Epley Maneuver – How many times should it take?

People often ask, “I have tried the Epley Maneuver, it didn’t work, should I keep trying?”

In general terms, it may take several attempts to fully treat BPPV and most people can expect to have some recurrences.  We suggest that you need only perform the maneuver when you have an attack.  If you are not having symptoms then you don’t need to to do the maneuver although it may prevent recurrences.  It is always important to seek the advice of your own doctor to obtain a diagnosis and to monitor your condition.

With that said here are several important questions to ask yourself about failed BPPV treatment.

  1. Do you have BPPV?
    1. To achieve success with the Epley Maneuver or home treatment for BPPV you must be sure you have a correct diagnosis. These maneuvers do not work if you do not have BPPV.  There are many other types of dizziness, although BPPV is the most common.
    2. Posterior BPPV?
      1. There are actually a number of sub-types of BPPV.  Posterior canal BPPV (P-BPPV) is by far the most common.  The Epley maneuver treats P-BPPV but not the others.
  2. Did you do the maneuver correctly?
    1. Although the treatment maneuvers for BPPV are very effective it is not yet clear how incorrectly you can perform them and still have success.  The major reason for home treatment failure is an incorrectly performed maneuver . Home BPPV treatment devices are designed to minimized this problem.  Careful attention to detail in the maneuver as well as ensuring the correct angles, side and duration will improve success.  The most common mistake,..not putting you head back far enough (it can be too far though).
  3. Do you have bilateral BPPV?
    1. A small percentage of people will have BPPV on both sides and so after successful treatment on one side will still have symptoms.  This can be confusing.  We recommend that people treat one side daily for one week then switch to the other side.
  4. Do you have recurrent BPPV?
    1. BPPV treatment does not cure the problem it only removes the stimulus temporarily so as many as 60% of people will have symptoms more than once.   Some people have highly recurrent BPPV so after they successfully treat one episode it can come back in a matter of days and make them think they failed in their maneuver.  Daily maneuvers may control these problems.  In rare cases of very symptomatic and resistant BPPV surgery can be performed to block of the balance canal which causes BPPV.
  5. Are you ever going to respond?
    1. Do you have something else as well?
      1. BPPV can be found along with any other disease which causes inner ear damage.  Conditions like Menieres, head trauma, or inner ear infections may causes BPPV.  As such it can be confusing as to which condition is causing the vertigo.  Generally these symptoms can be sorted out by a skilled ear doctor.  You might need help with this one.
    2. Do you have resistant BPPV?
      1. About 5% of people have BPPV which is resistant to maneuvers.  This may be because the disease causing crystals are too large to come out of the posterior canal or that they are stuck to the inner ear somewhere.   Regardless the Epley maneuver does not work for these people.  Again in certain circumstances surgery may be indicated.

95 Responses

  1. Clearwater Clinical
    |

    Thanks for the comments. I am sorry to hear you are still so dizzy. The problem is that not all BPPV is obvious. Some is horizontal, which you identify and some is posterior. Some more still is not BPPV at all but other conditions. When you have a complicated story like this it is best to see someone who specializes in vertigo like a Neuro-Otologist (sub-speciality of ENT) or a neurologist who deal with vertigo (many don’t). There are a variety of tests which can help including a ENG which can tell you if this is related to your ear or your brain. Also an MRI would help rule out other pathology. Best of luck.

  2. Seth
    |

    Hello, is it possible to have BPPV when the only position that causes light vertigo and increases my general off-balance feeling, is having my head facing downward? No side seems provocative over another. Going into the Dix Hallpike maneuvers (and holding for 30 secs) for me do not add to my dizziness. However, returning my head to straight and level orientation from many other positions does cause light vertigo or some chaotic sense of false movement just after stopping the motion (which fades within 30 secs of keeping still). Other than that, I have a persistent off-balance feeling that waxes and wanes over the days, and also a persistent hypersensitivity to all head movement that also waxes and wanes (independently of the other symptoms) throughout the days.

