You may not need treatment right away or at all. Your clinician will keep a close eye on your condition to see if it improves on its own. If your symptoms don’t improve, return, or get worse, treatment is the next step.

BPPV exercises are also called canalith repositioning maneuvers (CRMs) or particle repositioning maneuvers (PRMs). There are several types of BPPV exercises, including Epley maneuver and Gufoni maneuver. They use a series of precise head movements that allow gravity to carry the crystals through the semicircular canal and back into the utricle. A specially trained physical therapist performs the maneuvers and can teach you to do them on your own.

Your clinician may prescribe medications to reduce nausea and dizziness from BPPV, but medications do not treat BPPV itself.

Medications can also treat underlying causes of BPPV such as vestibular migraine and Ménière’s disease.

Balance therapy is a specialized exercise program to help you improve your balance, reposition crystals, and cope with vertigo and dizziness. A physical therapist teaches you exercises, such as:

• Balance retraining, to help you adapt to imbalance and feel steadier
• Canalith repositioning maneuvers, also known as BPPV exercises
• Habituation exercises, which teach your brain to ignore dizziness by exposing you to motions that typically cause you to feel dizzy
• Posture training, to practice standing and sitting
• Stretching exercises, to increase your flexibility
• Vision stability exercises, to help you control your eye movements
• Walking exercises, to practice maintaining your balance

Rarely, you may need surgery. There are two types of surgery doctors use for BPPV when other treatments are ineffective or you cannot perform BPPV exercises. They include:

• Posterior canal occlusion: We plug the semicircular canal to prevent fluid movement. This procedure relieves symptoms but causes a temporary loss of balance. Your brain typically adapts after surgery but vestibular rehabilitation therapy can help speed this process.
• Vestibular neurectomy: We cut the nerve that sends signals from the semicircular canal to the brain. Doctors rarely use this procedure, which can lead to sensorineural hearing loss.