Exercise guide
Vertigo is the feeling that you, or everything around you, is spinning. Inner-ear problems are the commonest cause, most vertigo gets better without treatment, and the right exercise depends on the cause. Brief spins when you lie down, roll over or look up are usually benign paroxysmal positional vertigo (BPPV), which is treated with a repositioning manoeuvre such as the Epley, done by a trained clinician.
If dizziness or unsteadiness lingers after an inner-ear illness, vestibular rehabilitation helps: short daily head and eye exercises, balance practice and walking that deliberately make you a little dizzy so your brain can adjust. In UK GP trials, a free self-help booklet of these exercises helped, though the effects were modest.
This guide helps you work out which kind of dizziness you have, explains the Epley manoeuvre and Brandt-Daroff exercises, teaches the head and eye exercises step by step, and covers falls, driving and the warning signs that need 999. It ends with a balance routine you can follow with 3D demos.
Vertigo is more than feeling dizzy: it's a spinning feeling that affects your balance. Inner-ear problems are the commonest causes (BPPV, labyrinthitis and vestibular neuritis, and Ménière's disease), along with migraine and some medicines. Most people with vertigo get better without treatment.
Call 999 for vertigo with double vision or loss of vision, hearing loss, trouble speaking, or weakness, numbness or tingling in an arm or leg. A stroke can cause dizziness, but it's rarely the cause: in one study in emergency departments, 0.7% of people with dizziness alone had a stroke or a mini-stroke.
A trained GP, physiotherapist, audiologist or ear, nose and throat (ENT) clinician confirms BPPV with a positional test and does a manoeuvre such as the Epley. In trials it cleared the vertigo in 56% of people, against 21% with a sham. Brandt-Daroff exercises are the home option NHS clinics give, but two trials found them less effective than a repositioning manoeuvre, and a third found them similar to a home Epley.
For dizziness that lingers after vestibular neuritis or labyrinthitis, exercise-based rehabilitation makes dizziness less frequent and less disabling (a Cochrane review of 39 trials), and US physiotherapy guidance strongly recommends it. Free self-help versions helped in UK GP trials, with modest effects.
The self-help booklet's routine takes under 10 minutes, every day and ideally twice, and recovery takes about 6 weeks. The exercises work by bringing on mild dizziness. Lie still during a bad attack, but start walking as soon as you can.
Dizziness makes falls more likely. Exercise next to a kitchen counter, with a bed or sofa nearby, sit down straight away if you feel dizzy, and don't drive while you're dizzy. You must tell the Driver and Vehicle Licensing Agency (DVLA) about dizziness that is sudden, disabling or keeps coming back.
Use this to describe your symptoms to a GP, not to diagnose yourself.
Vertigo feels like you or everything around you is spinning, enough to affect your balance, and an attack can last from a few seconds to hours, or many days or months if it's severe. Dizziness is a wider word for feeling off-balance, giddy, light-headed or faint. Some people also find that things seem to bounce or blur when they move their head.
Your brain combines three senses: your eyes, sensors in your muscles, joints and the soles of your feet, and the balance organ in each inner ear, which signals every time your head moves. A reflex between the inner ear and the eye muscles keeps your vision steady when your head turns. If one part sends faulty signals you feel dizzy or unsteady, and your brain gradually adjusts, faster if you practise the movements that make you dizzy.
Loose chalk crystals drift into one of the inner ear's canals, so lying down, sitting up, turning over in bed, looking up or bending down sets off a spin lasting about 5 to 30 seconds. It's common after a head injury or labyrinthitis. About 2.4% of people get it at some point, and it becomes much more common with age.
Usually a viral inflammation of the inner ear (labyrinthitis, which can also affect your hearing) or of its nerve (vestibular neuritis). Symptoms often ease after a few days and balance usually comes back over 2 to 6 weeks, but sometimes problems last for months, which is when vestibular rehabilitation helps.
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A rare condition with sudden attacks lasting from a few minutes to 24 hours: spinning, ringing in the ears (tinnitus), hearing loss and pressure in the ear. Exercises can't prevent or stop the attacks, but they can help the unsteadiness between them.
