I have BPPV. Which side do I treat first? Can I treat both sides?

We are often asked which side to treat with BPPV. This answer is relatively simple. The Dix-Hallpike maneuver is the standard test for BPPV. Basically what happens is that you lie down fast on your back and turn your head to one side (ideally looking up a bit too). After about 30 seconds have passed you will either be dizzy or have no reaction. In this example if you are on your left and you get dizzy on that side then you have left sided BPPV. The same is true vice-versa. Obviously you treat the side on which you have BPPV. However about 10% of people have BPPV on both sides or it is not clear on which side they have BPPV because they didn’t get dizzy during the test but do other times.

The answer to the question about treating both sides is a bit more complicated. If you have BPPV on both sides or are not sure which side you have BPPV then you can indeed treat both sides. People often ask if you can “undo” the Epley maneuver by treating the left side immediately after treating the right side. No you can’t. However, you can cause yourself to be more nauseous and may even throw up. Even worse you run the risk of converting posterior BPPV to horizontal BPPV. What is that you ask,… Well usually people have Posterior canal BPPV meaning the crystals are in the back most balance canal. When you do the treatment maneuver the crystals come out of this canal and float back into the vestibule of the vestibular apparatus (the balance organ). If you get a lot of these crystals floating around in there and then start rolling around again they can float into another balance canal – the horizontal canal. This is actually a much worse feeling BPPV. Luckily it is easily treating by a log roll (something you might accidentally do in bed) so it usually doesn’t last very long.

So in summary we suggest getting a proper diagnosis for BPPV – and treating the appropriate side. If you are unsure on which side you have BPPV or have it on both sides we suggest treating one side for one week then treating the other side for the next week. This avoids confusion as to the diagnosis and also avoids nausea and conversion to Horizontal BPPV.

49 Responses

  1. Naina

    Having a very hard time in every position…can only sleep almost on my back..what should I do. And was is dizzyfix? Worried!!

  2. Gloria

    I have bppv due to seeing a chiropractor. I had notice getting a headache after he popped my neck a few times, but just pushed it off because they went away. For two weeks in a row now, he’s had me lie on a table with my head back on a white block for 6 to 10 min. and i am thinking this is the culprit to my condition. I am writing this to say please tell your chiropractor if you have this condition. He can end up making you worse.

  3. Gloria

    I have bppv due to seeing a chiropractor. I had notice getting a headache after he popped my neck a few times, but just pushed it off because they went aw away. For two weeks in a tow now, he’s had me lie on s table with my head back on a white block for 6 to 10 min. and i am thinking this is the culprit to my condition. I am writing this to say please tell your chiropractor if you have this condition. He can end up making you worse.

  4. Lou Thomas

    I dissolved my otoliths by taking 10mg of vinpocetine 2x per day. I still take this every day, and if I stoo the problem returns.

    This increases blood flow to the head, which apparently causes calcium to be dissolved and carried away faster than it can form into otoliths.

    This supplement also thins the blood slightly so if you want to try this check with your doctor first to ensure it will not interfere with other meds or existing conditions.

  5. Falk

    Through doing the DIX-HALLPIKE test (closely following this video: https://youtu.be/KzLWOX770i4?t=368 ) I figured out that it was my RIGHT ear – and with doing the EPLEY MANEUVER (closely following before-mentioned video as well!) 1x/day for 5 days: Vertigo is GONE 100%!!! PS: Before that I saw a general doc, who prescribed me 10 days of Cinnarizine – which did NOT cure it; and instead gave me 10 days of pretty hefty side effects. (Feeling quote DROWSY…)

  6. Brenda

    I’ve had classic symptoms of BPPV over the last month. It started on the right side. After a few days and a bit of research I decided to attempt the Epley Maneuver at home. I had pretty instant results with it however it returned a few days later on the left side. I have treated that with the Epley as well and last night there were no intense spells when I was turning in bed. I still feel a bit off but I understand that can be normal too. What I am wondering, is there anything else that would cause the symptoms that I should be concerned about as I haven’t been to a doctor for this. Thanks

  7. Felix Teplitsky

    I have all the answers to all my question which I had before reading this post. The only questions remains – can calciuYom stones dissolve by itself with time and can I do Eplye
    maneuver several times a day if it does not work the first time?
    And thank You for making my life easier by not advising to sit 24 hours and then sleep at 45 degree. Thank You.

