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.

128 Responses

  1. Clearwater Clinical

    Good Question. It only works on P-BPPV. Other types of BPPV are usually short lived due to the anatomy.

  2. Lia

    Someone help!!! I have felt dizzy for a few months now, I initially was on antibiotics with having lymes disease, so thought the dizziness could of been a side affect, I’ve had the all clear for lymes, but still dizzy!! I’ve had the epley done twice and now I’m on betahistine and have been for a week and don’t see them working! It’s driving me mad

  3. Bob

    would Dizzyfix work on the other types of BPPV or just the most common P-BPPV?

  4. Clearwater Clinical

    Thanks for the clarification.

    Bouncing can sometime be something called “oscillopsia” when you loose vestibular function in both sides. This is very disabling and a person with this might even find it hard to stand or walk. I just though I would mention it as it can be diagnosed with a vestibular test called a VNG (where they put warm or cold water in your ears and measure your eye response. If you have already had this test you are clear. If you have not had it you might consider talking to your doctor about it.

  5. Sandi

    Thank you for your response. I have been trying to remain active and busy and will admit that after some balance yoga or a walk it seems better, but it keeps coming back-the bouncing. This bouncing is awful and yes it sometimes stresses me out. I have not taken any medications for vertigo- they gave me some, tried once and made me tired. Never took again. They gave me patches for nausea but I didn’t have that at the time so never used. As for other disorders all I can say is this bouncing came with the vertigo…a few days after spinning started. Prior to that I had none of these issues. I am 54, not what I call elderly and before a foot injury just after vertigo started I was walking 5 mi a day. I’m reasonably healthy, alert etc. I do have diabetes and general anxiety disorder. I am not on meds for anxiety at the moment. I am considering requesting something because this bouncing causes enough stress and anxiety I am finding myself slightly depressed-but was not deprEssex prior to. Anxiety and headaches make the bouncing worse. It’s now 5 weeks..u said a few??

  6. Clearwater Clinical

    Thanks for your comments. There are several possibilities. Some of which you are not going to like much. It is not uncommon to have residual dizziness after BPPV. This feels different for different people but certainly “not spinning” and “bouncing” or feeling off balance or like you are about to spin are common. After an episode of BPPV the brain is a little confused. The cerebellum has been hyper-stimulated by the presence of these crystals and takes a while to re-acclimatize back to normal. You can help this process by avoiding sedating or dizziness medications and by being active (not too much resting in bed). Any activity where you get up and move about with your head is good vestibular rehabilitation. This process normally takes a few weeks. This can be longer in people who are elderly, who don’t become active, who are on medications or who have other causes of dizziness. There are also some for whom this sensation of “off balance but not spinning” never goes away (although this is the vast minority). Things that can improve it are stress reduction, exercise and avoidance of things like caffeine and alcohol.

    As a second possibility you could have sub-clinical BPPV meaning you don’t see eye motion but you experience symptoms. This usually occurs when you do things that would normally stimulate a BPPV attack like lying down, but not just walking along. IF this is the case then you may benefit from home Epley maneuvers or additional treatments by your doctor. The “DizzyFIX” is one such home device.

    Third you may have another condition causing your symptoms like migraine (Migraine Associated Vertigo), depression or even things like MS or other neurological disorders. This would require review by your ENT and possibly neurology.

    It is impossible to diagnose someone by email so the above is intended as suggested directions of investigation. Given what you have mentioned in your post you may be best to pursue option 1 and possibly option 2. IF you have ongoing or different symptoms you should return to your own doctor for further investigation.

    Good luck.

  7. sandi

    In mid March I awoke with the room spinning-also low blood sugar. After several weeks of waiting and a med that didnt work I was referred to a ENT. At some point the dizziness was joined by what I describe as a bouncing. This is becomes worse the more anxious I am or if I should get a headache. After a couple more weeks of waiting for resolution/taking meds that do nothing I was finally sent to have a vng test. This showed the dizziness was fixable and the problem was on the right side. So then on to therapy where we did the Epley two times. When I returned the 3rd time they said they couldnt detect any eye movement so the vertigo was gone. I disagreed as I still had this bouncing feeling. I waited another week and when it didnt resolve I returned to the ENT who said this was residual vertigo and if it didnt resolve in 3 weeks to come back and he would do a ct scan although he didnt really seem to believe it was necessary. Well I am now 4 weeks past and I still have bouncing. Many mornings I get up and it seems gone–but it returns after awhile and I can almost tell you the moment as its a strange feeling. Upon laying flat on my back or to the right side I dont spin but it feels like it wants to–I can even feel my body tense up in response expecting the spin–but it stops before it goes. Sometimes I feel a heaviness in my head, it causes fatigue, occasional headaches, sometimes I cant even read-its to hard to focus. I also experience brain fog when its bad– some days are not so bad and others I bounce terribly. On bad days I can feel it sitting down but overall its mostly when Im on my feet. It does not bother me in the car and I have no issues driving. Sometimes if I do something bent over–cleaning something off the floor for example –it will go away for a short while. If bad enough it can cause nausea. At 4 weeks past I dont understand why this is not clearing up. I go about my normal day…errands, cleaning, computer work, appointments, shopping etc. I dont feel there is something else wrong as all the symptoms seem fall under vertigo (except I bounce rather tthen spin)–and it feels strange–like im going to spin- to lay flat–and I have times after getting up in the morning that its gone–maybe an hour and up to 4. Is this still vertigo–does it need another treatment–even tho the pt claimed there was no eye movement. I am getting very frustrated