Migraine in which vertigo, dizziness or unsteadiness are the main symptoms, sometimes without a headache, in episodes that can last from seconds to days. It affects just under 1% of people.
Persistent postural-perceptual dizziness (PPPD) is dizziness or unsteadiness on most days for 3 months or more, worse when you're upright, moving or in busy places, often starting after another balance problem. It's a problem with how the brain processes movement, not damage to the ear and not a psychiatric condition.
Feeling light-headed or faint when you stand up is usually a drop in blood pressure, and with a racing heart it can be postural tachycardia syndrome (PoTS). These need a GP check and different advice: see our PoTS guide. Some medicines can cause vertigo too, so check the leaflet.
BPPV is about twice as common in women as in men and much more common with age, and vertigo from the inner ear affects about 5 in 100 adults a year. None of this changes the exercises, but the US physiotherapy guideline says people over 50, people with memory problems and people afraid of falling are more likely to need a physiotherapist's supervision.
A Cochrane review of 39 trials (2,441 people with a balance problem in one inner ear) found exercise-based rehabilitation made dizziness less frequent and less disabling, with no harms reported, and called the evidence moderate to strong. The guideline from the American Physical Therapy Association (APTA) strongly recommends it, ideally supervised, and starting early.
Three UK GP trials tested self-managed versions of the same exercises. With one nurse appointment and a booklet, 67% improved, against 38% with usual care (170 people). A booklet, with or without phone support, gave better dizziness scores a year later (337 people), and the free online Balance Retraining programme gave better scores at 3 and 6 months (296 people aged 50 and over). The improvements were real but modest.
Following a finger or switching your gaze without moving your head doesn't train the reflex that keeps your vision steady, and the APTA advises against using these on their own. For gaze exercises, the head has to move.
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In a Cochrane review, the Epley cleared vertigo in 56% of people, against 21% with a sham or no treatment (5 trials, 273 people), with no serious side effects, though some people felt sick during it. The US guideline from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) strongly recommends a repositioning manoeuvre. In a Spanish trial, a single Epley by GPs after 2 hours' training made dizziness less disabling over a year (134 people).
Two trials found them less effective than a repositioning manoeuvre. After a week, 25% were clear, against 80.5% after one manoeuvre (81 people), and as self-treatment, 6 of 26 were clear against 18 of 28 with a home Epley. A 2026 trial of 50 people found home Brandt-Daroff and a home Epley similar, with about 40% clear at a month in both. The original 1980 report, which counted 66 cures in 67 people, had no comparison group.
In small trials of people who had been diagnosed and taught a home version for their side, 95% were clear within a week (70 people), and a self-Epley did as well as one in clinic (64 people). In a Korean trial of 128 people whose BPPV came back, those who used a web questionnaire to match a self-treatment video to their type of BPPV got rid of the vertigo more often (72.4%) than those who repeated the manoeuvre for their previous type (42.9%), and nobody fell. Two of the authors own most of the company that makes the program.
Sleeping upright or wearing a collar afterwards made only a small difference to the follow-up test and none to the vertigo, and the AAO-HNS strongly recommends against these restrictions.
For vestibular migraine, a Cochrane review found only one small trial of rehabilitation (40 people), so the effect is uncertain. For PPPD, it found no trials of rehabilitation that met its standards. Rehabilitation may help some people, but the Migraine Trust says it isn't right for everyone.
In a US survey of 5,086 adults aged 40 and over, people with a balance-organ problem who felt dizzy had 12 times the odds of falling, and in one clinic for older people, 9% had BPPV that nobody had spotted. The world falls guidelines say repositioning may reduce falls, but the evidence is limited.
Fitness exercise with no balance element, such as a static bike, hasn't been found to help a balance-organ problem, though walking is part of rehabilitation. Sport, dance and yoga help once your dizziness is nearly better.
