What it treats
Benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, where crystals in the inner ear move into the wrong canal and cause spinning on turning over or looking up. Vestibular neuritis and labyrinthitis, inner ear infections that leave lasting imbalance. Persistent dizziness after concussion. Meniere's disease between attacks. Vestibular migraine. Age-related balance decline. Persistent postural-perceptual dizziness, the chronic dizziness that can follow any of these.
What treatment involves
A detailed assessment of your symptoms, eye movements, positional tests and balance to identify which part of the system is involved. For BPPV, repositioning manoeuvres such as the Epley move the crystals back, often resolving vertigo in one or two sessions. For other causes, a programme of exercises that provoke mild dizziness in a controlled way, teaching the brain to recalibrate; these are progressed over weeks. Balance and gait training, and advice on activity and driving.
Vestibular rehabilitation exercises
- Gaze stabilisation: keeping your eyes on a target while you turn your head, to retrain the reflex that keeps vision steady
- Habituation: repeating movements that bring on mild dizziness until the brain stops over-reacting to them
- Balance training: standing and walking tasks made gradually harder, for example with feet closer together, eyes closed or on a soft surface
- Walking with head turns: to bring it all together in everyday movement
Exercises usually take a few minutes, several times a day. Mild, short-lived dizziness during them is expected, so do them somewhere safe, near a wall or a sturdy chair.
The evidence
Repositioning manoeuvres for BPPV have strong evidence and are first-line treatment in NHS and international guidance. Vestibular rehabilitation exercises have good evidence for reducing dizziness and improving balance after inner ear disorders and concussion, and for chronic dizziness where medication has little to offer.
How long it takes
BPPV: one to three sessions. Other conditions: typically six to twelve weeks of exercises with reviews every one to two weeks. Improvement is gradual and depends on doing the exercises.
When to get urgent help
Call 999 or go to A&E if dizziness comes with double vision or loss of vision, hearing loss, trouble speaking, weakness, numbness or tingling in an arm or leg, a sudden severe headache or chest pain. See a GP if vertigo will not go away or keeps coming back.
Vestibular First at Omnia
Our vestibular assessment and rehabilitation service in Chiswick, Vestibular First, is delivered by physiotherapists trained in vestibular care, with the option to combine with tai chi for balance and acupuncture for associated symptoms. A vertigo and BPPV assessment with treatment is £50; book through our booking page or call 020 4515 0000. Omnia Lifestyle is at 8 to 9 Bedford Corner, The Avenue, Chiswick W4 1LZ, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking.
Related guides
Read our longer guide to vestibular rehabilitation, find out what the vestibular system is, whether physiotherapy can help dizziness and whether your dizziness is BPPV, and how rehabilitation helps after concussion and with chronic dizziness.