  8. CR

    Reading all this is familiar but but at 68 I must confess I am concerned how I do the maneuver
    If I am now experiencing the intermittent DIZZYNESS blind positional vertigo left side as well
    I should do one week original and second week left side .?
    It seems to help but when I do the RT side I don’t feel the spin only when turning in bed .
    It’s like as if I am not experiencing the episode .one time my doctor did the maneuver and said I did not have it at time of maneuver a few years ago. It’s possible to feel residuals dizzy but while in the eply it doesn’t start ?
    Please help. CHR

  9. Clearwater Clinical

    Up as in Up-Beating nystagmus refers to the top of the head. However, BPPV has characteristic rotatory geotropic nystagmus with and upbeat component. Meaning, the top of the eye beats (rotates) towards the affected side in a slight twist motion, while the pupil moves up towards the upper lid a bit in the lateral decubitus position (so on the right side the eye beats towards the floor on the right)

  10. Diane

    Two days ago, I rolled over in my bed and immediately experienced extreme dizziness and spinning. I thought I must have moved too quickly; was dehydrated etc. Then I tried to get up and everything really started moving. I literally fell back down to the bed. I laid back down and after the symptoms subsided quickly, I tried again-the same experience. Being a speech-pathologist the first thought that entered my mind was a checklist for symptoms of stroke. I knew it wasn’t that. I called out to my husband and he assisted me in getting up. Once up and steadied, things improved greatly. Once I settled I thought of BPPV. I spoke with an audiologist who is a colleague and have scheduled an appointment with my doctor. I tried the manoeuvres today (I know I should wait until the diagnosis) and it is so apparent that it is the right ear that is affected. It is crazy how quickly things can change with your health. Frightening experience. I hope that with guidance from my physician and I am sure PT, I will be able to manage this successfully. All the best to everyone who has been thrust into dealing with this unsettling health issue. Thank you for providing this informational website.

  11. Nikki

    Hi,does enclosed areas worsen bppv. I’m doing the epley and it appears to be going , but once I hit an enclosed area, I feel funny. Looking for answers

  12. thomas

    ” (ideally looking up a bit too)”
    1. what does “up ” mean exactly ? towards the eyes anatomical upper pole ,ie, the eyebrows , or towards the eyes current “up” during the procedure , ie the ceiling
    2. in other references one author said “In typical nystagmus, the axis is near the undermost canthus. Minimize suppression by directing the patient gaze to the anticipated axis of rotation” , which practically means look towards the floor, does this contradict with your statement ?
    thank you

  13. Carla McPherson

    As a 56 year old healthy female, I was diagnosed with BPPV 4 months ago after out of the blue waking up with nystagmus and dizziness. Unfortunately, I was unsuccessful in ridding myself of imbalance symptoms after doing the Epley Maneuver with the assistance of a PT. Meclizine & Valium (though hesitant to take either as I do not routinely take medications) didn’t seem to make a difference and the head MRI was negative. As time progressed (approximately 2 months after my initial symptoms) , I developed “sinus type” headaches and began a course of antihistamine and decongestant as needed and have started a 2 week regimen of prednisone. My health care providers were questioning the initial BPPV diagnosis and are recommending further workups (CT, neurology consult, Valium regimen, VNG). The headaches have improved as of late after this course of therapy but the dizziness has always ensued. I’ve also begun cranialsacral therapy to help treat the dizzy symptoms. Currently, I’m finishing the prednisone 2 week regimen and I have only today arrived in San Diego for a vacation weekend from Tucson. My body felt the need for some ocean air and relaxing beach time. Luckily, I also been able to take a medical leave for the month of October. Hours after arriving, the nystagmus symptoms (that have been gone for many weeks) woke me up. I decided to retry the Epley Maneuver eliciting a response immediately after starting on my right side. I’m holding the decongestants as my headaches are still mild or non existent here. Can the humidity changes be affecting my positional changes? I also feel the need to just let Mother Nature takes its course and retry the Epley daily if the nystagmus reoccurs and continue with my rest & relaxation at the beach and finish the last days of the prednisone. Does this plan of course sound prudent? Would you suggest anything else right now? Similar to the other postings, I echo the frustration as I would really like my normal pre-vertigo life back!