The National Institute for Health and Care Excellence (NICE) says to offer a repositioning manoeuvre such as the Epley when a healthcare professional trained in it is available, unless you have an unstable neck problem, and calls it simple, low-risk and effective. In the NHS it's done by trained GPs, physiotherapists, audiologists and ENT clinicians. Ask your GP.
Some people feel a bit dizzy and off-balance for a day or two, and some need two or more treatments. You don't need to sleep upright or wear a collar afterwards, and your clinician should check within about a month that it has cleared.
NHS ear, nose and throat and audiology clinics often give these after an Epley, because they're easier to do on your own. The usual dose is a set of 5 in the morning, afternoon and evening, every day for 2 weeks: this is clinic practice, not a dose tested in trials. If you're still dizzy after 2 weeks, go back to your clinic. The steps are below.
Our reading of NICE and the US guideline together: do an Epley on yourself only after a clinician has confirmed BPPV and which side is affected, and shown you how. The manoeuvre is done for one side and is designed for crystals in one particular canal, so a version for the wrong side is unlikely to help, and the test first rules out other causes. Once you've been taught, a home version can work well if BPPV comes back.
Anti-sickness tablets and antihistamines shouldn't be used routinely for BPPV. It's a mechanical problem, so medicines don't move the crystals.
About a third of people get BPPV again after treatment. In one trial of people with low vitamin D, vitamin D and calcium made BPPV come back less often, so if yours keeps returning, ask your GP whether your vitamin D should be checked.
This explains what a trained clinician does; it isn't a guide to doing it yourself. From Ménière's & Vestibular UK, the US BPPV guideline's description of the Dix-Hallpike test, and the Cochrane review of the Epley.
Only for BPPV that a clinician has diagnosed. They're likely to make you dizzy, so do them somewhere safe, preferably with someone with you. Steps and dose from NHS leaflets (United Lincolnshire, University Hospitals Sussex and West Suffolk); the dose is clinic practice, not tested in trials.
Four kinds of exercise: gaze stabilisation (moving your head while keeping your eyes on a target), habituation (repeating the movements that make you dizzy until they stop doing so), balance training, and walking. It's usually led by a physiotherapist or audiologist.
Lasting dizziness or unsteadiness after vestibular neuritis or labyrinthitis, between Ménière's attacks, and for some people with vestibular migraine. It isn't for an attack of vertigo, or for BPPV on its own, which needs a repositioning manoeuvre.
The Balance Retraining booklet is meant for use once a doctor has confirmed the exercises are safe and suitable for you. The NHS says to do the exercises with a physiotherapist or audiologist: a GP can refer you, or you may be able to refer yourself, though waits can be long. Self-help versions worked in UK GP trials, so the booklet is a reasonable start while you wait (our suggestion).
The booklet's dose: 10 movements in 10 seconds, rest 10 seconds, then 10 more, for each exercise, taking under 10 minutes in all, every day and ideally twice. In its trial, people did 5 to 10 minutes twice a day for 12 weeks, or until their symptoms went, and the gains were modest.
The APTA suggests more: gaze exercises at least 3 times a day, adding up to at least 12 minutes a day in the first weeks after an inner-ear illness, or 3 to 5 times a day for at least 20 minutes a day for 4 to 6 weeks if dizziness has lasted longer, plus about 20 minutes of balance work a day. These doses are weak recommendations, based on limited evidence and expert opinion.
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Ten seconds after each exercise, score your dizziness: 0 none, 1 very slight, 2 mild, 3 strong. Practise the ones that score 1 to 3 every day, more slowly if 3. Score them again each week, and when one scores 0 at full speed, do it standing, then while walking a few paces.
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It's common to feel worse when you start, and that isn't a bad sign: if the exercises don't bring on any dizziness, they won't work. Most people have good and bad days, and after a few weeks of daily practice the exercises make you less dizzy. Recovery takes about 6 weeks, even with the exercises.
If your balance is poor, walking for 5 to 10 minutes a day helps it improve; go out with someone at first, and keep your eyes on a fixed point rather than looking around all the time. Sport, dance and yoga help once your dizziness is nearly better.
