Vertigo (BPPV) Treatment

Benign paroxysmal positional vertigo (BPPV) is the single most common cause of vertigo, accounting for approximately 50% of all dizziness cases. It occurs when tiny calcium crystals (otoconia) become dislodged from their normal position in the inner ear and migrate into one of the semicircular canals.

When you change head position — rolling over in bed, looking up, or bending forward — these displaced crystals create a false sense of spinning that can be intense and disorienting. Common triggers and symptoms include:

• Brief but intense spinning when rolling over in bed or lying down
• Dizziness when tilting your head back to look up
• Nausea or a sensation of the room moving with position changes
• Unsteadiness or difficulty walking, especially in the dark
• Anxiety and fear of movement due to unpredictable episodes

Episodes typically last less than a minute but can cause significant distress and functional limitation. BPPV can develop at any age, though it is most common in adults over 50 and is more prevalent in women. It may follow a head injury, inner ear infection, or occur without a clear cause.

The good news is that BPPV is one of the most treatable conditions in all of medicine. With the correct repositioning maneuver, symptoms can often be resolved in a single treatment session.

Treatment begins with a precise diagnostic assessment to determine which ear and which semicircular canal is involved. Our therapists use specific positional tests — including the Dix-Hallpike and Roll Test — to identify the exact location of the displaced crystals. Accurate diagnosis is essential because each canal requires a different repositioning technique.

Once identified, we perform the appropriate repositioning maneuver:

• Epley Maneuver — The gold standard for posterior canal BPPV, the most common type
• BBQ Roll / Lempert Maneuver — For horizontal (lateral) canal BPPV
• Deep Head Hang — For anterior canal BPPV, the rarest variant

These maneuvers use gravity to guide the displaced crystals back to their correct location. The procedure takes about 15 minutes and can produce immediate relief. Your therapist performs each maneuver with careful attention to your response, adjusting technique and pace to minimize discomfort.

Every session is one-on-one with a licensed physical therapist trained in vestibular assessment and treatment. This specialized expertise ensures an accurate diagnosis on the first visit and the most effective treatment approach for your specific type of BPPV.

Most patients experience significant or complete resolution of vertigo after one to three treatment sessions. About 80% of posterior canal BPPV cases resolve with a single Epley maneuver. After treatment, your therapist will provide positioning guidelines for the first 24 to 48 hours to prevent the crystals from migrating again.

We will schedule a follow-up to confirm the BPPV has fully resolved and address any residual imbalance. Some patients — particularly older adults or those with recurrent BPPV — benefit from a brief course of balance rehabilitation after the vertigo resolves to restore confidence and stability with daily activities.

If your dizziness does not respond to repositioning maneuvers, this suggests a different vestibular cause, and we will adjust our assessment and treatment plan accordingly. Our therapists are experienced in differentiating BPPV from other vestibular conditions and will ensure you receive the right diagnosis.

For your first visit, wear comfortable clothing and avoid heavy meals beforehand, as repositioning maneuvers can temporarily provoke dizziness and nausea. Bring your insurance card and any relevant medical records or imaging. Delaware does not require a physician referral to begin physical therapy, and we accept Medicare and most major insurance plans. Our office staff will verify your benefits before your first appointment.