  14. Cathy

    I have the dizzy fix and I need to treat both ears. Can I do the right ear for two days (once a day, two consecutive days) then switch to the left ear without waiting for one week later? Will not waiting actually do some harm, as in more likely to get dizzy or more likely to get evenworse?

    Also, the dizzy fix booklet says to wait one week to treat the second ear. What exactly does that mean? One week after the last treatment of the first ear? Or one week from the first day the first ear was treated?

    Thank you in advance for explaining…we really need help getting over this awful spinning dizziness that affects our sleep and our lives.

  15. Clearwater Clinical

    There is a 10% change of getting BPPV on both sides.

    Your second question is difficult to answer professionally. In general terms if you are having worsening symptoms that are different that those associated with BPPV (which are positional, short lived, spinning – which resolves after 1-5 minutes). IF you have other symptoms such as confusion, weakness, chest pain, slurred speech, numbness or pretty much anything other than those listed symptoms you should seek local help. The internet is good for general commentary but not really good for specific personal advice – so please take my comments as generalities.

  16. Maria

    Is it normal that it started on one side and now moved to both? Just to confirm, when it initially started, I would get dizzy if I turned on my right side. Does that mean it was my left or right side that was affected? When should I be concerned that it’s something more than just Vertigo?
    This is a great site by the way 🙂

  17. Clearwater Clinical

    You are correct – sounds terrible and can be very draining and even depressing. Certainly addressing the social and emotional aspects of dizziness is helpful. Are you able to find support from your family doctor, friends and family? Usually there isn’t much benefit from doing the Epley more than once a day. The response fatigues over time meaning the more you do it the less obvious it is that it is working. Hence, it may be of use to repeat the Epley more than once but this hasn’t really been proven. There isn’t a harm to it though. Serc doesn’t really help with BPPV but there is some research that suggests it might increase the blood flow to the inner ear- which might speed healing, although this isn’t yet main stream.

    Time will help!

  18. Maria

    I’ve had vertigo for over a month now. I have gone to the ENT and he did the Epley on me stating that my left side was the issue. Now when I do the Epley at home, I am dizzy on both sides. I understand that I should be doing the Epley one week at a time for each side but can you tell me how many times a day I should be doing it? I sleep propped up and try to avoid any sudden movements. Sometimes just tilting my head slightly forward causes me to be unbalanced. The ENT prescribed Serc 16mg every 12 hours. The whole thing is really unpleasant and draining. Is there anything else I can do to help myself?

  19. Clearwater Clinical

    BPPV can strike at any age and doesn’t necessarily need to be due to one of those listed risk factors. The youngest I have ever seen was 12. I have heard of even younger but in children there is another condition called BPV which is not related to BPPV (I know – confusing), this BPV is probably migraine related. In any case, it is good to get a diagnosis first from your own doctor. In cases of highly recurrent BPPV you can actually do the maneuver daily at home. Some people use a treatment device such as dizzyfix. You will need to choose a side to start on. It is not uncommon to feel unwell or off balance for several days to weeks with BPPV, either during, in-between or after treatment. This feeling does eventually do away. Remember to discuss all treatments with your own doctor and follow up if your symptoms change.

  20. Melissa Lopez

    I’ve have vertigo for 2 yrs now and I’m only 26 and am very healthy I went to ent and I’m clear I did get told I have bppv and visual vertigo I never hit my head and cat scan shows no tumors so idk why out of no where I will spin and I always feel unsteady for days on end

  21. Clearwater Clinical

    Good questions. There isn’t much that can be done to prevent BPPV from returning ever. However, the Epley Maneuver will make it go away in most cases (80% of the time). Some people only ever get one episode, some people get recurrent BPPV. It isn’t clear that preventative maneuvers keep it away but it can’t hurt. Sleeping at 45 degrees “might” help your BPPV but makes your sleeping worse so it is generally felt to be ineffective as it makes you sleep deprived which makes it harder to cope with your existing symptoms. “Post maneuver” precautions are generally not recommended by ENT anymore. Meclizine only makes you a bit sleepy and helps people cope with dizziness it doesn’t treat BPPV or any other cause of dizziness. If you like how it makes you feel and your own doctor recommends it then it is an option for you. However, the generally accepted treatment for BPPV is the Epley maneuver not medication. If you find you have recurrent BPPV you might consider an home treatment device like DizzyFIX so you can do it at home whenever you need to. Best of luck.

