Vertigo and BPPV relief: how vestibular physiotherapy and the Epley manoeuvre work

Benign Paroxysmal Positional Vertigo (BPPV) is the single most common cause of sudden peripheral dizziness. Patients describe feeling as though the room is spinning wildly for 20 to 60 seconds whenever they roll over in bed, bend down to tie shoelaces, or tilt their head back. Fortunately, BPPV can frequently be resolved in just 1 to 3 targeted sessions with a trained vestibular physiotherapist.

Understanding how inner ear crystals cause vertigo

Inside your inner ear lies the vestibular labyrinth, which detects head movement and gravity. Microscopic calcium carbonate crystals called otoconia normally reside within the utricle. If these crystals become dislodged due to head trauma, aging, or inner ear inflammation, they float into the fluid-filled semicircular canals. When you move your head, the loose crystals displace fluid and inappropriately stimulate cupular hair cells, signaling false rotation to your brain.

Recognizing classic BPPV symptoms and triggers

• Brief rotational spinning sensation: Intense dizziness lasting less than one minute, usually accompanied by involuntary rhythmic eye movements called nystagmus.
• Positional movement triggers: Episodes occur specifically during head movements relative to gravity, such as turning over in bed or looking up at a high shelf.
• Absence of hearing changes: Pure BPPV does not cause ringing in the ears (tinnitus), ear fullness, or sudden hearing loss.
• Normal balance between episodes: While lingering unsteadiness is common, spinning stops completely once your head remains still.

Clinical assessment: Dix-Hallpike and the Epley manoeuvre

A certified vestibular physiotherapist performs the Dix-Hallpike test to determine which ear and which semicircular canal are affected. Once identified, the clinician guides you through the Epley manoeuvre, a series of four calibrated head positions held for 30 to 60 seconds each. Gravity gently rolls the loose crystals out of the canal and back into the utricle where they no longer trigger false signals.

Distinguishing benign vertigo from central stroke red flags

It is critical to distinguish inner-ear vertigo from central neurological emergencies like cerebellar stroke. Seek immediate hospital evaluation if dizziness is accompanied by the 5 D symptoms: Diplopia (double vision), Dysarthria (slurred speech), Dysphagia (difficulty swallowing), Dysmetria (clumsy limb coordination), or Drop attacks (sudden unexplained collapse).

Evidence reviewed 25 September 2026. General information only.

Sources reviewed

American Academy of Otolaryngology - Head and Neck Surgery Clinical Practice Guideline: BPPV; Journal of Vestibular Research; Neurological Society of India Consensus Guidelines.