off balance or light-headed. Some describe a feeling of falling through the bed when they lie down. About half of people with BPPV feel unsteady between the spins.
How long does BPPV last without treatment?
Each spin lasts seconds, but the condition can go on for several weeks while the crystals dissolve. In the US guideline, about 20% of people recovered on their own within a month and up to 50% within 3 months. Treatment shortens it: the Epley manoeuvre often works in one session.
BPPV or something else?
BPPV should not cause constant dizziness that is the same whatever you do, hearing loss, fainting, headaches, numbness or pins and needles, or problems with speech or coordination. If you have any of these, other conditions need to be ruled out:
Swipe sideways to compare →
| Condition | What sets it off | How long it lasts | Hearing |
|---|---|---|---|
| BPPV | A change in head position | Usually less than a minute | Not affected |
| Labyrinthitis | Often follows a cold or flu | Constant for days; balance back within 2 to 6 weeks | Hearing loss and ringing |
| Vestibular neuritis | Often follows a cold or flu | Constant for days | Not affected |
| Ménière’s disease | No trigger | Attacks lasting 20 minutes or more | Hearing loss, ringing or fullness in one ear |
| Vestibular migraine | Often no trigger; migraine triggers | 5 minutes to 72 hours | Can ring or feel full, without lasting hearing loss |
| A stroke | Comes on suddenly | Constant | Can be affected; with double vision, slurred speech or weakness: call 112 |
The vertigo page covers every cause of spinning, and the dizziness page feeling faint or light-headed.
How is BPPV diagnosed, and which ear is it?
BPPV is diagnosed from the story and a positional test. In the Dix–Hallpike test, a clinician turns your head to one side and moves you quickly from sitting to lying back, then watches your eyes. In BPPV, the spinning and the eye movements start after a delay of a few seconds and settle within a minute.
How do I know which ear is affected?
The affected ear is the one facing down when the test brings on the spinning; if the first side is negative, the test is repeated on the other side. Without the test, the side you turn or roll to when the spinning starts gives a clue, which is how NHS self-help guides choose between a left and a right manoeuvre. Both ears are affected in up to 10% of people.
Which canal is it?
Each inner ear has semicircular canals that sense turning in different directions. The posterior canal is affected in 85 to 95% of cases, and is the one the Epley manoeuvre treats. The horizontal canal is affected in 5 to 15%: spinning comes mainly when you turn your head from side to side while lying down, and it is treated with a different roll manoeuvre.
A negative test does not always rule BPPV out, and a test that brings on eye movements of the wrong kind or timing needs further checks for other causes.
What is the Epley manoeuvre, and how well does it work?
The Epley manoeuvre is a sequence of head and body positions that moves the loose crystals out of the balance canal and back to where they belong. A clinician moves your head through each position and holds it there for a short time. It is the treatment guidelines recommend for the common, posterior-canal type of BPPV.
Swipe sideways to compare →
| Treatment | How it works | How well it works | Where |
|---|---|---|---|
| Epley manoeuvre | Head positions move the crystals out of the posterior canal | About 70% better after the first attempt, nearly 100% after repeats | Clinic, or at home once taught |
| Semont manoeuvre | A different sequence of positions for the same canal | Similar to the Epley in trials | In a clinic |
| Roll manoeuvre | Rolling through positions while lying down, for the horizontal canal | Used for the less common horizontal-canal type | Clinic, or at home once taught |
| Brandt–Daroff exercises | A set of position changes repeated at home | One Epley treatment worked better than a week of the exercises done 3 times a day | At home |
| Medicines | Ease sickness only | No medicine has been shown to fix BPPV | Short courses only |
In a Cochrane review of 11 trials with 745 adults, symptoms resolved in 56% of people after the Epley manoeuvre, against 21% after a sham manoeuvre.
What are the risks of the Epley manoeuvre?
It is safe, and no serious side effects were reported in the trials. It brings on a spin briefly, and 17 to 32% of people felt sick during it. Some people with neck problems could not tolerate the positions, which is why the doctor asks about your neck and back first. You may feel unsteady or tired for a few hours or a couple of days afterwards, so do not drive straight after treatment.
What to do after the Epley manoeuvre
Go back to your normal activities and move your head as naturally as you can. Some clinics advise avoiding lying flat or on the treated side for a couple of nights, but the US guideline recommends against such restrictions. If the spinning has not gone after a month, you need to be checked again.
Which BPPV treatment might the doctor recommend?