    These have all been going on for the past 3 1/2 weeks. I saw a doctor last week who diagnosed me with BPPV, but surprisingly did not administer the DH test. Only the “follow my pen with your eyes” test, with me sitting still, upright. She vaguely mentioned a slight horizontal nystigmus, then had me stand up with my eyes closed while she pushed on me (I did not stumble or fall), and that was that. I don’t quite fit the mold for classic BPPV. But there are elements of positioning vertigo (or at least some sense of slow turning at times or chaotic movement) as well as elements of persistent disequilibrium and motion hypersensitivity. Important note: I feel minimal symptoms when either my head is level (or tipped up a little) or when I am in bed laying on either side or on my back and I have been still for awhile. In fact, when I’ve been laying in bed for a bit on my back or on either sides, I don’t notice my condition much if at all.

    I’ve been having on and off disequilibrium dizzy spells since I was 7 (I’m now 35), that are usually mild but occasionally severe. Severe ones maybe one every other year and other years maybe two episodes. I can have up to several mild ones a year that I can ignore. I’ve even had some years without any at all. They’ve usually been self-limiting to within a week in length. This one now is the worst and longest one thus far.

    I also have had a handful of episodes within the last 20 years that were very clearly BPPV, where I would get violent vertigo for 30 seconds while looking up, down and to one side, and those clear-cut cases would always resolve within 12 hours. Perhaps those were HC-BPPV?

    So I wonder if it is indeed possible that what I am currently having could be PC-BPPV with my own personal variation of symptoms and positioning triggers.

  3. Clearwater Clinical
    |

    Thanks for your comments. This is a difficult question as the answer really depends on what you actually have wrong with you. Have a look at this post and see if it helps:
    http://www.clearwaterclinical.com/blog/2009/06/i-tried-the-epley-maneuver-but-it-didnt-work.html

  4. Clearwater Clinical
    |

    Thanks for the question. BPPV is not usually associated with headache. However, migraine can certainly cause vertigo. I might suggest that you speak with your physician about the possibility of MAV (Migraine associated vertigo). MAV will present with vertigo, headaches, light sensitivity, nausea as you describe. The Epley maneuver will not help with MAV not will any home devices. If you get frequent episodes you may consider daily medication (like blood pressure pills or anti depressants) which often avoid migraines totally. If you have rare migraines you may consider abortive medications like Imitrex.

  5. Clearwater Clinical
    |

    Thanks for the question. Untreated BPPV lasts a variable amount of time but is often less than 2-12 weeks. Treated BPPV will often go away instantly. However, it does leave a residual “off balance” feeling for several days to weeks. This goes away spontaneously but can be a little annoying. The best thing to do is to keep active so you accommodate more quickly.

  6. Lisa Millette
    |

    I was just diagnosed with BPPV yesterday. I feel a little better today but as if i have motion sickness still. The dizziness hasnt totally gone away but is better. I keep doing the home repositioning thing and seems to help. How long does this typically last as I am flying tomorrow?

  7. Dee
    |

    Hi. I have been diagnosed with bppv. I have had several dizzy spells off and on for about 2 months. However, for the last 3 weeks I’ve extremely dizzy, severe headaches, light sensitivity, nausea and vomiting. When I do the Epley exercises it causes all of my symptoms to greatly increase. Is that normal? Should the exercises eventually work?

  8. Devyani
    |

    Dear Sir,

    I have had dizziness, nausea and vertigo for over a year. The doctor said I have BPPV but did not say which side as there was no nystagmus in the Dix Hallpike Manoeuvre. He advised me to do Epley Manoeuvre on both sides 5 times each twice a day for 3 weeks. I have been doing the same for a week and a half but there is no improvement and in fact now I have ringing in my ears –when lying down. Please help as I don’t know what I should do.

  9. Clearwater Clinical
    |

    Thanks for your comments.

    I am sorry to hear about your problem. What you describe sounds like a conversion from posterior-BPPV to Horizontal-BPPV. As you describe this is worse. Interestingly the symptoms no longer come on when lying flat but rather happen when your head is elevated at about 30 degrees off the bed and turn your head left or right.

    There is good news – although these symptoms are worse they are usually short lived – meaning that they go away by themselves much quicker than BPPV. The Brandt-Darroff exercises are not designed to treat this condition. There is a maneuver similar to the Epley called the “Log Roll Maneuver” in which you roll slowly like a log away from the side that causes you dizziness. You may be able to find a video of it.

