What to Avoid after BPPV treatment

Believe it or not, when I first started treating BPPV in 2006, we used to have our patients sleep upright and wear a soft cervical collar for a few days after treatment.

Yes, it is true! Things have changed since then.

The research has evolved at this point, so we have new instructions on what to avoid after BPPV treatment.

In this blog, I will give you the official evidence-based precautions of what to avoid after BPPV treatment.

I will also share with you additional precautions that I have learned from my patients who had a recurrence of BPPV shortly after I successfully treated them.

I hope this information helps you maximize your recovery from BPPV!

Evidence-Based Precautions after BPPV Treatment

The only precautions that are now supported by research after BPPV treatment are these:

  1. Sit up for 20 minutes after treatment is completed. What to avoid after BPPV treatment includes bending forward to put on your shoes, leaning back to recline, and tipping your chin down to check your phone. It is important that you just sit upright with your head level for a 20 minute rest break, on a chair or the couch.
  2. Avoid vigorous head shaking for one week.

I usually advise my patients specifically, “No jumping, jogging, or vigorous head shaking for one week after treatment.”

These two evidence-based precautions will allow the BPPV crystals to settle in after treatment.

Some patients have a hangover effect after BPPV treatment, which may include fatigue, nausea, overall wooziness, and general malaise. I advise my patients to rest and take it easy until any hangover passes after BPPV treatment.

What Can I Do for Exercise?

I usually advise my patients to rest until the hangover passes, which usually takes about 12-24 hours. In some rare cases, the hangover effect after BPPV treatment can last 48-72 hours.
After any hangover passes, a good way to start moving is to go on an easy walk on a level surface, with limited head turns.

As long as they are not at risk of falling and they don’t move their head around too quickly, that should be a good way to get some light movement.

Walking can get patients recovering from vertigo back to exercising by easing into it. Take caution crossing any streets as the quick head turns could trigger dizziness.
Some of my patients like to use a recumbent bike with a backrest, if they want to do cardio while they are in the middle of a series of BPPV treatments.
Patients may even lift light weights or do strength training with their head upright while they are recovering from BPPV, such as bicep curls, mini squats, or lunges.

Do I Need to Sleep Upright?

The most important thing is get a good night’s sleep after BPPV treatment so your brain can reset.

Some patients need extra sleep after the BPPV treatment, so I usually advise my patients to go to bed early or at least on time after the BPPV treatment. Sometimes, my patients take something to help them sleep more deeply, if needed.

For some very difficult or extremely stubborn cases, I may suggest for my patient to sleep propped up until treatment is all completed. But most people do not need to take that precaution.

Sleeping upright is considered an old recommendation and I rarely recommend it.

One doctor that I work very closely with recommends for all of his patients with BPPV to sleep upright for the rest of their lives.

If your health care provider recommended for you to sleep upright, then you can discuss your questions and concerns with them to receive individual guidance for your situation.

In my experience, sleeping upright causes people to develop neck pain. I have met many people who developed neck pain or back pain from sleeping propped up due to vertigo.

Sleeping propped up might create a secondary cause of dizziness from the neck. Click here to learn about upper cervical dizziness.

How to Avoid Vigorous Head Shaking

If my patient feels the recurrence of BPPV within the first week after I had completed their treatments, I have always asked them what they were doing.

I have been gathering information from my patients so I can learn more about what to avoid after BPPV treatment.

With the information I have gathered from my patients over the years, I learned that a lot has to do with head shaking/movement. I have made a list for you of specifically what to avoid after BPPV treatment for the first week.

These are some examples of activities that caused my patients to get BPPV again, within a week after we finished their care.

Research indicates that returning to your normal activities as soon as possible after an episode of BPPV is associated with better outcomes.

That is true, but I still caution you to avoid the following activities that can jar or shake your head to possibly dislodge the crystals again during the first week of your recovery.

What To Avoid after BPPV treatment (for one week):

  1. Enthusiastic dancing, such as headbanging or bobbing your head in the car
  2. Shaking your head around vigorously while exercising, including bouncing and jumping jacks
  3. High impact exercises such as running, burpees, or jump squats
  4. Jumping on a trampoline
  5. Using a handheld blender, or mixer with beaters, such as to make cake batter or guacamole
  6. Putting your hand on a blender to stabilize the base or the lid, while you’re making a smoothie
  7. Shaking up a martini
  8. Blowing raspberries on the belly of a baby
  9. Bouncing a baby on your lap vigorously
  10. Sitting or lying on a vibrating mat for a back massage
  11. Sitting on a vibrating massage chair at the nail salon, such as during a pedicure
  12. Holding any kind of vibrating massager or activator tool near your head, neck, or arms
  13. Using handheld power tools, such as a sander, drill, or dremel – This is especially true for certain profession like dentists, jewelers, mechanics, and building contractors.
  14. Listening to extremely loud music or audio, especially through headphones or earbuds
  15. Riding in a bouncy or bumpy vehicle, like a jeep, truck, or tractor – Also avoid riding in any vehicle on a bumpy road or rough terrain.
  16. Gymnastics and tumbling
  17. Diving off a springboard, high dive, or cliff
  18. Cliff jumping – You may want to consider avoiding this type of activity longer than one week for safety reasons! 🙂

Pro Tip: Make sure you tell any provider that works on you, like a chiropractor or massage therapist, to avoid using any vibrating tool or activator tool near your head or neck for at least a week after BPPV treatment.

I hope these tips on what to avoid after BPPV treatment are helpful.

What about an Electric Toothbrush?

Some patients decide to avoid using an electric toothbrush for a week after BPPV treatment. Generally, using an electric toothbrush is fine for most people right after BPPV treatment.

If you have frequently recurring episodes of BPPV and you decide to implement extra precautions, you could turn off the vibration. For most people, this is not necessary.

What if BPPV Recurs?

If you notice dizziness with lying down, rolling over, or turning quickly, then you likely need more treatments for BPPV.  The crystals can dislodge anytime, but may never come back at all.

For more tips on recognizing a recurrence of BPPV, click here.

The key is to get BPPV treated right away, so you can move on with your life!

If you find that you are getting “recurrent idiopathic BPPV,” which means no known cause of recurrences, then you may want to adopt a lifestyle of less vigorous head motions. This may help reduce how often the BPPV crystals are dislodging. However, this precaution is only necessary in persistent cases.

Most people are able to resume normal activity one week after BPPV is resolved. I suggest you discuss that with your Vestibular Provider.

Returning to your normal activity as soon as possible after recovering from BPPV is important to avoid getting out of shape!

For more tips on BPPV prevention, click here.

For information about Driving after Vertigo Treatment, click here.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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