Numerous preliminary reports suggest certain "vestibular rehabilitation" exercises may help some cases of vertigo.18, 19, 20, 21, 22, 23 These exercises were also found to be effective in relieving vertigo in two controlled studies,24 including one on BPPV.25 While vestibular rehabilitation exercises may be done at home, initial guidance by a qualified practitioner is necessary.
BPPV appears to be caused by an accumulation of free-floating cell fragments in the fluid of the inner ear.26, 27 Certain manipulation therapy maneuvers, referred to as particle repositioning maneuvers (PRMs), are intended to relocate this debris to a harmless location,28, 29, 30 in order to improve symptoms. Both preliminary31, 32, 33, 34, 35 and controlled36, 37, 38 trials achieved significant improvement in, or elimination of, BPPV using these maneuvers. Most studies report that over 90% of people with BPPV treated one or two times with PRM respond to this treatment, although up to 45% may develop BPPV again within a few years, requiring further treatments.39, 40, 41
Research indicates some cases of vertigo are related to spinal disorders affecting the head and neck.42, 43, 44, 45, 46, 47, 48 Preliminary studies report that certain treatments, such as spinal manipulation,49, 50, 51, 52 physical therapy,53 and combined approaches including manipulation and specific exercise programs,54, 55 result in significant improvement of vertigo symptoms.
Trigger points are thought by most,56, 57, 58 though not all,59 authorities to potentially cause pain and abnormal function in other parts of the body. Trigger points appear to develop as the result of injury, poor posture, structural abnormalities of the leg or pelvis, emotional tension, and other body stressors.60, 61 Also known as myofascial pain dysfunction (MPD), this condition, when it affects certain muscles of the head and neck, has been associated with vertigo in preliminary research.62, 63, 64 Musculoskeletal healthcare specialists and other practitioners can often treat MPD with a variety of natural therapies, including deep pressure massage,65, 66, 67, 68, 69 transcutaneous electrical nerve stimulation (TENS),70, 71 and other approaches,72 but no controlled studies have investigated the effectiveness of these treatments specifically for vertigo.
In a preliminary study of people with migraine headaches, most of whom (83%) also experienced vertigo, a combined and individualized approach using dietary changes, medication, physical therapy, lifestyle changes, and acupuncture resulted in complete or substantial improvement of symptoms in a significant number of participants.73 In addition, a large number of case studies presented in two preliminary reports suggest acupuncture may help to reduce symptoms of vertigo.74, 75 These preliminary studies have yet to be confirmed by controlled clinical trials.