    It is safe to do the Epley maneuver again once your existing symptoms improve. You may also like to try the home device for P-BPPV. You are still at risk for conversion from posterior to horizontal (the risk is 5% or so) but are not more at risk than anyone else.

    Good luck – and consult your own physician if you have unusual symptoms or things get worse or persist.

  10. Clearwater Clinical
    |

    Thanks for your comments.

    If you no longer get dizzy during the maneuvers then one of 3 things has happened.
    1) You are cured (for now)
    2) You are doing it incorrectly
    3) You have become acclimatized to the maneuver.

    It is difficult to really get used to the feeling so I doubt it is #3, you have done it before so I guess not #2. This leaves #1 – so yes you can probably stop. It is OK to continue longer if you would like – there are no side effects different from the risks of rolling over (which does include the risk of conversion from posterior BPPV to horizontal BPPV). If you like you can try the home device.

    Walking and other activity is good for your balance system. This is essentially vestibular physiotherapy – all activity is good – so long as you don’t put yourself at risk (no climbing ladders). Good active living actually speeds the process of recovery and reduces the duration of “weird” feeling after treatment of BPPV.

    Good luck.

  11. Sandra
    |

    Hi. I had labyrinthitis about 2 yrs ago. Recently had 2 more bouts of vertigo. I followed the instructions for semont exercises and have done them 5 times now. The last 2 times I have not had the spinning vertigo when doing the exercises. Should I stop now. Or should I continue to do them a bit longer? I still have the strange off balance feeling which I understand should pass in a few weeks. Is it good to walk now. Walking made me worse before but would like to exercise a bit. I also have a really stiff feeling at the back of my head/neck especially at the left size ( this is the side of the vertigo I think). Is this related do you think or another problem? Would appreciate your comments. Thanks.

  12. sheila
    |

    I was diagnosed with BPPV 5 yeaes ago by my GP and have been fortunate that the episodes are largely liveable and short term, until now…this episode has been3 weeks and left side. My GP had spoken to me about epley manoevre but in his absence my partner and i watched the procedure a few times over on the internet and tried it.starting on the left we did the 4 movements..it has made my vertigo 100 times worse!..whilst i can now look left and right whilst lying flat and get no symptoms i cannot sit stand or walk without fear of falling over..i am guessing the epley worked in shifting the crystals but to somewhere else!.. Will it be safe to do the epley again and if so how long after the first one has been performed or is there another method? I have read about BD exercises but thse seemed to make it worse too! Any ideas?…

  13. Clearwater Clinical
    |

    The curative effects can last days to months to years. The odd “floaty” effects after a successful maneuver can last a few weeks.

  14. Paula Peterson
    |

    Hi,

    How long does it take before the effects of the Epley maneuver to wear off?

  15. Clearwater Clinical
    |

    Thanks for your question.

    If you have BPPV then the Epley maneuver is the best treatment. Meclicine and Zofran do not really help. You can do this maneuver at home with some help from a home treatment device (www.dizzyfix.com) or from your ENT, neurologist or physio.

    Thanks.

  16. Clearwater Clinical
    |

    Thanks for your questions. There are several reasons why BPPV exercises can be ineffective. You can see some of these on our blog at http://clearwaterclinical.com/blog/2009/04/epley-maneuver-how-many-times-should-it-take.html

  17. Clearwater Clinical
    |

    Thanks for your comments. Usually the weird feeling lasts about 2 weeks. It depends on how old you are and how much you are moving around. If you sit still or take anti-nausea medications it usually takes longer. If you are elderly then it also takes longer. The best advice is to keep moving your head around and keep active, in a safe way, so that you re-train your brain back to normal.

    This “icky” feeling is the result of your brain getting used to the particles in your inner ear. When you move the crystals out with the Epley maneuver you have to get “re-used” to the the state of normal. It takes a couple of weeks.

  18. Paula Peterson
    |

    Hi,

    I had the epley maneuver done 3 days ago-because I was diagnosed with BPPV((Canalithiasis). Afterwards, the therapist told me that ” I would feel icky/awful and feel that I am floating for a couple of days and that is normal”. How long does this feeling last and how does caffine effect it?

    Also, why does the Epley maneuver effect my body in this way?

