Most vertigo can be treated effectively, and the right approach depends on what’s causing it. The most common cause by far is benign paroxysmal positional vertigo (BPPV), where tiny calcium crystals drift into the wrong part of your inner ear. This type often resolves with simple head maneuvers you can do at home or in a doctor’s office. Other causes, like vestibular migraines or inner ear disorders, require different strategies ranging from dietary changes to rehabilitation exercises.
Repositioning Maneuvers for BPPV
If your vertigo hits in short bursts when you move your head, roll over in bed, or look up, BPPV is the likely culprit. The standard treatment is a repositioning maneuver that guides the displaced crystals back where they belong. The most widely used is the Epley maneuver, which involves a specific sequence of head positions held for 20 to 30 seconds each.
Here’s how it works: sit on a bed and turn your head 45 degrees toward the ear that triggers your symptoms. Then lie back quickly so your shoulders land on the pillow and your head reclines slightly off the edge, still turned at that angle. After holding that position, you slowly turn your head to the opposite side, then rotate your whole body to align with your head. Each position is held long enough for gravity to move the crystals through the canal.
A doctor or physical therapist can perform this in the office, but you can also do a home version once you know which ear is affected. Many people feel significant relief after a single session, though some need it repeated a few times. Your symptoms may briefly worsen during the maneuver itself, which is normal and expected.
Brandt-Daroff Exercises
If repositioning maneuvers don’t fully resolve your BPPV, or if you’re not sure which ear is the problem, Brandt-Daroff exercises are a useful alternative. These involve sitting on the edge of a bed, then quickly lying down on one side with your nose pointed slightly upward, holding for 30 seconds, returning to sitting, and repeating on the other side. The typical recommendation is several repetitions at least twice a day. Improvement tends to be gradual, building over weeks or months rather than happening overnight.
Vestibular Rehabilitation Therapy
For vertigo caused by inner ear damage, vestibular neuritis, or other conditions where the brain needs to recalibrate its sense of balance, vestibular rehabilitation therapy (VRT) is the go-to treatment. This is a structured exercise program, usually guided by a physical therapist, that trains your brain to compensate for faulty signals from the inner ear.
The exercises are surprisingly simple but require consistency. A typical program from Stanford Medicine includes several categories you practice three times a day:
- Head turns side to side: Turn your head and eyes to look left, hold for 2 to 3 seconds, then turn right and hold again. Start with 5 to 10 repetitions and work up to 15 to 20. Once that’s comfortable, you progress to doing the same thing while walking.
- Head nods up and down: Look up at the ceiling, hold for 2 to 3 seconds, then look down. Same progression from seated to walking.
- Head shaking “no”: Gently shake your head side to side for up to one minute. If that’s too intense, start with just 10 seconds and gradually increase.
- Rotation exercises: Move your head and hands together in a coordinated turning motion, 10 times back and forth. Start with 5 if that feels like too much.
The key principle is progressive difficulty. Each exercise has multiple levels. You begin with small, controlled movements while seated, then advance to performing them while walking at a normal pace. Daily walks are also part of the program. Most people notice steady improvement over several weeks, though the early sessions can temporarily increase dizziness before things get better.
Medication for Symptom Relief
Medications don’t fix the underlying cause of vertigo, but they can take the edge off acute episodes. The most commonly used option is meclizine, an antihistamine that blocks signals to the brain responsible for nausea, vomiting, and dizziness. The typical adult dose ranges from 25 to 100 milligrams per day, split into smaller doses throughout the day. Drowsiness is the most notable side effect, along with dry mouth and sometimes blurred vision.
These medications work best for short-term relief during intense episodes. Using them for too long can actually slow your recovery because they dampen the signals your brain needs to recalibrate. Think of them as a way to get through the worst days, not a long-term solution.
Managing Vestibular Migraines
Vestibular migraines cause vertigo episodes that can last minutes to hours, sometimes with a headache and sometimes without one. This makes them tricky to identify. Treatment focuses heavily on avoiding dietary triggers, which are more specific than most people realize.
The major triggers to watch for include:
- Caffeine: Limit to no more than 2 servings per day, and keep the amount and timing consistent. Fluctuations matter as much as quantity.
- Aged cheeses: Brie, cheddar, gouda, parmesan, Swiss, blue cheese, and similar varieties are common culprits.
- Processed meats: Bologna, pepperoni, salami, hot dogs, sausages, jerky, and other cured or preserved meats.
- MSG and related additives: Check labels for “natural flavoring,” “hydrolyzed protein,” and “autolyzed yeast.” Soy sauce, bouillon cubes, and canned soups are frequent sources.
- Alcohol: Red wine, ale, and malted beer are particularly problematic, though all alcohol can trigger episodes.
- Chocolate, nuts, and peanut butter.
- Certain fruits: Avocados, figs, raisins, and red plums. Citrus and bananas should be limited to small amounts.
- Artificial sweeteners: Aspartame in particular.
Keeping a food diary can help you identify which triggers affect you personally, since not everyone reacts to the same items. Preventive medications are also available for people with frequent episodes, and these are typically prescribed based on your specific symptom pattern.
Ménière’s Disease
Ménière’s disease causes recurring vertigo episodes along with fluctuating hearing loss, ringing in the ear, and a feeling of fullness or pressure. Episodes can last 20 minutes to several hours. The primary lifestyle change is reducing sodium intake, since excess salt affects fluid balance in the inner ear. Most guidelines recommend staying well below the standard 2,300 milligrams per day, with many specialists targeting 1,500 milligrams or less.
Medications that improve inner ear blood flow have shown effectiveness in both controlling vertigo episodes and preventing hearing deterioration over time. Treatment plans are usually tailored to how severe and frequent your episodes are, starting with conservative measures and escalating only if needed.
When Vertigo Signals Something Serious
Most vertigo is caused by inner ear problems and resolves with the treatments above. Rarely, vertigo signals a stroke or other central nervous system problem, and these cases look different in important ways.
The red flags that point toward a more dangerous cause include: double vision, slurred speech, weakness or clumsiness in your arms or legs, difficulty swallowing, or hearing loss that is sudden and one-sided. A stroke can occasionally present as vertigo with no other obvious neurological signs, which is why doctors use a specialized three-part bedside exam called the HINTS test. It evaluates specific eye movement patterns and can distinguish an inner ear problem from a brainstem event more reliably than a CT scan in the first hours.
If your vertigo comes on suddenly and is continuous (not triggered by head movement), lasts hours or days without letting up, and is accompanied by any of the symptoms above, that warrants emergency evaluation. BPPV, by contrast, produces brief spinning episodes lasting under a minute that are clearly tied to changes in head position.