  22. Michael

    What manuver is the best to prevent vertigo from returning. How often should I do the manuver? If extreme vertigo hits should I take me meclizine? I now am sleeping at a 45 degree angle, recommended by my therapist.

    Thanks for helpingme ahead of time! :}


  23. Clearwater Clinical

    Great question. Post maneuver BPPV is really just the body recovering from the disease state, once you do the maneuver. However, it can be reduced by taking gravol or Meclizine or antivert (or other vestibulo-suppressant drugs) at the time of the maneuver as a prophylactic. However, recovery is a bit like recovering from weakness, you can’t get stronger by resting, you have to exercise. So it is with vertigo. You must challenge your balance system to recover in order to re-acclimatize. This sounds easier than it is, but you might find that things get easier with time, practice and avoidance of the first bought of nausea associated with the maneuver. Good luck.

  24. Clearwater Clinical

    Wow, that sound terrible. I hope you have been able to access some physician care in your location. Constant vertigo is not typical of BPPV although there are many contributing causes and BPPV may be one of them. I would seek the direct advice of a vestibular specialist which is a type of ENT doctor dealing with dizziness.

  25. Clearwater Clinical

    If your right ear is effected you will get dizzy when you lay down on the right side. You may also get dizzy getting up from the right side. You will treat the right side by starting the maneuver on that side.

  26. Clearwater Clinical

    I am sure there is a genetic component but it isn’t clearly identified with a single gene or anything yet. Perhaps more likely there are some risk factors that you share with your sibling. Anyone can learn the Epley maneuver. Some people need a little more help than others. The DizzyFIX is designed to provide anyone with all the help they need to get through the maneuver while being dizzy. Good luck.

  27. Julie jones

    I am into my 4 th month of constant vertigo. I have had to leave my place of employment due to being unwell. I usually have it for approx 9 weeks. Its my left side as i get terribly sick. My head feels like its swishing inside with a hose. I get the shivers vomit and fall if standing. I m 61 and have been getting episodes 3 times per year for 5 years. I also get nystagmus which is very scary. It seems like it won’t go away .i live alone and stay in bed hoping to just never wake up.

  28. amanda

    Hi this is new to me but on reflection has explained alot of my dizziness. I had my first real episode the other night after falling asleep quite soundly and then having the need to roll over..I felt i left my head behind and was extremely dizzy and nauseous straight away..or I felt like I had just jumped off a whirly ride as a kid ?? Second night I experienced this was the same and after reading about Vertigo I had all the classic symptons ( I am 55) and my sister (60) has suffered in the past. Do you know if this is a genetic disorder or just bad luck?…Can anyone learn this method of stabilization by a trained physician?

  29. Marcia Starnes

    If my affected ear is the right, should I lay on my left side? I get dizzy when I lay on the right when I get up.

  30. Bob Needham

    I was diagnosed with BPPV a number of years ago. However, it is triggered only when I’m swimming. It also seems to be triggered only if I breathe to my left (I breathe both sides although my strong side is breathing to the right). It is also triggered when I do flip turns. It doesn’t happened all the time. When I start feeling lightheaded I start doing open turns (no flip) but it continues to get worse so I have to get out of the pool.

    I am a 64 year old marathon swimmer and my training involves a lot of yardage. It can average 10,000 yd when I am into my serious training for a swim. However I’m having attacks doing the short workouts I am doing now.

    It only happened once in 2011, once 2012 & once in 2013. I rarely swam the next 3 years but I just returned to training and it is happening very frequent. I can alleviate the symptoms by properly doing the manuver, but I remain nauseous for at least 24 hours. Any suggestions?