Anti-sickness and antihistamine tablets are for the first few days only (up to 3 days for labyrinthitis), because longer use can slow recovery. Never stop or change a prescribed medicine yourself: ask your GP.
Once a GP has checked your dizziness: the head and eye exercises below once or twice a day, the balance routine at the end of this guide, a 5 to 10 minute walk each day, and a request for vestibular physiotherapy.
From the Balance Retraining booklet (University of Southampton and Ménière's & Vestibular UK), whose self-help programme helped in UK GP trials. When one scores 0 at full speed sitting down, do it standing, then while walking a few paces.
The booklet's shake-and-stare and nod-and-stare exercises; the APTA guideline calls this gaze stabilisation. Stop, and see a doctor before starting again, if it brings on sharp or lasting pain in your neck, head or ear, a full feeling or noises in the ear, deafness, double vision, fainting, or numbness or weakness in your arms or legs.
Exercise next to a kitchen counter, a wall or a sturdy chair, or beside a bed or sofa so there's something soft to lean on if you start to fall. Keep the floor clear and the light good, and carry a phone or wear an alarm.
Sit down straight away when you feel dizzy, turn the lights on if you get up at night, and get out of bed slowly, sitting on the edge for a while before you stand. Squat rather than bend to pick things up, and use a walking stick if you're at risk of falling.
Lying flat, sitting up, looking up and bending down are the classic BPPV triggers, and the NHS advises against bending over or stretching your neck up during vertigo. Our suggestion: move slowly into and out of head-down yoga poses, lying back and tipping your head back, and leave them out during a bad spell.
If you've fallen or are worried about your balance, ask your GP about a falls assessment: NICE's includes asking about dizziness and, if you get spinning, a test for BPPV. You may be able to refer yourself to a falls service. In older people generally, balance and functional exercise cuts falls by about a quarter, and our older adults guide covers it.
Don't drive, cycle or use tools or machinery while you feel dizzy. You must tell the DVLA about dizziness that is sudden, disabling or keeps coming back, and you can be fined up to £1,000 if you don't.
With Ménière's disease, the NHS says to consider the risks and take care with swimming, climbing ladders or using dangerous machinery. With any vertigo that comes on suddenly, don't swim alone (our suggestion).
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Hold one-leg stands for 5 to 10 seconds, 3 on each side, and take at least 5 heel-to-toe steps (NHS). Make one thing harder at a time (less hand support, then eyes closed, then slow head turns), and leave the balance board until one-leg standing on the floor is steady.
3D demoSemi-tandem stanceBeginner · A wall
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSingle-leg standBeginner · A wall
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoStanding marchBeginner · No equipment
3D demoBalance board standBeginner · Other / check instructionsWalk for 5 to 10 minutes a day if your balance is poor, outdoors or along a corridor, with someone at first (Balance Retraining booklet). Practise getting up from the floor with someone there, and breathe slowly, one breath every 4 to 6 seconds, when you feel dizzy.
Do the vestibular routine every day, after the head and eye exercises above. The other workouts build strength and balance for falls prevention on good days.
A 15-minute routine for lasting dizziness from an inner-ear problem: the vertigo guide's head and eye exercises, then balance at a counter and a short walk.
15 minBeginner7 movesA wall, Cardio machineBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentStrength and balance 3 times a week plus walks, for older people once the dizziness is settling.
Stop, and don't start again until a doctor says it's safe, if the exercises bring on:
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Ménière's & Vestibular UK, a charity for people with dizziness and balance problems, runs a helpline on 01306 876883.
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Lie still during a bad attack, but start walking as soon as you can. Avoiding movement slows recovery and can lead to a tense neck, and rehabilitation works by bringing on mild dizziness in a controlled way.
The cause decides. BPPV needs a repositioning manoeuvre, which beats exercise in the short term; exercises can't stop Ménière's attacks; feeling faint on standing is about blood pressure; and dizziness with stroke signs is an emergency.
Success rates like this go back to a 1980 report of 66 cures in 67 people, which had no comparison group. In a randomised trial, 25% were clear after a week and 42.5% after a month, against 80.5% and 92.7% after a repositioning manoeuvre, though a 2026 trial found home Brandt-Daroff and a home Epley similar.
