Key takeaways:
The specific cause of your vertigo — peripheral or central — helps determine the best approach to treatment and exercise.
The most common type of vertigo is benign paroxysmal positional vertigo (BPPV), which is a peripheral vertigo. Central vertigo is less common and is caused by conditions like stroke, multiple sclerosis, or migraine.
Exercises, including the Epley maneuver, Semont maneuver, and Brandt-Daroff maneuvers, help treat BPPV. Balance and coordination exercises, such as Cawthorne and gaze stabilization exercises, can help treat other types of vertigo.
Vertigo describes an uncomfortable sensation of movement. It feels like your surroundings are spinning around you. It’s different from dizziness, which just makes you feel lightheaded. Vertigo can be associated with nausea and vomiting, problems with balance, and difficulty focusing your eyes.
Vertigo is a symptom of an underlying condition, not a diagnosis. There are two main types of vertigo, which help to determine the cause of vertigo:
Peripheral vertigo: Around 80% of people with vertigo have peripheral vertigo. This is caused by an issue with your inner ear or vestibular nerve. The most common type of peripheral vertigo is benign paroxysmal positional vertigo (BPPV). This condition causes symptoms when you change positions or quickly turn your head. Acute vestibular neuronitis and Ménière’s disease are other common causes of peripheral vertigo.
Central vertigo: This type is less common and is due to issues affecting your brain or brain stem. Multiple sclerosis, stroke, brain tumors, and even migraines can all cause central vertigo.
The best exercises to treat and prevent this condition depend on the type of vertigo you have (more on this below).
1. Epley maneuver
The Epley maneuver is a type of canalith repositioning exercise. This exercise works well for those with BPPV, but not for people with other types of vertigo. Research suggests that treating BPPV with the Epley maneuver and medication can be more effective than medication alone.
The instructions below are for treating the right ear. If your problem is with your left ear, turn your head in the opposite position of what is written below. If you aren’t sure which ear is affected, talk with a healthcare professional or watch this video with tips on how to know which ear is affected.
Here’s how to do the Epley maneuver.
Step 1: Sit on a bed with your legs extended out in front of you.
Step 2: Turn your head 45 degrees to the right.
Step 3: Lie back quickly with a pillow under your shoulders so your head hangs down slightly (about 20-30 degrees). Keep your head turned 45 degrees to the right.
Step 4: Hold this position for 30-60 seconds.
Step 5: Turn your head 90 degrees to the left, until it’s at a 45-degree angle to the left.
Step 6: Hold this position for another 30-60 seconds.
Step 7: Roll onto your left side and move your head to look left (down toward the bed or floor). Hold for 30-60 seconds.
Step 8: Sit up and stay still for 15 minutes before moving.
Step 9: Repeat these steps once a day until your symptoms resolve.
2. Semont maneuver
The Semont maneuver is another type of repositioning exercise used to treat BPPV. It works in a similar way as the Epley maneuver. It helps to move calcium crystals back to the correct place in your inner ear.
Research has found that the Semont maneuver is up to 90% effective after 4 sessions. A 2021 study comparing the Semont and Epley maneuver found that both were effective for treating BPPV. But the Epley reduced dizziness slightly more. You can try both to see which you prefer.
These instructions are for the right ear. If your left ear is affected, do the opposite of what’s written.
Step 1: Sit on the edge of a bed and turn your head 45 degrees to the left.
Step 2: Quickly lie down on your right side, keeping your head in that same position. You’ll be looking diagonally up at the ceiling.
Step 3: Hold this position for 1 minute.
Step 4: Quickly move to your left side, keeping your head in that same position. You’ll be looking diagonally down at the floor.
Step 5: Hold this position for 1 minute.
Step 6: Slowly return to the sitting position and turn your head to face forward.
Step 7: Sit for 10 minutes before moving.
Step 8: Repeat these steps once a day until your symptoms go away.