  31. Mims

    I am having a bad episode of BPPV in (I think) my left ear. First time was about 6 years ago but nothing for 18 months. This is the first time I have done the D-H this way. I had a severe reaction in every position until I sat up. I don’t throw up but get cold & clammy & shake. Praying this goes as quickly as it started which was on waking this morning. It’s a very nasty & scary condition & any sufferer has my sympathy.
    Any advice welcome. I diagnosed that it was left ear by lying on both sides & getting the vertigo when I turned left.

  32. Clearwater Clinical

    Yep, the Epley (so long as you do it correctly) works very well if you indeed have BPPV. The best way to do it for sure right is to see an expert or have a home device like DizzyfIX. Episodes come back in about 50% of people so be ready to do it again. Only about 10% of people have it in both ears.

  33. Cathy

    I had the worst vertigo I have ever had in years for 3 days. My husband helped me do this last night before bed and I woke up and it is completely gone. I did pray before we started and between the 2 I am back to myself today. I can hardly believe it. Thanks

  34. Clearwater Clinical

    Hmm, I’m not sure I understand your question, but I am guessing that you are asking if doing the Epley Maneuver will make BPPV go away forever? The answer sadly is no. Most people (about 60%) experience recurrent BPPV where it comes back every few years. Some people (10%) get BPPV in both ears. Some unlucky people get highly recurrent BPPV where it can come back almost daily. However, the first correct treatment of BPPV with be effective about 89% of the time (in our studies anyway). This effect may last form months to years or forever. So it is well worth getting a correct diagnosis and treatment. Take a look at http://www.dizzyfix.com for some details.

  35. Joremie Anito

    Yes I was diagnosed of BPPV 2 years ago. Whenever I do the Epley manuever the dizziness became worst and most of the time vomiting follows. My question is, does this case will really disappear forever?

  36. Clearwater Clinical

    Quick answer – yes it helps. Don’t take them before you see your doctor as it can mask the findings that the doctor wants to see, but yes it can help you deal with the dizziness. The only good news is that if you do get through the entire maneuver it will be the last time you feel that way.

  37. Clearwater Clinical

    Thanks for the question. It sounds like you have BPPV but of course you should check with your own doctor. Most people do no actually vomit during the manuever but it sure does cause vertigo and nausea. You are correct that if you have right sided symptoms that you should do the manevuer on the right side. Some people find that taking things very slowly helps reduce the degree of symptoms. The diagnostic maneuver (Dix-Hallpike) should be done quickly but there is no need for the Epley to be done quickly, so take your time if that helps. BPPV will settle after a few minutes but I understand that the nausea can last longer. Some others will take anti-nausea medication like Anti-vert (Meclizine) or Ativan (Benzo) or Gravol prior to the maneuver to help manage the symptoms. Worst comes to worst and you do vomit, have a bowl near by and a cool cloth to help you settle down. Regardless if you vomit, it is worth it as that should be the last time you will experience the symptoms if you successfully complete the maneuver. Best of luck.

  38. Clearwater Clinical

    Recurrent or Highly recurrent BPPV is the reason that the DizzyFIX was invented. The device is intended to help people with frequent episodes of BPPV treat themselves quickly at home. Check with your doctor to see if you have BPPV. If you are certain then the DizzyFIX has a >88% of treating you according to previously published research.

  39. Joremie Atangan

    I’m suffering BPPV now for 2 years and until now I am still looking for an answer if this case will have a cure? And when it will stop coming back? Usually in my case it reoccurs after 2-3 months which is really alarming to me. Can you please give me any advice or help on how to stop this? Thank you very much

  40. BRian

    I have BPPV when turning my head to the right when lying down. Do I do the EPLY when lying on the right side? If I do I’ll vomit.

  41. wendy quinn

    I am suffering with bppv and have been told by my doctor to try the epley manoeuvre.tonight…. I have tried the test to see which ear is affected and its definitely my left ear as got very dizzy and feel very sick !! Would it help if before I do the epley tomorrow I take some of my anti giddiness tablets ? Bit worried about doing it now !! Thanks

  42. Clearwater Clinical

    Thanks for sharing. Good tip re “eyes closed” if no one is watching. Often times with dizziness you can visually suppress vertigo (meaning eyes open can help you fixate your eyes. However, BPPV is not one of those so it really doesn’t matter eyes open or closed. Whichever you find most comfortable.

