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Can BPPV be fixed in one visit?
Often, yes. For the most common type of BPPV, one canalith repositioning manoeuvre (the Epley) resolves the vertigo for many people, and in the Cochrane review a single treatment outperformed a week of home Brandt-Daroff exercises. Two things to know: some people need a second manoeuvre at a follow-up visit, and BPPV returns in roughly a third of people, which is why the first visit also teaches you what to do if it does.
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The short answer
What BPPV is. Benign paroxysmal positional vertigo happens when tiny calcium crystals in the inner ear come loose and drift into one of the semicircular canals, usually the posterior canal. Each time your head moves into certain positions, rolling over in bed or looking up, the crystals move and you get a brief, intense spinning that settles within a minute.
What the evidence says about one treatment. The Cochrane review of the Epley manoeuvre for posterior-canal BPPV included 11 trials with 745 participants. Complete resolution of vertigo was significantly more common after the Epley manoeuvre than after a sham manoeuvre or no treatment, and a single Epley treatment was more effective than a week of Brandt-Daroff exercises done three times a day at home. Recurrence after successful treatment was reported at 36 percent. In the pooled trials, complete resolution of vertigo rose from about 21 percent with a sham manoeuvre to 56 percent with the Epley. Source: Cochrane Database of Systematic Reviews, The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo, 2014 update.
So one visit is a realistic expectation, not a guarantee. Here is what the visit involves, why a second one is sometimes needed, and what to watch for.
What happens at the visit
Your physiotherapist starts with questions about what sets off the spinning, how long it lasts and what else you notice, then confirms the diagnosis with the Dix-Hallpike test: you lie back quickly with your head turned, and the physiotherapist watches your eye movements. The direction and timing of the eye movement show which ear and which canal is affected, and that decides which manoeuvre to use.
The Epley manoeuvre itself takes a few minutes. You move through a sequence of head and body positions, holding each for about 30 seconds to a minute while the crystals drift back to where they belong. You may feel the spinning during the manoeuvre; that is expected and it passes. Afterwards you sit for a few minutes before standing, and you can go home the same day. Many people feel lighter or slightly off-balance for the rest of the day, which is normal.
Why some people need a second visit
A second manoeuvre is sometimes needed when the crystals have not fully moved, when both ears are affected, or when the crystals are in the horizontal canal, which needs a different manoeuvre and tends to take more than one attempt. Some people also notice residual dizziness or unsteadiness for days after the spinning has stopped; this usually settles on its own, and a short course of balance exercises helps if it lingers.
At Next Step we book a follow-up check a week or two after the first visit to repeat the Dix-Hallpike test and treat again if needed. If you are symptom-free, the follow-up is short.
When it is not BPPV
Not all dizziness is BPPV, and the assessment is designed to tell the difference. Vestibular neuritis causes constant, not positional, vertigo over days. Vestibular migraine produces dizziness with or without headache, often with light sensitivity. Cervicogenic dizziness relates to the neck. Concussion can produce several of these together. Your physiotherapist tests eye movements, balance, neck movement and the response to position changes to work out which it is, and refers you to a physician when the pattern suggests something that needs medical assessment, such as sudden hearing loss, double vision, weakness or severe headache alongside the dizziness. See our dizziness and vertigo page and concussion page.
What you can do at home, and if it comes back
We teach home exercises when they fit your diagnosis, and only after the assessment. We do not recommend doing the Epley manoeuvre from an online video before you have been assessed, because the manoeuvre is specific to the affected ear and canal and performing the wrong one can move crystals into a different canal or do nothing at all. If you have been treated here before and know which side was affected, ask us; in some cases we will show you a self-treatment to use if it recurs.
If it comes back. With recurrence reported at around 36 percent, a return of symptoms months or years later is common and not a sign that the first treatment failed. Book a vestibular assessment as soon as it starts; the same test and manoeuvre apply, and most recurrences respond the same way.
Cost, booking and who you will see
Ask for a vestibular assessment when you book. It is $150, with follow-up visits at $125; see the fee page. Extended health plans usually cover it under physiotherapy and we direct-bill most insurers. No referral is needed. Vestibular assessments at Next Step are done by Ankita Vashisht and Jaiganesh Ravindra Babu, registered physiotherapists with vestibular rehabilitation training; see our team page. Bring someone to drive you home if the spinning is severe.
To book, call (587) 855-4559 or use the online booking form. No referral is needed.
Clinically reviewed by Roopreet Kaur, Registered Physiotherapist, Next Step Physio & Neurorehab Clinic. Last reviewed October 2026.
FAQ
Treatment
How many Epley manoeuvres does it take to fix BPPV?
Often one. Some people need a second manoeuvre at a follow-up visit, particularly if both ears or the horizontal canal are involved.
Does BPPV go away on its own?
It can, over weeks or months, as the crystals dissolve or settle. Treatment with a repositioning manoeuvre usually ends it much sooner.
Can I do the Epley manoeuvre at home?
Only after a physiotherapist has confirmed which ear and canal are affected. The wrong manoeuvre can move the crystals into another canal or make symptoms worse.
After treatment
Will BPPV come back?
In roughly a third of people it recurs within a year or so. It can be treated again the same way, and recurrence does not mean the first treatment failed.
Do I need a referral for vestibular physiotherapy?
No. You can book a vestibular assessment directly.
How long does BPPV take to go away after the Epley manoeuvre?
The spinning often stops the same day. Mild unsteadiness or a lighter-headed feeling can last a few days and usually settles on its own.