Treatment depends on whether the story fits BPPV, which canal is likely to be involved and how well you can tolerate the positions. This is the framework the doctors use, in line with the US clinical guideline:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Brief spins on lying down or rolling over, clearly to one side | The Epley manoeuvre, in a clinic or at home once taught | Partly | For the Dix–Hallpike test and a clinician-performed Epley |
| Spins on turning the head from side to side while lying down | A roll manoeuvre for the horizontal canal | Partly | Usually, for the test and the manoeuvre |
| Not sure of the side, or both sides | Brandt–Daroff exercises for a couple of weeks, then a review | Yes | If there is no improvement |
| Severe sickness with the spins | A short course of anti-sickness medicine alongside the manoeuvre | Yes | If you cannot keep fluids down |
| Neck or back problems | An assessment of which manoeuvre is safe for you | Partly | For the manoeuvre, by a trained clinician |
| Still spinning a month after treatment, or it keeps coming back | A review, and vestibular physiotherapy | Partly | For repeat manoeuvres and balance rehabilitation |
| Dizziness with double vision, slurred speech, weakness, numbness, hearing loss or a severe headache | Emergency care: this is not BPPV | No | Call 112 now |
Spins when you lie down or roll over? A doctor can tell you in one consultation whether it is BPPV and what to do.
See available times →Treatment options for BPPV
What you can do yourself
- Move your head deliberately rather than keeping it still all day: avoiding movement can make symptoms last longer and cause a stiff neck.
- Get out of bed slowly, sitting on the edge for a while before you stand, and turn the lights on at night.
- Squat rather than bending over to pick things up.
- Only try a home manoeuvre after a doctor or physiotherapist has shown you which one and which side, and have someone with you.
- Do not drive while you are having spins, or straight after a manoeuvre.
Brandt–Daroff exercises
Brandt–Daroff exercises are a set of position changes you repeat at home. NHS self-help guides suggest them for a couple of weeks when you are not sure which side is affected, or when symptoms are on both sides, before reassessing, and in trials they were done 3 times a day. They work less well than the Epley manoeuvre, but they are an option when it is not possible. Ask the doctor to show you how before you start.
Prescription treatment
A prescription is never issued without a consultation. No medicine fixes BPPV, because it is a mechanical problem, and guidelines advise against the routine use of medicines that dampen the balance system, such as antihistamines and benzodiazepines. If sickness is severe, the doctor may prescribe a short course of anti-sickness medicine, but long-term use can delay recovery. Benzodiazepines are controlled medicines and are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Tablets on their own, or taken for weeks. Keeping your head rigidly still. Scans and other tests when the story and the positional test clearly fit BPPV, which the US guideline advises against.
Does BPPV come back?
It can. In the Cochrane review, symptoms came back in 36% of people after treatment, and there is no proven medicine to prevent this. If the same spins return, the self-check and the manoeuvre can be repeated, and a doctor can check it is still BPPV and the same side.
Why do I still feel dizzy after treatment?
Some people have a general dizziness or an odd sense of movement for a while after the spins have stopped. This usually settles, and vestibular physiotherapy, a programme of balance exercises, can help when it does not. Anxiety and avoiding head movements can make it last longer.
Falls
BPPV is harmless in itself, but a spin can cause a fall. In one study of older people referred with BPPV, three in four had fallen in the previous 3 months, which is one more reason to treat it rather than live with it.
Special situations
Older adults
BPPV is more common with age, and 1 in 3 adults over 65 falls each year. Have someone with you for any manoeuvre, and ask about balance exercises.
Neck or back problems
The Epley manoeuvre turns and tips the head. If you have neck or back problems, tell the doctor before trying anything at home: in trials, some people with neck problems could not tolerate the manoeuvre, and a trained clinician can decide what is safe for you.
After a head injury
BPPV can follow a blow to the head. Any new headache, confusion or vomiting after a head injury needs emergency care first; the concussion page covers recovery.
Driving
Do not drive while you have spins. In the UK, drivers must tell the DVLA about vertigo.
BPPV while travelling in Europe
BPPV can start anywhere, and rolling over in bed is a common trigger. The doctor can recognise it by video wherever you are staying, and tell you whether a manoeuvre at home or an in-person visit is the right next step.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When BPPV is treated online, and when you need in-person care
Treated online: recognising BPPV from the classic story, working out the likely side, home exercises and a home manoeuvre once it has been shown to you, short courses of anti-sickness medicine, follow-up after treatment, and BPPV that comes back.
In-person care: the Dix–Hallpike test, an Epley, Semont or roll manoeuvre done by a clinician, adapted manoeuvres for neck or back problems, vestibular physiotherapy, and any dizziness that does not fit BPPV.
When to get in-person care
Call 112 or go to an emergency department now for:
- spinning or dizziness with double vision or loss of vision
- slurred speech or trouble speaking
- weakness, numbness or tingling in an arm, a leg or the face
- sudden hearing loss
- being unable to walk or stand
- a sudden, severe headache that reaches its worst within 5 minutes, or dizziness after a head injury
- fainting
Get medical advice the same day for:
- constant dizziness that does not change when you keep still, or dizziness that does not fit brief spins
- dizziness with a new, different or severe headache, or a high temperature
- dizziness with being sick, or feeling very sick
- a fall during a spin
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about the spins: say which movements set them off, which side you roll to when they start, and how long each one lasts, and mention any hearing change.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s BPPV? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Vertigo can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about BPPV
What is BPPV?
