Vertigo Exercises: Epley, Brandt-Daroff and Balance Training

01Why

Why exercises help vertigo

The brain integrates signals from the inner ear, eyes and body position sensors to keep you balanced. When one inner ear is damaged or confused, the brain can adapt through repeated exposure to the movements that provoke symptoms, a process called vestibular compensation. In BPPV, specific head movements physically move the displaced crystals back into place. Exercises are more effective than rest or long-term sedating medicines. See vertigo and dizzy when lying down.

02Safety

Before you start: safety and diagnosis

• Get a diagnosis first. Which exercise helps depends on the cause and the affected ear.
• Do exercises on a bed or mat, with a helper if possible, and at a time when you can rest afterwards.
• Remove hazards, and do not drive or use machinery right after.
• Take them slowly; mild nausea and brief dizziness are expected.
• Stop and seek help if symptoms are severe, you vomit repeatedly, or new neurological signs appear.
• Avoid repositioning manoeuvres if you have serious neck, spine or heart problems unless advised.
• Keep a note of which side and position provoke vertigo.

03Epley

Epley manoeuvre for posterior canal BPPV

The Epley is the standard treatment for the most common type of BPPV. It is best performed by a clinician after confirming the affected ear with a Dix–Hallpike test. A home version for the right ear (reverse for the left) typically is:

• Sit on a bed with a pillow behind you so that you will lie back onto it, head turned 45° to the right.
• Quickly lie back with the pillow under your shoulders and head tilted slightly back, still turned right; wait 30–60 seconds or until vertigo stops.
• Without lifting your head, turn it 90° to the left; wait 30–60 seconds.
• Turn your body and head another 90° to the left, so you face the floor diagonally; wait 30–60 seconds.
• Sit up slowly on the left side and stay seated for a few minutes.

Repeat once a day until vertigo has been gone for 24 hours. Do not do it if you are unsure which ear is affected, because the wrong side can worsen symptoms. Afterwards, avoid lying flat or sudden head movements for a day, according to your clinician’s advice (restrictions are often not needed).

04Others

Other repositioning manoeuvres

• Semont manoeuvre: a quick side-to-side movement from lying on one side to the other, done with a clinician; used for posterior canal BPPV.
• Barbecue (log) roll: for horizontal canal BPPV, rolling in 90° steps while lying down.
• Gufoni manoeuvre for horizontal canal BPPV.
• Deep Hallpike and Yacovino variants for anterior canal BPPV.
• Clinicians choose the right one according to eye movements during testing.

05Brandt

Brandt-Daroff exercises

Brandt-Daroff exercises can be done at home when the affected side is unknown, but they are less effective than the Epley and take longer.

• Sit on the edge of the bed, then lie on your side with your head angled up about 45° and hold for 30 seconds or until vertigo stops.
• Sit up for 30 seconds, then lie on the other side for 30 seconds.
• Repeat 5 times on each side, three times a day, for about 2 weeks or until vertigo has stopped for 2–3 days.

Symptoms may worsen initially. Stop if you feel unwell.

06Rehab

Vestibular rehabilitation exercises

• Gaze stabilisation (VOR x1): hold a card with a letter at arm’s length, turn the head side to side while keeping the letter in focus, 1 minute, 3 times a day.
• Habituation: repeat the movement that provokes dizziness (such as lying down and sitting up, or turning the head quickly) in small, repeated doses.
• Balance training: stand with feet together, then in tandem (heel to toe), then on one leg, progress to eyes closed and foam surfaces, near a wall.
• Walking exercises: turn the head while walking, walk with small head movements, practise on different surfaces.
• Seated and standing transitions: sit to stand slowly, repeated several times.
• Tai chi or yoga can support balance; check with a clinician.
• A vestibular physiotherapist tailors a programme and monitors progress, typically 4–12 weeks.

07Expect

What to expect

During exercises, mild dizziness and nausea are normal and show that the brain is being challenged. Over days to weeks, symptoms should decrease. After a successful Epley, many people are free of vertigo immediately, though some residual unsteadiness may persist for a few days. If vertigo continues after three to four attempts, return to your clinician because the wrong canal or ear may be involved, or another diagnosis may apply.

08Lifestyle

Everyday tips

• Get up slowly from bed, sitting for a minute first.
• Use two pillows to keep the head slightly raised at night during episodes.
• Avoid sudden head movements and looking up for long periods.
• Drink enough fluid and limit alcohol and caffeine.
• Sleep well and manage stress, which worsens dizziness.
• Take care on stairs and use handrails.
• Review medicines with your doctor if they might cause dizziness.

10Cases

Three common situations

Brief spinning when rolling to the right in bed: likely right posterior canal BPPV; a clinician-guided Epley usually resolves it.

Unsteadiness for weeks after an inner-ear infection: vestibular rehabilitation exercises help.

Constant dizziness with a severe headache and double vision: urgent medical assessment, not exercises.

11Summary

Key points to remember

Exercises can cure BPPV and help the brain compensate for inner-ear problems, but they must match the diagnosis. Get assessed, perform them safely and expect temporary dizziness. Our team can diagnose your vertigo and guide treatment.

This guide is for general information and does not replace an assessment by your own doctor or therapist.