Fact sheet

Vertigo (BPPV)

Short, violent spins when you roll over in bed, look up or bend down. Loose crystals in the inner ear are to blame. A head-turning manoeuvre fixes most cases in minutes, no tablets needed.

Typical signs: spinning that lasts under a minute, set off by changing head position: rolling over, lying down, looking up or bending. Nausea is common. Up to half of people feel a bit unsteady between spells.

Why it happens: tiny calcium crystals drift from their usual spot into the inner ear’s balance canals, sending confusing signals as you move. Usually there’s no clear cause. Head injury is the commonest known trigger. It’s more common in women and usually starts in your 50s to 70s.

Diagnosis: the Dix-Hallpike test: a doctor or physio lies you back quickly with your head turned and watches your eyes flick. No scan is needed for typical BPPV.

The BPPV ladder

A mechanical problem with a mechanical fix. Dizziness tablets don’t move crystals.

  1. Step 1 · Self-careMove carefully and stay safeSit on the edge of the bed before standing, use a night light, and skip ladders and driving while spells are frequent.
    Works
    Not a treatment, but BPPV raises the risk of falls, especially in older people
    Cost
    Free
    How long
    Until it’s treated or settles
    Watch for
    Falls, especially at night.

    Gravity is not your friend this week.

  2. Step 2 · Self-careWait and seeFor mild spells, if you’d rather not be tipped upside down.
    Works
    Many people improve on their own as the crystals settle; most cases resolve within 6 months
    Cost
    Free
    How long
    Weeks to months
    Watch for
    Slower than treatment, and the spinning is miserable in the meantime.

    Patience works. The Epley is just faster.

  3. Step 3 · GPEpley manoeuvreYour head is moved slowly through four positions to roll the crystals out of the balance canal.
    Works
    Spins stopped in about 56 in 100 after treatment vs 21 in 100 with a fake manoeuvre; sometimes needs repeating
    Cost
    Part of a GP visit, or physio about $90–150; Medicare rebates with a GP care plan
    How long
    About 10 minutes; 1–3 sessions
    Watch for
    Nausea during it (up to 1 in 3) and feeling off for a day or so. Don’t drive straight after.

    Possibly the most satisfying 10 minutes in medicine.

  4. Step 4 · Self-careHome manoeuvre, once taughtIf it returns and you know which ear is affected, repeat the manoeuvre you were shown.
    Works
    Works when done on the correct side. Brandt-Daroff exercises worked less well than one Epley in a small trial
    Cost
    Free
    How long
    A few minutes, repeated if needed
    Watch for
    Doing it on the wrong side wastes effort. Confirm the side first.

    A video is not a diagnosis.

  5. Step 5 · Allied healthVestibular physiotherapyFor tricky canal types, frequent returns or lingering unsteadiness. The Semont manoeuvre is an alternative to the Epley.
    Works
    Semont and Epley work about equally well; balance retraining helps leftover unsteadiness
    Cost
    About $90–150 a session; Medicare rebates with a GP care plan
    How long
    1–4 visits
    Watch for
    Look for a physio with vestibular training.

    The specialists in spinning, minus the theme park ticket.

  6. Step 6 · SpecialistENT surgeon or neurologistIf it doesn’t respond, keeps coming back or doesn’t look like typical BPPV.
    Works
    Fewer than 1 in 100 people ever need surgery
    Cost
    Specialist fees vary; Medicare rebates with a GP referral
    How long
    Varies
    Watch for
    New symptoms such as hearing loss or weakness need a review.

    Rarely needed, but good to have in the corner.

Costs are rough Australian prices in November 2026 and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.

Save your money

Popular, heavily marketed or often asked about, but the evidence is weak or says no.

What you can do

See your GP if

Get emergency help (call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.) if dizziness comes with new weakness or numbness, a drooping face, slurred speech, double vision, trouble walking, a sudden severe headache, or constant vertigo that stops you standing. These can mean a stroke.

Common questions

Will BPPV come back?

It often does. About 1 in 3 people have it return after treatment, and some studies report about 15 in 100 a year. It usually responds to the same manoeuvre again.

Can I do the Epley manoeuvre myself?

Yes, once a doctor or physio has confirmed it’s BPPV and which ear is affected, and taught you how. Done on the wrong side, it won’t help.

Is vertigo a sign of a stroke?

Usually not. BPPV spells are brief and set off by head movement. Constant vertigo, or dizziness with weakness, slurred speech, double vision or trouble walking, needs emergency care.

Do tablets help BPPV?

Not really. Dizziness tablets don’t fix the loose crystals and may slow recovery. A repositioning manoeuvre is the treatment.

Helpful resources

Evidence and more information

Reviewed 1 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP, physio or pharmacist.

Related

maladywise.com/bppv/