At least a half of all cases of BPPV will get better without treatment though this may take a while. As BPPV is basically a mechanical disorder, drugs have no effect and should be avoided.
Most cases of BPPV that do not resolve rapidly can be relieved by the appropriate particle repositioning manoeuvre, of which the most commonly performed is the Epley manoeuvre.
What is the Epley manoeuvre?
The Epley manoeuvre is used to treat the commonest type of BPPV, where the chalk crystals are free-floating in the posterior semi-circular canal in the inner ear. The Epley manoeuvre begins by making the patient dizzy with the appropriate Hallpike Test. The patient is then rolled over (in stages, pausing for about half a minute in each position) onto the opposite side (nose towards the floor), before being sat up again. This manoeuvre floats the chalk crystals round the affected canal and out of the far end, back to where they belong. Once there, they may reattach themselves, or possibly dissolve. They may however remain free-floating and liable to fall back into one of the semi-circular canals.
Up to a third of patients may suffer one or more further bouts of BPPV at some time in their lives. This is not a major problem: the manoeuvre can be repeated as and when necessary.
Following treatment, a small number of patients will feel a bit dizzy and off-balance, occasionally for a day or two. Patients who are liable to vomit when dizzy should take appropriate medication prior to treatment. This manoeuvre has offered instant relief of symptoms in nine out of ten patients; however some may need two or more treatments.
Rarely, instead of being free-floating, the chalk crystals may become attached to a (different) lump of jelly within the semicircular canal. In these cases (cupulolithiasis) the bouts of vertigo will be more prolonged, up to two minutes in duration. This is more difficult to treat, but may respond to prolonged positioning (up to 12 hours lying with the affected ear uppermost) or to the Semont Liberatory Manoeuvre. Alternatively, repetitive positioning “Brandt-Daroff” exercises may be used.
What are Brandt-Daroff exercises?
Brandt-Daroff exercises are simple movements to help stop the dizziness in BPPV. Your clinician will give you more information and show you how to do them at home. The exercises may provoke dizziness when performing them so you may want to have someone with you when doing them. Make sure you are in a safe space when doing the exercises. In BPPV loose chalk crystals get in the wrong place in the inner ear, these exercises are designed to put the crystals back in the right place. You may need to persevere with the exercises, but they have a good success rate.
Where can I get further information and support for BPPV?
- Please contact us to request a FREE BPPV information pack - email us: info@meandve.org.uk or give us a ring: 01306 876883 to chat with a member of our team
- See your GP for advice if you have any question or concerns about your symptoms. They may refer to a specialist if neccessary
- Join our next online Vestibular Insights session: BPPV Demystified: Why It Happens and How to Manage It (26 Mar 2026)
- Become a member to receive regular information, resources and updates
- Donate to support our work and help us continue supporting people affected by BPPV and other vestibular conditions
Please note, Ménière's & Vestibular UK can provide general information, but is unable to provide specific medical advice. You should always check with your medical professional for information and advice relating to your symptoms/condition.