3. Foster maneuver
The Foster maneuver is a good option for those with BPPV who feel too dizzy when doing other vertigo exercises. Also called the “half somersault,” the Foster maneuver doesn’t work as quickly in reducing vertigo symptoms as the Epley maneuver, according to research. But it may cause less dizziness afterward.
These instructions are for treating the right ear. If your left ear is affected, do the opposite of what is written.
Step 1: Kneel on the floor and place both hands on the ground.
Step 2: Tilt your head back. Hold in this position for 15-30 seconds, or until the dizziness passes.
Step 3: Bend forward, place your forehead on the floor, and tuck your chin toward your chest.
Step 4: Turn your head 45 degrees to face your right elbow. Hold for 30 seconds, or until the dizziness passes.
Step 5: Keep your head turned in the same direction as you quickly raise your upper body until your head is level with your back (parallel to the floor). Keep your hands on the floor. Hold for 30 seconds.
Step 6: Raise up to the starting kneeling position.
Step 7: Wait 15 minutes before repeating.
Step 8: You may need to repeat 4-5 times before your symptoms improve.
4. Brandt-Daroff exercise
The Brandt-Daroff exercise is another move that can help move calcium crystals in the ear to the correct position for those with BPPV. Research suggests it’s less effective than the other maneuvers mentioned here.
The Brandt-Daroff exercise may be good for people with back issues because it’s a slower sequence. Here’s how to do it.
Step 1: Sit upright on your bed or sofa.
Step 2: Turn your head 45 degrees to the right.
Step 3: Keeping your head in this position, quickly lie down on your left side. Stay there until your dizziness goes away, then wait another 30 seconds. If there’s no dizziness, wait 30 seconds.
Step 4: Sit up quickly and wait for 30 seconds.
Step 5: Turn your head 45 degrees to the left.
Step 6: Keeping your head in the same position, quickly lie down on your right side. Stay there until your dizziness disappears, then wait another 30 seconds. If there’s no dizziness, wait 30 seconds.
Step 7: Sit up quickly and wait 30 seconds.
Step 8: Repeat the full sequence five more times, twice a day.
5. Cawthorne exercises
Cawthorne exercises are a set of moves that may help improve balance, equilibrium, and dizziness. These exercises use specific head and eye movements to help retrain your brain, which decreases symptoms. These exercises can be used for both peripheral and central vertigo.
Cawthorne exercise 1: Eye exercise
Follow these steps to do the first exercise.
Step 1: Sit in a chair with both feet flat on the floor.
Step 2: Keep your head still. Look up toward the ceiling, then down to the ground.
Step 3: Start slowly, then move more quickly. Repeat 20 times.
Step 4: Repeat this exercise twice a day.
Cawthorne exercise 2: Head exercise
Then, move to the next exercise.
Step 1: Sit in a chair with both feet flat on the floor.
Step 2: Turn your head from one side to the other.
Step 3: Start slowly, and then move more quickly.
Step 4: Repeat 20 times.
Step 5: If you don’t feel dizzy, repeat the steps with your eyes closed.
Step 6: Repeat this exercise twice a day.
6. Gaze stabilization exercise: Near-far focusing
Gaze stabilization exercises help your brain adapt to visual signals, which affect your proprioception (the sense of where your body is in space). The exercises train your eyes to shift focus quickly, which is essential for maintaining balance and mobility.
Step 1: Sit in a chair with your feet on the floor.
Step 2: Hold your thumb about 10 in from your face. Focus on it for several seconds.
Step 3: Quickly shift your focus to another object about 10 ft away.
Step 4: Continue to alternate your focus between your thumb and the other object for 3-5 minutes.
7. Romberg exercise
Like gaze stabilization, posture stabilization exercises like the Romberg exercise help improve balance and proprioception. This is helpful for people with vertigo who have trouble with standing balance.
Step 1: Stand with a wall behind you and a chair in front of you. This gives you support in case you fall.