    Thanks,
    Paula peterson

  19. quratulain
    |

    Its been more than 2 months that I got diagnosed BPPV. It effected my left ear. But although I qm now quite mobile but still cannot turn on left side. Cause as. I turn on left side I get vertigo. I do the prescribed maneuvers but still feel heavy headedness and get tired very easily. Please any help will be greatly appreciated, thanks

  20. Melissa
    |

    I have been lightheaded for one week. The room is not spinning…it is a feeling of not being able to focus. I often lose my balance also. It is present from the time I get up in the morning until I fall asleep at night. My doctor dx me with BPPV. Also, gave me meclizine- which does not help and Zofran. I was instructed to do the Epley maneuver at home. It is not working. I am losing my mind and cannot miss more work. I am a nurse in the ER so I do not feel safe going to work while I feel like this. I need help. Suggestions?

  21. Ash
    |

    Just had an Epley performed four days back and although the spinning is gone but after that treatment I’ve started feeling alot of pressure in my head and ears especially when I stand up similar to the head pressure of orthostatic hypotension after standing up but this is way more exaggerated although blood pressure remains fine on checking then? Did anybody else feel this way after having that treatment and any suggestions on what it could be and how to deal with it?

  22. Clearwater Clinical
    |

    Very few people perform surgery for this. Several do though. In Canada Dr. Lorne Parnes does the surgery (University of Western Ontario). Many U.S. Neuro-otologists might also. I would recommend trying the maneuver in professional hands prior to surgery.

  23. Clearwater Clinical
    |

    The home treatment device requires you to have some neck mobility as well. Most of the maneuver can be done by rolling your body to the angles required but you do have to be able to look up.

  24. marni macdonald
    |

    My husband, 82, has been diagnosed with BPPV. We were advised to Google the Epley maneuver which we did and have tried it once with I would say about a 75% success. However, my husband has virtually no mobility in turning his head to the right side. His BPPV is left-sided. I see there is a Home Treatment Device, but that page is not opening. Would appreciate your response.
    Thanks, marni

  25. Julia
    |

    I am suffering from chronic reoccuring BPPV (dx by nystagmus) and was brushed off by dr and told to do Epley at home. It’s not working and I’m tired of living in fear of falling. I’m otherwise athletic and have given up cycling and running. I’m willing to have surgery and sacrifice hearing if necessary in order to regain mobility. Can anyone recommend a good place to have BPPV surgery. It doesn’t sound common. Thanks.

  26. Clearwater Clinical
    |

    Interesting questions. Usually, people do no describe double vision with BPPV. Some describe a sense of motion and vision problems. Usually this only lasts while the vertigo lasts (a few seconds). Does the vertigo and double vision go away, after how long?

    Yes it is safe to do both sides. We recommend doing one side one week and the other the next just so it is clear what is going on. You usually cannot undo one side by doing the other side maneuver.

    Yes daily movement is recommended. Some suggest sitting upright while sleeping after a maneuver, but we find all that leads to is exhausted patients. We do not recommend so called “post maneuver precautions”. Avoid putting yourself in situations of danger when dizzy, no ladders for example.

    IF you have “vertigo” (spinning dizziness) with any head motion then you do not likely have BPPV. However, if you had vertigo when laying down and rolling over but have now treated your BPPV and that sensation has gone you are sometimes left with a vague feeling of off-balance which is worse with any motion. This is not uncommon and does go away after a few weeks. If you are unsure of the diagnosis, please speak with your physcian.

  27. Sam
    |

    I am a male of 53 years. I woke up 6 days ago to a severe bout of vertigo. Within 2 days the room stopped spinning but I still get very dizzy if I walk or move my head side to side or up and down.

    My doctor told me i have BPPV. He did not tell me on which side or both. I have surfed the net for answers and I believe it resides on my left side.

    My questions:
    – after doing the various home exercises the immediate side effect is a double vision. Why?
    -as I may be incorrect with my own diagnosis to the effected side is it safe to do both left and right exersizes?
    -is daily movement recommended ? I want to continue with life.
    –if I sit still most feeling of virtego are mild. Any head movement makes me dizzy.

    Thank your for your help.
    Sam

  28. Clearwater Clinical
    |

    Thanks for the comments but that is a tricky one over email. Certainly no one should try to diagnose someone via a blog, with any luck your local physician can review my comments and provide a diagnosis.

