For patients · Reading time 9 minutes · Version 1.0 · Translation of the German page, medically reviewed on 8 October 2026 · the German version is authoritative · Diese Seite auf Deutsch
Dizziness and vertigo: when it is urgent, which kind it is, and the manoeuvre that helps in five minutes
Dizziness is one of the most common symptoms in general practice and one of the most poorly treated. The most common cause, positional vertigo, can be fixed with a manoeuvre in a few minutes, and only 8 out of 100 people get it. Here you will find which signs mean calling for help, how to tell the six common kinds of dizziness apart by duration and trigger, and the manoeuvre step by step, with a timer and videos.
The essentials in three sentences
- Dizziness with double vision, slurred speech, weakness or being unable to stand is an emergency. Dizziness on its own almost never is.
- The duration reveals the cause: seconds when turning over is positional vertigo, days on end is nerve inflammation, hours with ear symptoms is Ménière's, minutes to hours without ear symptoms is often migraine.
- For positional vertigo, no medicine helps; a manoeuvre does. You can do it yourself, and below you will find how.
1
Signpost: when it is urgent
Fifteen signs, four levels. Tick whatever applies and the page tells you how urgent it is.
Tick whatever applies. If nothing applies, leave everything blank.
No warning sign
Then it is most likely one of the common, harmless kinds of dizziness described below. If it spins for seconds when you turn over in bed, it is almost certainly positional vertigo, and you can treat that yourself.
Your ticks are neither stored nor sent anywhere.
2
Six pictures: which dizziness is it?
Telling them apart by duration and trigger, not by intensity. For each picture: what helps and what does not.
The most common cause of spinning dizziness. One person in forty gets it in their lifetime, women and older people more often. Only 8 out of 100 receive the effective treatment.
How to recognise it
- Violent spinning for seconds, at most a minute
- Set off by turning over in bed, lying down, sitting up, tilting the head back, bending down
- Nausea with it, often hours of unsteadiness afterwards
- No hearing loss, no ringing in the ear
- Tiny calcium crystals have slipped into the wrong canal of the balance organ
How long it lasts
Untreated: days to weeks, two weeks on average. With the manoeuvre, often over in five minutes.
What helps
The repositioning manoeuvre, step by step below. It moves the crystals back where they belong. Medicines do not help; resting prolongs it. About one in three has a recurrence within a few years; then simply repeat.
3
The manoeuvre for positional vertigo, step by step
First find the side, then the Epley manoeuvre. The clock counts the minimum time for each step; the videos show what it looks like. Best done with someone in the room the first time.
Before the first manoeuvre, to find the affected side. The manoeuvre only works on the correct side.
Well establishedDix-Hallpike positioning test, simplified
Step 1 of 5
Sit on the bed so that, when you lie back, your head comes slightly over the edge; a pillow under the shoulders works too. Someone should be with you.
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What the manoeuvre achieves, in numbers
Symptom-free, out of 100 people, from the Cochrane review and the Berlin self-treatment study.
Epley manoeuvre for positional vertigo
56 out of 100 compared with 21. Symptom-free after one manoeuvre at the practice, compared with a sham manoeuvre. The positioning test turned negative in even more. Recurrence within a few years in 36 out of 100; then simply repeat.
Hilton 2014, Cochrane, 11 trials
Epley at home versus Sémont at home
95 out of 100 compared with 58. Symptom-free after one week of self-treatment, Berlin study. The Sémont manoeuvre at home mostly failed on execution. That is why Epley comes first here.
Radtke 2004
5
What you can do yourself, and what tablets can do
Ordered by strength of evidence. With dizziness more than with anything else: the most effective thing is movement, and medicine is the exception.
The manoeuvre, not the tablet
Well establishedFor positional vertigo, the repositioning manoeuvre is the treatment. Anti-dizziness medicines change nothing about the crystals; they only make you drowsy.
Hilton 2014
Balance training
Well establishedAfter nerve inflammation, with functional dizziness and in older age: exercises that challenge balance, ten to 20 minutes a day. Turn your head while walking, stand on one leg, fix your gaze while moving your head. In studies, two out of three had clearly less dizziness. Physiotherapy with a vestibular focus is available on prescription.
McDonnell 2015, Cochrane, 39 trials
Move rather than rest
Well establishedThe brain only relearns balance when it is challenged. After the first two or three days of nerve inflammation: get up, walk, move your head, even if it is unpleasant. Those who stay lying down stay dizzy longer.
Tai chi and balance exercises against falls
Well establishedFrom 65 on, regular balance and strength exercises reduce the number of falls by about a quarter. Tai chi is the best-studied form; courses are offered by adult education centres and clubs.