  43. Pati Young

    Well, 10 days later. Still wobbly, but Bonine helping. No throwing up. Meant to mention in my other post that I have found that I don’t need to have my eyes open if no one is witnessing me do the mameuver. I can tell when the nystagmus hits. Keeping my eyes shut prevents me from throwing up most times especially after the initial bout.

    This bout continues to be confusing. Usually I have my BPPV on the left side but I’m clearly more dizzy when I turn to the right.

    Last time took 3 weeks to recover. Looks like this time heading for same.

  44. Clearwater Clinical

    Thanks for the great comment. Some people are very sensitive to the Epley maneuver and do indeed throw up when this is attempted. Most find this gets less intense over time. It sounds like you are able to do your own Epley at home – great. Once you have a correct diagnosis of BPPV and have successfully treated it before your suggestion of taking some medication to dull the symptoms while you do the maneuver is a good one. You may find that weekly ‘preventative’ Epley maneuvers are effective at avoiding “big” episodes of BPPV. This is not well discussed in the medical literature but I have found it effective. Do one maneuver a week and see if you have any more recurrences – let me know. As a note – during a ‘preventative’ maneuver you will not likely experience dizziness as your BPPV has not reached a critical point. The idea here is to prevent that from happening at all. As always you should discuss any treatment plans with your own physician before initiating them. Good luck.

  45. Chimpati

    I am 60 and have had BPPV for too many years. Each time I get it, there is a learning curve. Glad to find this web site; happy to compare notes with other sufferers. I am a strong proponent of the Epley and Halpike Dix: both self taught and re-trained in vestibular PT. The simpler maneuver seems to be enough to correct things for me most times. More recently, I seem to have vertigo on the right in the 1st lying back position and then on the left when I sit up. This is confusing. However, most importantly for me has been to learn that taking Bonine (over the counter anti-nausea meds & therefore easier to keep down once I get nauseous) ASAP before I do any maneuvers. This prevents me from throwing up. Further, my PCP prescribed dissolving Zophran for the very intense beginning of my BPPV. This helps knock me out and protects me from throwing up. I use it for sleep the 1st couple of nights. Now I just need to remember to carry the Bonine with me and take it when I feel the BPPV coming on which I usually do for a few days before, Then maybe I wouldn’t be so afraid to do the maneuvers earlier on. Never too old to learn new ways to cope….

  46. Clearwater Clinical

    You are exactly correct. First and third position are the right places to have vertigo. If you have it in the 4th position (sitting up) it usually means you didn’t do it quite right. Looking toward the floor is the most gravity sensitive position as the crystals are falling out of the canal into the vestibule.

  47. Clearwater Clinical

    If you don’t do the maneuver correctly it will fail. Some studies show success of maneuvers as low as 5% in inexperienced hands. Yes usually you have a “reverse” spin if the crystals fall back during the maneuver.

  48. Jill

    Oh, I should also mention that when I did the second epley, I had what felt like two vertigo spins in the third position (like I spun then it stopped for a split second then started again before stopping after 10 seconds or so). I’m so worried I screwed something up and moved the crystals back or just irritated the canal even more (I had the epley done by a pt a few years ago and had no more vertigo on the second epley. I’m worried though because on this most recent episode of doing the epley again I’ve had less vertigo in first position and only spun for a few seconds (I know this is a good thing), but I had more vertigo in the third position than I did the first time I did the epley, worried I’ve done something.

  49. Jill

    I did the epley at home since I have bppv in my left ear. Each time I’ve done it I’ve only gotten spinning vertigo in the first and third position:ex. go back get vertigo, 2nd position no vertigo, 3rd position on side with head turned to floor vertigo, 4th position sitting up no vertigo. Is this normal? From what I’ve read aren’t you supposed to get vertigo in each position, especially the last one when you sit up? The worst vertigo seems to be in the third position for me (on my side with my head turned at an angle towards the floor). I noticed the second time I did it (2 days after the first), I had less vertigo in the first position, but more during the third position. Any input?

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