  8. Clearwater Clinical

    Hmm good questions. BPPV is only associated with head motion. However, you may have more than one kind of dizziness. BPPV can be relatively easily diagnosed by a Dix-Hallpike maneuver which tests if you experience nystagmus when you quickly lie down on one side. If this happens then you have BPPV almost 100% of the time. However, if you are dizzy all day, even when sitting still this is not BPPV. Other conditions like headache, migraine, depression, MS and many others can cause this type of feeling (as well as even old age). Clearly all this should be looked at in detail by your own family doctor, a neurologist and someone specializing in the ear like a neuro-otologist with an interest in dizziness. Good luck.

  9. Clearwater Clinical

    That all sounds awful. However, it does not sound typical of BPPV. You may want to consider specialist consultation (if you haven’t already). Certainly other investigations like an MRI might help rule out central causes. A caloric test and a VNG would also help rule in or out a vestibular (ear related) cause. Other considerations might be migraine, depression or MS. Clearly all this should be looked at in detail by your own family doctor, a neurologist and someone specializing in the ear like a neuro-otologist with an interest in dizziness. Good luck.

  10. Clearwater Clinical

    A few things here: 1) You can get BPPV on both sides. If this is the case just treat one side at a time. Doing a right sided maneuver should not make you very dizzy when you roll to your left as it is a slow motion, although you can have some symptoms. We suggest doing one side per week and repeating the maneuver daily on the same size until it no longer makes you dizzy when you lie down on that side. Then move to the other side. 2) there is a possibility that you have converted typical posterior BPPV into Lateral canal BPPV. The experience of this is worse dizziness on the affected side than before you did the maneuver. This can be very upsetting feeling, but often resolves on its own. You can treat horizontal (lateral) canal BPPV by something called a log roll (which you can search on youtube).

    Obviously these comments are to help in general but you should seek specific advice from your own physician about your medical conditions.

  11. Deb Pletsch

    Hi. My friend had the maneuver done for her right side but was still dizzy. When she went to do the maneuver again she became really really dizzy when turning onto her left side! Is it okay to do the maneuver now for her left side. She is afraid as now is really dizzy on both sides. How should we proceed?

  12. Cheryl

    I have had persistent vertigo for about twenty years, but in the past two years it has become extremely severe, to the point where I can’t walk, stand, or even sit up. These episodes last for at least two to three months and never go away completely. It’s accompanied by headaches and crushing fatigue, but this may be a separate condition. We’ve tried many treatments and medications over the years with no success. My doctor only recently had me start doing the Epley Maneuvers, but there is little result. I guess I just want to know how long it is before I start feeling better, how often I should do the maneuvers, and how long should I continue doing them should I start to feel more normal. This is severe enough that I’ve applied for disability since I can’t hold down a job missing three months of work at a minimum each year, usually more. We’ve already tested for pseudotumor cerebri, just in case you’d ask.

  13. Sylvia

    I have had light headed dizziness since August for going on 6 mos went to ent who sent me to rehab who claimed it wasn’t bppv just went bk to ent who tested my rt side and said it is bppv but she didn’t offer to do the maneuver and is setting me up w a emg. I’m so worried she indicated bppv would only cause dizziness upon head movement my question is Is the true. Because in dizzy all the time. Thanks any advice I’d love to hear how you guy are doing

  14. Matt

    Hello just got the Epley maneuver done on Monday of this week, so two full days have gone by. My ent said to keep my head straight for a week. Do I really have to wait a week to see if the maneuver worked?

  15. Sharron

    Hi Everybody,

    June 2015I had BPPV in both ears and suffered for months but finally the EPLEY and PT fixed me and I have felt normal. I woke up Monday, lifted my head and BAM the spinning was back, just in time for Christmas. I have done the EPLEY at home four times this week and yet it hasn’t worked. I did the EPLEY this morning and today I have felt rotten all day. Dawn reading your post was like reading something I have gone through. I too am a vomit phobic lol ….. and the Dix Hallpike is horrific and aggressive and just plain terrible. Unless you have been through it you just can’t describe how terrible it is.

