How do you know if you need the Epley maneuver?

The Epley maneuver is a treatment used to treat vertigo and dizziness caused by benign paroxysmal positional vertigo (BPPV). BPPV occurs when calcium carbonate crystals become dislodged in the inner ear. The Epley maneuver aims to reposition these crystals so they no longer cause dizziness and vertigo.

If you are experiencing vertigo and dizziness, especially when changing positions, you may have BPPV and benefit from the Epley maneuver. Here are some key signs and symptoms that indicate you should consider this treatment:

Experiencing Vertigo When Moving

The main symptom of BPPV is vertigo and dizziness when moving the head in certain positions. Typically, vertigo is triggered by movements such as:

  • Rolling over in bed
  • Getting in or out of bed
  • Bending over
  • Looking up

You may feel spinning, swaying, unsteady, or that you are going to fall over when making these motions. If you experience sudden vertigo when moving the head, it is likely a sign of BPPV.

Vertigo Episodes are Brief

With BPPV, vertigo episodes are brief, usually lasting less than one minute. The vertigo is most intense at the onset of the position change and then subsides. This is in contrast to other conditions like Meniere’s disease where vertigo episodes can persist for hours at a time.

If your vertigo comes on suddenly when moving but goes away quickly when returning to a static position, BPPV may be the cause.

Nausea May Accompany Vertigo

Along with vertigo, nausea and vomiting can sometimes accompany BPPV. The spinning, swaying sensation can cause nausea. You may feel nauseated when the vertigo first hits as you change position. In most cases, the nausea is short-lived like the vertigo.

No Hearing Loss or Tinnitus

BPPV affects the inner ear balance mechanisms but does not cause hearing loss or tinnitus. These symptoms can accompany other inner ear disorders like Meniere’s disease. If vertigo and dizziness are your only symptoms without hearing changes, BPPV is more likely.

Performing the Dix-Hallpike Test

To help confirm BPPV, your physician may perform the Dix-Hallpike test. This involves:

  1. Sitting upright with your legs extended and head turned 45 degrees to one side.
  2. Laying back quickly with head tipped below horizontal.
  3. Returning to sitting position after 20 seconds.
  4. Repeating on the other side.

If this maneuver triggers vertigo and nystagmus (jerking eye movements), it indicates BPPV on that side. The Dix-Hallpike test can help definitively diagnose BPPV.

Vertigo Persists and Recurrs

Untreated BPPV often persists and comes back. The vertigo is triggered by routine movements and may become more frequent over time. Recurrent bouts of position-triggered vertigo are a hallmark of untreated BPPV.

When to See a Doctor

You should make an appointment with your doctor if you experience the following:

  • New onset vertigo
  • Recurring vertigo that persists more than one week
  • Vertigo along with hearing loss or ringing in the ears
  • Vertigo with neurological symptoms like weakness, loss of balance, or slurred speech
  • Head injury immediately preceding vertigo symptoms

A doctor can perform examination tests and determine if BPPV is likely the cause. If BPPV is confirmed, they may perform the Epley maneuver in the office to treat it.

Home Epley Exercises

For some cases of BPPV, your doctor may recommend home Epley exercises between office treatments. This involves performing modified versions of the Epley maneuver at home multiple times per day. Home exercises can help maximize treatment results. They typically include:

  • Lying flat with head turned to one side, then switching sides
  • Sitting upright and tipping head forward, then leaning back
  • Kneeling and tilting head up, then lying on your back

Ask your doctor for specific instructions if they recommend home Epley maneuvers. Only perform them if your doctor advises it.

When to Expect Resolution of Symptoms

In many cases, just 1-3 sessions of the Epley maneuver in the doctor’s office resolves BPPV vertigo. However, for some patients it may take weeks of repeating home Epley treatments for the vertigo spells to completely stop.

Factors that influence resolution of symptoms include:

  • Cause of BPPV (idiopathic vs. head injury)
  • Which ear’s balance mechanism is affected
  • Severity of calcium crystal displacement
  • Patient’s age
  • How compliant the patient is with home Epley instructions

According to research, resolution rates are:

After 1 week 50-70% resolved
After 1 month 80-90% resolved
After 3 months 90-100% resolved

Be patient but persistent in continuing the Epley until your symptoms are fully resolved. This may take days or weeks depending on your individual case.

Can BPPV Return After Treatment?

Yes, BPPV can come back even after successful treatment with the Epley maneuver. Recurrence rates are around 30% within the first year after treatment. There are a few reasons BPPV may return:

  • Some calcium crystal debris remained in the inner ear after treatment and eventually get dislodged again, triggering another BPPV episode.
  • Scar tissue from the initial BPPV episode can come loose over time, releasing new debris that causes vertigo.
  • Ongoing calcium metabolism disorders may promote new crystal formation.

Repeated Epley maneuvers are usually effective in retreatment of recurrent BPPV. Exercise caution moving your head, and be alert for any feelings of spinning or dizziness that signal a recurrence.

What If the Epley Maneuver Fails?

In about 20% of cases, the Epley maneuver fails to fully resolve BPPV after several treatment sessions. If you are not seeing improvement, there are some additional options including:

  • Repeat Dix-Hallpike test – Confirm vertigo is still coming from same ear.
  • Try alternative particle repositioning maneuvers – Such as the Semont maneuver or Gufoni maneuver.
  • vestibular rehabilitation therapy – Specialized physical therapy exercises aimed at central compensation.
  • Surgical plugging of the posterior semicircular canal – For intractable cases only.

Talk to your doctor if vertigo is not resolving after a month of Epley treatments. There are usually other options to consider before resorting to surgery.


The Epley maneuver is a safe, effective treatment for dizziness and vertigo caused by BPPV. If you experience brief episodes of spinning triggered by head movements, especially while lying down or looking up, you likely have BPPV.

See a doctor for evaluation if vertigo persists. They can perform positioning tests to confirm the diagnosis, and may initiate Epley treatments in the office and as home exercises. With compliant follow-through of this maneuver, BPPV can usually be resolved fully within 1-3 months.

Leave a Comment