Sherrington 2019, Cochrane
The medication list
Well establishedSleeping tablets, sedatives, some blood pressure, heart and pain medicines, antidepressants, allergy medicines: many cause dizziness, especially in combination. Bring the list; often one can be stopped or reduced.
Stand up in stages
Some studies, small effectFirst sit up, sit for half a minute, circle your feet, then stand and hold on. If everything goes black: cross your legs and tense the muscles, crouch down, or sit back down. At night, switch the light on before you get up.
Drinking
Some studies, small effectWith circulatory dizziness, one and a half to two litres a day, more in the heat, and a large glass of water in the morning before getting up. Anyone told to limit fluids because of the heart keeps to that limit.
Eyes, ears, feet
Some studies, small effectBalance needs three senses: eyes, inner ear, soles of the feet. An up-to-date pair of glasses, a hearing aid that is actually worn, firm shoes instead of slippers and a rug without an edge help more than you would think.
Medicines: few, and briefly
Dimenhydrinate 50 mg (over the counter)
Against nausea and vomiting with dizziness: one to two tablets, if needed every six to eight hours, at most 400 mg a day. Not for children under 6 without medical advice.
Only in the first one to three days of continuous spinning. Then stop: the drug dampens the balance system and delays recovery. Causes drowsiness, do not drive, no alcohol. For positional vertigo it does nothing.
Betahistine (prescription only)
Prescribed for Ménière's disease.
In the largest trial, 221 people over nine months, it was no better than placebo at either the normal or the high dose. Anyone taking it and feeling better need not stop; anyone starting it should know this.
Adult dosing as given in the package leaflet. The leaflet in your hand takes precedence.
6
From other traditions, and from advertising
Further reading. Each item says how well it is supported by Western studies.
Ginger
Asia
Effective in small studies against the nausea of dizziness and motion sickness, as tea, capsule or a piece of root. Not against the dizziness itself.
Vitamin D against recurrences
Recent research
People with a vitamin D deficiency after positional vertigo had fewer recurrences in a Korean trial with 1,050 participants when given vitamin D and calcium: in the following year, 38 instead of 47 out of 100 had another episode. Only with a proven deficiency, so have it measured.
Acupuncture
China
Small studies with unclear results, at best against nausea. No substitute for a manoeuvre.
Ginkgo
Asia
One study found it as good as betahistine, which after the large betahistine trial does not say much. Harmless, but unproven.
Homeopathic dizziness remedies
Germany
Widely sold. The available studies come from the manufacturer and had no placebo group. What works is the time that passes.
Cracking the neck
Chiropractic
"Cervicogenic dizziness" is often diagnosed and rarely proven. Abrupt manipulation of the cervical spine can, in rare cases, tear a carotid artery. Gentle physiotherapy of the neck is something else and is fine.
7
Quick check: what will you take away?
Five questions for anyone who likes. No marks.
1. It spins violently for ten seconds when you turn over in bed. What is it most likely to be?
2. Which sign with dizziness means calling the emergency number?
3. How often does the Epley manoeuvre work for positional vertigo?
4. After inflammation of the balance nerve: what speeds up recovery?
5. Betahistine for Ménière's disease: what did the large German trial find?
No marks, no time pressure. Your progress is kept on this device only.
What this page cannot do
It is for adults and makes no diagnosis. The signpost sorts by urgency, the six pictures help you recognise a pattern, the trainer guides you through the manoeuvre for the posterior canal; the horizontal canal needs a different manoeuvre, which we show at the practice. Continuous spinning is examined, not just calmed down, because a stroke in the cerebellum looks the same on day one. Take medicines according to the package leaflet in your hand. This page is a translation of the German original, which is the medically reviewed version; where the two differ, the German text applies.
Version 1.0 · Translation of the German page, medically reviewed on 8 October 2026 · the German version is authoritative
Reviewed by Stefan Höhne, Facharzt für Allgemeinmedizin. Numbers, doses and emergency numbers are identical to the German version and checked automatically. If anything is unclear, the German text applies.
Sources: Hilton and Pinder, Cochrane 2014 (Epley manoeuvre); Radtke et al., Neurology 2004 (self-treatment, Epley versus Sémont); von Brevern et al., JNNP 2007 (frequency of positional vertigo); McDonnell and Hillier, Cochrane 2015 (balance training); Fishman et al., Cochrane 2011 (cortisone for nerve inflammation); Adrion et al., BMJ 2016 (BEMED, betahistine for Ménière's); Sherrington et al., Cochrane 2019 (fall prevention); Jeong et al., Neurology 2020 (vitamin D against recurrences); guidelines of the German Society of Neurology. Medically responsible: Stefan Höhne, specialist in general practice (Facharzt für Allgemeinmedizin). This page is independent: no sponsor, no advertising, no brand names; we have no connection to the linked video channels. All patient information (German)