Step 2: Stand with your feet close together and your arms down at your sides.
Step 3: Hold for 30 seconds, maintaining balance.
Step 4: If you can do this easily, repeat the exercise with your eyes closed.
Step 5: Hold onto the chair for support if needed. Your goal is to stand without swaying or holding onto the chair.
Step 6: Repeat this exercise twice a day.
What are the best exercises for vertigo?
An exercise-based treatment program called vestibular rehabilitation therapy (VRT) can help treat vertigo. The type of exercises you do depends on the type of vertigo you have.
Exercises for BPPV focus on the small calcium carbonate crystals (called canaliths) in your inner ear. These crystals can become loose and move out of place. Canalith repositioning procedures help to move these crystals back to their proper place. Other types of peripheral vertigo don’t improve with repositioning exercises and may benefit from other types of eye and head exercises.
Treatment for central vertigo focuses more on balance, gait, and coordination exercises. The idea is to train your brain to adapt and compensate. The repositioning exercises referred to above won’t help if you have central vertigo because the cause is different.
Consult a healthcare professional or a physical therapist before starting any vertigo exercises. They can help you determine the best exercises for your condition. And use caution: Don’t do all of these exercises on the same day. They’re designed to be done one at a time, for a week or longer, to gauge how well they’re working. If one exercise isn’t working after a trial period, wait 1 to 2 days before trying a different exercise.
Know that you may experience temporary dizziness while doing these exercises. If this happens, stop and wait for the dizziness to pass before continuing. Don’t stand up until you feel better.
Frequently asked questions
The most effective exercise depends on the type of vertigo you have. Research found that those with the most common type of vertigo, benign paroxysmal positional vertigo (BPPV), had 90% improvement with the Epley maneuver, about 73% improvement with the Semont maneuver, and 50% improvement with the Brandt-Daroff exercises. For those with central vertigo, balance and coordination exercises are best.
If you have BPPV, exercises like the Epley maneuver can be a quick way to cure your vertigo. Medications such as antihistamines and motion sickness medication can also quickly relieve vertigo symptoms. But they won’t cure the cause of vertigo. Vertigo symptoms due to central causes respond more slowly to treatment.
For people with BPPV, sudden position changes or quick head movements can trigger an attack. Lifestyle factors such as lack of sleep, diet (like alcohol, caffeine, high-sodium foods), and dehydration can increase symptoms. Stress and anxiety can also lead to an increase in vertigo symptoms.
The most effective exercise depends on the type of vertigo you have. Research found that those with the most common type of vertigo, benign paroxysmal positional vertigo (BPPV), had 90% improvement with the Epley maneuver, about 73% improvement with the Semont maneuver, and 50% improvement with the Brandt-Daroff exercises. For those with central vertigo, balance and coordination exercises are best.
If you have BPPV, exercises like the Epley maneuver can be a quick way to cure your vertigo. Medications such as antihistamines and motion sickness medication can also quickly relieve vertigo symptoms. But they won’t cure the cause of vertigo. Vertigo symptoms due to central causes respond more slowly to treatment.
For people with BPPV, sudden position changes or quick head movements can trigger an attack. Lifestyle factors such as lack of sleep, diet (like alcohol, caffeine, high-sodium foods), and dehydration can increase symptoms. Stress and anxiety can also lead to an increase in vertigo symptoms.
The bottom line
Vertigo makes you feel like your surroundings are spinning. It’s a symptom of an underlying condition. So, it’s important to find the cause (peripheral or central) to know the best treatment and exercises for you.
The most common type of peripheral vertigo is benign paroxysmal positional vertigo (BPPV). It responds quickly to a few different exercises such as the Epley maneuver, Semont maneuver, and Brandt-Daroff exercises. Central vertigo is less common and can be more difficult to treat. For both types, balance and coordination exercises, medications, and lifestyle strategies can also help reduce vertigo symptoms.
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