This is the most common cause of vertigo — and how to treat it at home

If you have had vertigo, you’re familiar with the sensation that you are swirling, swaying or tilting when, in actuality, you’re not moving at all.

Unlike dizziness — which causes lightheadedness or unsteadiness — vertigo feels more like spinning. It can be relatively mild, making you feel like you are standing on a rocking ship, or be so severe that it can trigger nausea and vomiting and make it impossible to see straight, walk straight or function.

While there are a number of causes of vertigo, the most common is benign paroxysmal positional vertigo (BPPV). The estimates vary greatly, but about 2 percent of people will develop BPPV at some point, and it’s about twice as common in women as men. It can be debilitating and often recurs in people who have it.

“When I have a severe episode, I’m pretty miserable,” said Sandy Sloan, 82, of Menlo Park, California, who has recurrent vertigo symptoms. “The world is spinning around. It’s quite dramatic. I can’t even stand.”

But BPPV can be treatable with certain exercises or maneuvers — many of which can be done at home, experts said.

What is BPPV?

BPPV is a condition of the vestibular system, a motion-sensing set of structures in the inner ear.

In each ear, there are tiny crystals that help detect gravity and linear motion, so that you can sense up-and-down movement like riding in an elevator. Those crystals, which are normally resting on a membrane, can come loose and fall into one of three semicircular canals that sense rotational movement, such as spinning, said Carol Foster, professor emerita of otolaryngology at the University of Colorado Anschutz.

This triggers BPPV, and the symptoms can vary depending on which canal the crystals fall into — posterior, horizontal or anterior.

Most commonly, the crystals fall into the posterior canal, causing a spinning sensation that can seem both visually and viscerally similar to riding a very fast carousel. Less commonly, they can enter the horizontal canal, which can make you or the world seem to shift or spin horizontally. And in rare cases, they can get into the anterior canal, causing things to appear to flip head over heels, Foster said.

Sloan has BPPV and vestibular migraine, a neurological condition that can also cause movement and balance issues either with or without headaches. This combination of conditions led to such frequent recurrences of vertigo that it’s one reason she decided to retire from her job as an attorney, she said.

Now, with medication for the migraine and treatments she does for BPPV at home, she said the vertigo has become manageable.

Although anyone can experience BPPV, some people are more likely to get it. This includes women, older adults, people who have bone-thinning conditions such as osteopenia (low bone density) and osteoporosis (more severe bone loss), and those who have had a head injury, said Kristen Steenerson, a clinical associate professor and director of the Vestibular Neurology Clinic at Stanford University.

How can I treat BPPV?

Physicians and physical therapists use various maneuvers to help reposition the crystals, which can be an effective way to resolve symptoms.

Here are three maneuvers you can try at home, specifically for the most common cause of vertigo — posterior canal BPPV. (Note that, when done correctly, vertigo often gets temporarily worse while doing the maneuvers. If you think you may be at risk of falling, you may want to ask someone to assist you, experts said.) If you have any concerns, consult a health care provider before attempting these maneuvers.

The Epley maneuver

The Epley maneuver is the first line of treatment used to treat BPPV in the United States. It’s often used by health care professionals in clinics but you can do them yourself at home.

For the Epley:

1. Sit on the edge of the bed with your eyes open and turn your head about 45 degrees toward the side that seems to be causing the vertigo.
2. Holding your head in this position, quickly lie down on your back with your head hanging slightly off the bed. Stay in the position until the vertigo symptoms start and then stop, or about 30 seconds.
3. Turn your head slowly toward the other side, also about 45 degrees, while continuing to lie on your back with your head slightly off the bed. Wait about 30 seconds.
4. Keep turning your head in that same direction by rolling your body about 90 degrees so that you are lying on your side. Your nose should be pointing toward the floor. Wait about 30 seconds.
5. Sit up.

The half-somersault maneuver

Foster, who has had BPPV herself, pioneered her own method called the half-somersault maneuver, she said.

Although it has less evidence behind it than the Epley maneuver, in a 2012 study, Foster and her colleagues compared the effectiveness of the half-somersault to the Epley in patients with BPPV. They found that it took fewer Epley maneuvers than half-somersault maneuvers to resolve symptoms, but people reported more dizziness while performing the Epley, leading the authors to conclude that the half-somersault may be better tolerated as a home exercise.

Laura Christman, a friend of Foster, said she has been using the half-somersault for years.

Christman, 72, of Denver, said she started experiencing vertigo in her 30s but was not diagnosed with BPPV by her own physician until a couple years ago. Without an official diagnosis for all those years, she said she relied on Foster’s half-somersault to manage the symptoms on her own.

For the half-somersault:

1. Kneel on the floor and tip your head straight up toward the ceiling. Stay in this position until the vertigo symptoms start and then stop, or about 30 seconds.
2. Quickly lean forward and turn your head upside down so that the crown of your head is touching the floor as though you were about to perform a somersault. Then turn your head, about 45 degrees, toward the elbow on the side that seems to be causing the vertigo. Wait for the symptoms to start and then stop, or about 30 seconds.
3. Keeping your head turned, quickly raise your head to the level of your back so that you’re on your hands and knees. Wait for the symptoms to start and then stop, or about 30 seconds.
4. Sit up.

The Li maneuver

The Li maneuver does not require you to turn your head as you would for the Epley and half-somersault. Although it is relatively new, “preliminary evidence is very promising,” Steenerson said.

Sloan, who prefers this variation, said that when she starts to feel a vertigo episode coming on, she does the maneuver — sometimes more than once — to curb a full-blown attack.

For the Li:

1. Sit on the edge of the bed and, with your head straight ahead, quickly lie down on the ear that seems to be causing the vertigo. Stay in this position until the vertigo symptoms start and then stop, or about 1 minute.
2. Quickly flip over to the other side. Wait about 4 minutes.
3. Sit up.

For all of these maneuvers, you may need to repeat them until the vertigo is completely resolved.

Vertigo on its own is not life-threatening, said Jeffrey Staab, professor and chair of the Department of Psychiatry and Psychology at the Mayo Clinic who specializes in vestibular and balance disorders.

Rarely, however, vertigo symptoms can indicate a more serious problem. Seek urgent medical attention if you experience a sudden onset of vertigo especially coupled with a sudden onset of any other neurological symptoms such as numbness or tingling, slurred speech, a change in attention or coordination, or difficulty walking as it could be a sign of a stroke, Staab said.

Also, vertigo with a sudden change in hearing may suggest a more serious brain condition such as a tumor, he said.

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