The Epley is done for one side and designed for crystals in one particular canal, and NICE routes it through a trained professional after a positional test. Home versions work well once a clinician has confirmed your side and shown you how.
The US guideline strongly recommends against restrictions after the manoeuvre: in trials they made a small difference to the follow-up test and none to the vertigo.
Anti-sickness and antihistamine tablets are for the first few days of labyrinthitis, because longer use can slow recovery, and they shouldn't be used routinely for BPPV.
A charity says so, but a large German survey found about 2.4% of people get it at some point in their lives, rising to almost 10% by the age of 80.
Fitness exercise without a balance element, such as a static bike, hasn't been found to help a balance-organ problem. Walking, sport and yoga help once you're nearly better.
It depends on the cause. For BPPV, the brief spins when you lie down, roll over or look up, the Epley manoeuvre done by a trained clinician works best, and Brandt-Daroff exercises are the home option. For dizziness that lingers after an inner-ear illness, vestibular rehabilitation works: head and eye exercises, balance practice and walking.
Often, yes. Across 39 trials, vestibular rehabilitation made dizziness less frequent and less disabling, with no harms reported, and free self-help versions helped in UK GP trials, though the effects were modest. BPPV is the exception: it needs a repositioning manoeuvre.
Once a GP has checked your dizziness, sit on a firm chair with a bed or sofa beside you. Turn your head side to side 10 times in 10 seconds, rest and repeat, then nod, then do both with your eyes closed and while looking at your finger. Keep it under 10 minutes, every day and ideally twice, and move on to standing and then walking as each gets easier.
A set of head and body positions, done by a trained clinician, that moves loose crystals out of the inner-ear canal causing BPPV. A positional test first shows which ear is affected; then you're rolled in stages onto your other side, pausing about half a minute in each position, before sitting up. In trials it cleared vertigo in 56% of people, against 21% with a sham.
Only once a doctor, physiotherapist or audiologist has confirmed which side is affected and shown you how: that's our reading of the UK and US guidelines together. In small trials of people taught a home version after a diagnosis, most were clear within a week. Doing it from a video without a diagnosis risks treating the wrong side or missing a different cause.
Sit on the edge of your bed, turn your head 45 degrees to the left and lie down on your right side for 30 seconds or until the dizziness passes, sit up for 30 seconds, then repeat to the other side. NHS clinics usually suggest 5 repetitions in the morning, afternoon and evening for 2 weeks, with someone nearby. If you're still dizzy after 2 weeks, go back to your clinician.
Most people find the exercises make them less dizzy after a few weeks of daily practice, and recovery takes about 6 weeks. Physiotherapy programmes often run for 4 to 6 weeks, and in UK trials the benefit was still there 6 months to a year later.
Yes, mildly: if they don't bring on any dizziness, they won't work, and you may feel a bit worse at first. Stop and see a doctor if they cause severe or lasting neck, head or ear pain, deafness or noises in the ear, double vision, fainting, or numbness or weakness.
During a bad attack, lie still in a quiet, dark room. As it settles, start walking as soon as you can, with someone at first. Between attacks, general exercise is fine with something to hold nearby: sit down straight away if you feel dizzy, and don't drive or cycle while you're dizzy.
Call 999 if vertigo comes with double vision or loss of vision, hearing loss, trouble speaking, or weakness, numbness or tingling in an arm or leg. Ask for an urgent GP appointment or call 111 for vertigo with a severe headache, being very sick or a high temperature. Most dizziness isn't a stroke, but a stroke can cause it.
Vestibular rehabilitation may help some people, but only one small trial has tested it, so the effect is uncertain. If your migraine is very active, the exercises can make symptoms worse for a while, so medicines and lifestyle changes may come first. Our migraine guide covers exercise for preventing migraine.
Feeling light-headed or faint as you stand is usually a drop in blood pressure, not vertigo. Stand up slowly and see a GP if it keeps happening; if your heart races when you stand, read our PoTS guide.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