    There are several reasons why an episode of BPPV may not be cured by the Epley maneuver. You can review this blog to find out more about that specific problem.

    Finally there are two other possibilities 1) You have horizontal BPPV – which is typically worse turing your head side to side. Try this to diagnose it. Lift your head off bed when lying down and turn your head as far to the left or right as you can. IF this brings on BPPV like vertigo then you have horizontal canal BPPV. This can be treated by a simple “Log Roll” maneuver. 2) You may not have BPPV at all – it depends on how long the vertigo lasts. If you have vertigo from wake up to bed time made worse by turing you head left and right and with a ringing in your ears you may have Labyrinthitis. This is a viral inner ear infection. Again your doctor should see you to diagnose this and to do a hearing test (given that you describe a blocked feeling).

    Good luck – hopefully these suggestions will help direct you and your physician to a solution.

  29. Nat
    |

    Hi,

    I have had BPPV in the past and have done the epley maneuver and it always worked.

    Just couple of days back, the bppv reoccurred and now even after doing the Epley maneuver for 4 days there is no cure.

    I used to always feel dizzy when i used to turn to my left or right while sleeping but this time i feel dizzy when i wake up from a horizontal position to a vertical postion (like when i wake up from bed). I also feel unstable while walking and cannot turn my head left or right without feeling unstable. I also feel a blocked sensation to my right ear and this time I dont have any ringing or knocking sensation in my ear.

    Can you kindly clarify if this is still BPPV and should i continue doing the epley maneuver?

    I need help…pls help me..

  30. Jim
    |

    Nice article. My problem arose from an interaction with a daily prescription drug, everyday I took it I got sicker and sicker. Stopping the drug ended major episodes but now I deal with day to day vertigo.

  31. Clearwater Clinical
    |

    Thanks for a great question. The answer is not so simple and it really depends on what exactly you have wrong with you. My reply will make some assumptions so as usual you should discuss this with your own physician.

    Lets assume you did have labyrinthitis. If you did the usual course is that you are continually very dizzy (spinning) for a few days, then just quite bad for a few more, then a bit better, then just a bit off, then normal. This process of “accommodation” takes about 2-4 weeks. There is not real cure or treatment except time and activity for labyrinthitis. Also labyrinthitis can result in BPPV.

    IF you do have BPPV now or did have it all along then this is characterized by short lived vertigo only when you roll over, look up or move in certain ways. BPPV can be very well treated by the Epley Maneuver or by devices used at home. Usually after treatment for BPPV you feel a bit “off” for a few weeks. This is normal and you can read more about it elsewhere on this blog.

    Anxiety does make the experience of vertigo worse. Like anything stress makes headaches or broken legs feel worse. Sometimes medications, which don’t help BPPV do help with anxiety and help you cope with BPPV or labyrinthitis. You can read about this here.

    Finally if you have persistent symptoms or worsening problems make sure to go back to your doctor. Good luck.

  32. penny
    |

    About 14 weeks ago I woke up spinning doc said I had labrynthitis he put me on tabs after 12 weeks didnt go saw ent specialist they told me to come off the serc I did and spinning returned had eply manover 3 weeks ago can now lay on my left side and back but everyday I still feel dizzy, I have now been diagnosed with anxiety due to the fear of this conditon I feel at the end of my tether and dont know what to do, coud the aniexty be making the dizziness worse/

  33. Clearwater Clinical
    |

    Great question. We actually have had others ask too and have posted a reply here: http://clearwaterclinical.com/blog/2010/11/the-epley-maneuver-worked-why-do-i-still-feel-dizzy.html

    Hope that helps and glad you are feeling better.

  34. Louise
    |

    Hello
    I was diagnosed by consultant ent with bppv. At the time I saw him my symptoms had subsided but he showed me and gave me instructions to do a self treatment of epley. 7 days ago I awoke to bppv on the left side again. It wasn’t too bad so I left it 24 hours. As it was not going away I did the epley treatment myself with some help from my partner. One attempt and it had disappeared when I was rolling onto left side again. I repeated the manoeuvre to be sure and have to say was quite impressed. However about 24 hours after that I started to feel abit heavy headed, spaced when upright and still am now. I am at work and moving around and doing some head and eye exercises . Is this normal will this subside. Last time my bppv cleared up itself after about 2 weeks (before my visit to doc) and I had the same weird feeling just wondered if there is anything else to do to help get me back to normal.
    Thanks

  35. Clearwater Clinical
    |

    That is a hard question to answer. The real test for BPPV involves someone watching your eyes for something called “Nystagmus” when you have having the dizziness that happens when you lay down or roll over. This test is called the Dix-Hallpike. Your family doctor or spouse can check for it. Try Youtube for a video of nystagmus. In specific answer to your question – if you get spinning dizziness lasting seconds with certain positions then that is consistent with BPPV. However, you should check with your own doctor for a proper diagnosis.