BPPV is benign paroxysmal positional vertigo, an inner ear problem in which tiny calcium crystals come loose and drift into a balance canal. Certain head movements then set off brief spins, usually lasting less than a minute.
What triggers BPPV?
BPPV is triggered by a change in head position: lying down, sitting up, rolling over in bed, looking up or bending down. Often there is no clear cause for the crystals coming loose, but a head injury, an inner ear infection and long spells lying on your back can set it off.
How long does BPPV last?
Each BPPV spin usually lasts less than a minute. Without treatment, episodes can go on for several weeks: in the US guideline, about 20% of people recovered within a month and up to 50% within 3 months. The Epley manoeuvre often works in one session.
Will BPPV ever go away?
Yes. BPPV often settles on its own over weeks or months, and the Epley manoeuvre works for about 70% of people at the first attempt and for nearly all with repeat attempts. It can come back, and the manoeuvre can be repeated.
How do you get rid of BPPV fast at home?
The fastest fix is the right repositioning manoeuvre for the affected canal, usually the Epley manoeuvre, done by a clinician or at home once you have been shown how. Tablets do not fix BPPV.
What is the Epley manoeuvre?
The Epley manoeuvre for BPPV is a sequence of head and body positions that moves the loose crystals out of the balance canal and back to where they belong. Each position is held for a short time, and it often brings on a brief spin while it works.
What are the risks of the Epley manoeuvre?
The Epley manoeuvre for BPPV is safe, with no serious side effects reported in trials. Between 17 and 32% of people feel sick during it, you may feel unsteady for a few hours afterwards, and people with neck or back problems may need an adapted version.
How do I know which ear is affected?
In the Dix-Hallpike test for BPPV, the affected ear is the one facing down when the spinning and the eye movements start. Without the test, the side you turn or roll to when the spinning starts gives a clue. Both ears are affected in up to 10% of people.
Does BPPV come back?
It can. BPPV symptoms came back in 36% of people after treatment in a Cochrane review. No medicine prevents it, and the manoeuvre can be repeated.
Can BPPV be prevented?
Not reliably, because the crystals come loose for no clear reason, but a few things lower the chance of another episode: keep vitamin D in the normal range, since low vitamin D is linked to recurrent BPPV, treat osteoporosis, avoid long spells flat on your back, protect the head from knocks, and after a successful manoeuvre go back to normal head movements rather than guarding the neck. BPPV that returns is treated the same way, and the manoeuvre can be learned for home use.
Why do I still feel dizzy after BPPV treatment?
After BPPV treatment, some people have a general dizziness or an odd sense of movement after the spins stop. It usually settles, and vestibular physiotherapy can help if it does not. Avoiding head movements can make it last longer.
Can an online doctor treat BPPV?
Partly. A doctor can recognise BPPV from your story by video, work out the likely side and teach exercises or a home manoeuvre. The positional test and a clinician-performed Epley manoeuvre are in person, as is any dizziness that does not fit BPPV.
- Clinical practice guideline: benign paroxysmal positional vertigo (update), Bhattacharyya N, et al. Otolaryngology–Head and Neck Surgery, 2017.
- Epley manoeuvre for benign paroxysmal positional vertigo, Hilton MP, Pinder DK. Cochrane Database of Systematic Reviews, 2014.
- Benign paroxysmal positional vertigo (BPPV), NHS Lanarkshire vestibular physiotherapy (UK), updated 14 August 2025.
- BPPV: benign paroxysmal positional vertigo, University Hospitals Sussex NHS Foundation Trust (UK), reviewed 8 December 2025.
- Benign paroxysmal positional vertigo (BPPV), Mayo Clinic (US), updated 31 December 2025.
- Benign paroxysmal positional vertigo (BPPV), Cleveland Clinic (US), reviewed 31 May 2026.
- Dizziness: approach to evaluation and management, Muncie HL, Sirmans SM, James E. American Family Physician, 2017.
- The Epley maneuver for treatment of benign paroxysmal positional vertigo, Seehusen DA, Chaffee DM. American Family Physician, 2015.
- Vestibular dysfunction: prevalence, impact and need for targeted treatment, Agrawal Y, Ward BK, Minor LB. Journal of Vestibular Research, 2013.
- BPPV, Ménière’s and Vestibular UK (charity), accessed 15 October 2026.
- Labyrinthitis and vestibular neuritis, NHS, National Health Service (UK), reviewed 6 August 2026.
- Vertigo, NHS, National Health Service (UK), reviewed 2 May 2023.
- A1.6.6 Vestibular migraine, International Classification of Headache Disorders, 3rd edition (ICHD-3), International Headache Society, 2018.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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