  36. Epley meaning | Info007cleanin
    |

    […] Epley Maneuver – How many times should it take? « Why am I dizzy …Apr 28, 2009 … When he did the Epley manuever I was extremely off balance and dizzy after it. Because I was so dizzy does that mean I definetly have it? […]

  37. Clearwater Clinical
    |

    Thanks for your comments. The Epley and the Semont maneuver perform, in the end, the exact same result. However, neither has a 100% success rate. It certainly may be possible that the Epley just didn’t work those few times for you and then the Semont did. It is also possible that the rapid motion required for the Semont “shook” loose some particles that were getting stuck. We will never know for sure. The important part is that you are better and that now you know two possible ways to treat BPPV (although they are both really the same way). There are also devices available that can help you perform correct maneuvers.

    Activity is usually better for recovering from balance problems as it is essentially physiotherapy for the inner ear. For example following an inner ear infection called Labyrinthitis the best treatment is activity. Sitting still, although it relieves the symptoms, prolongs the recovery, much in the same way that resting an injured leg forever would result in a weak leg.

    In answer to the swimming part – certainly swimming while dizzy can be disorienting and dangerous. If you are no longer getting dizzy then it would appear safe to swim – but it may be wise to get the go ahead from your own physician.

  38. Sabet
    |

    Dear Dr,
    Thanks for reply, I did Semont maneuver for left and it worked
    so why Eply did not work? do you believe having activity is better than to sit?
    I have stopped swimming since I got dizzy , can I start it again?

  39. Clearwater Clinical
    |

    Usually following an episode of BPPV which has been treated the person is left with an odd off balance feeling for a couple of weeks. This is normal and will go away faster if you try to keep up your activity, but will take longer if you sit still. It is possible to have BPPV on both sides so if you only had one side treated and the other side is causing symptoms I would go back. As usual if you have serious concerns or new symptoms you should seek local medical advice.

  40. Clearwater Clinical
    |

    Thanks for your comments. Usually BPPV is fixable except in about 5% of cases where there may be a “log jam” or the wrong diagnosis or the wrong side or the crystals are stuck to the side. It may be that you have the wrong side or diagnosis. I would see your own physician again to reconfirm the diagnosis prior to taking any other steps.

  41. Sabet
    |

    Dear Dr , I have left ear bppv and every time eply fixed the problem but this time I am dizzy but eply not working is converted to horizontal? How. An I make sure?

  42. Sabet
    |

    Dear Dr,
    I have left ear bppv for years but this time I did eply but no respond
    When I lie down 45 degrees I don’t feel dizzy but I have dizziness is it converted to Horizontal? How can I test it?

  43. Peggy
    |

    Hello,
    I was diagnosed with BPPV on the left side by therapist at ENT and treated on that side, but the symptoms come on when I turn my head to the right or lie on my right side. Is this normal? I’m just wondering if I should repeat Epley on right side too. The vertigo is gone since they did the Epley but I’m now having trouble focusing my eyes and feel off balance when I walk or move my head. I was told I could go back to work that day but it’s now been 2 days and dont’ feel up to it.
    Do you think this is normal?
    Thanks

  44. Clearwater Clinical
    |

    Hmm, I am not perfectly clear on your question. Are you getting dizzy on your right or your left when you first lie down?

    The side that you get dizzy on during the first position is the one in which you have BPPV. It is possible to have BPPV in both ears and to have it first in one ear and then in the other so that may explain what you are experiencing.

  45. Sabet
    |

    Dear Doctor,
    I have left ear bppv for years but this time when I do eply maneuver in right ear
    when I lay down with head 45 I fell not dizzy do I return to my first position I fell dizzy
    Please advise me the problem, thanks

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