    I think I will call for a Dr appt. on Monday and see if they can get me in with the ENT as an emergency to see if they can fix me as I have more confidence in them performing it than I do. I know when I do go there I will be a bag of nerves and crying and shaking and panicking …. just awful BUT I want this gone … AGAIN!!!

    Not sure whether to have a day off tomorrow and give my body a rest, but at the same time I want to get this fixed. Today is probably the worst I have felt after the EPLEY.

    Would love to chat with anybody who has the joy of suffering this!!!!

  16. Clearwater Clinical

    There is no evidence that daily maneuvers will prevent recurrence but certainly there is no evidence of harm. It would make sense to me to do this.

  17. Clearwater Clinical

    If you turn out to have BPPV then many people do report that they can “feel” when it is coming on, even aside from the actual spinning.

  18. Clearwater Clinical

    Light spinning is normal after the Epley or the DizzyFIX. So long as you don’t have “full on” spinning or other symptoms then this is generally normal. Please talk to your own physician about the specifics of your case.

  19. Clearwater Clinical

    Thanks for the question.

    The Epley Maneuver will feel just like the Hallpike. This sadly is the only way to move the particles causing BPPV out of the canals in the ears. The good news is it is the last time you should feel dizzy. The success rate of the Epley Maneuver is between 30-100% successful depending on who does it. If you have either a device such as the DizzyFIX or a trained person doing it then your success will be high. Certainly you can actually do it yourself with no guidance other than YOUTUBE but I find that this is a scary thing for most people and that the success rate is lower as you are less likely to do it correctly. The best solution would be to have every physician be well trained in the maneuver. However, this is not the case. Good luck – and yes, once you have a diagnosis, you certainly can take medication such as Benzodiazepine (at the direction of your physician) prior to the maneuvers.

  20. Karin in Orlando

    I just had the Epley Maneuver done on Wednesday and after the first round the BPPV went away. I have not had any dizziness since and I would highly recommend it for anyone so that they can get rid of their vertigo if they indeed have BPPV.

  21. Dawn

    I was just seen by an ENT today and diagnosed with BPPV. The Dix Hallpike maneuver was performed to the right only. The reason it was done only to the right is because it seems that that is the side my issue is generating from, based on recent experiences. The recent experiences have been more a lightheaded/off-balance.. maybe a single “spin” type episode. The Dix Hallpike test? WOAHHHHHHHHHHHHHHHHH.. Wayyyyy worse reaction than anything that I’ve actually been experiencing. And I seem to have developed a panic reaction somewhat to this.. or did to the test because I had to stay in the office for almost 2 hours afterwards to recover. Full body sweat, severe nausea (never threw up), entire body vibrations (she took my blood pressure at one point).

    They want to the do Epley maneuver on me but umm… I really really REALLY fear doing it. To go through even ONE more of those rotations I’m not sure I can handle, never mind she said she’d have to do at least two, maybe up to four, at one time.

    Is this normal? Is there anything else I can do? There’s no question I got full on spins from the test. They did stop as soon as she stopped. I guess I have a fear of vomiting.. a phobia in fact (yes this does exist lol.. I looked it up) I’ll do ANYTHING to not vomit (and indeed took a Phenergan from my stash in order to quell the nausea).

    I asked if there’s anything pre-emptive that could be taken, she suggested Ativan. Apparently, my post-test reaction was “on the far side of the Bell curve” as she put it.

    I’m REALLY scared.. Welcome thoughts and feedback if anyone reads this!

  22. Jack iller

    Yesterday was wonderful. Today off kilter a little. Should j do a n epley myself or wait til i see my pt tomorrow.
    Th a ks

  23. Jack iller

    I had zn epley done 6 days ago. I havent had any spinning but had a day of xlight dizziness. It went away. Do i need z other epley .

  24. Daneen

    I experienced vertigo for the first time on Aug 6. The spinning has not reoccured, but I feel dizzy most of the time. The only manuever that seems to work is the deep head hang which lasts about a day. The strange thing is that I can feel when the affects of maneuver have worn off. I get this wierd feeling in my body and the unsteadiness begins. I have an appointment with an ENT specialist tomorrow and am praying he can offer some real help.

  25. Norm Shaw

    Is their any problem with doing this once a day every day as a sort of maintenance, thanks,Norm

  26. Clearwater Clinical

    Usually 1 time is enough. However, you have to do it right. We developed the DizzyFIX to help people do it right. In the hands of a family doc success can be as low a 30% while with and ENT as high as 90%. So – I suggest if you are still having spinning attacks then seek further help. If you are only having off balance sensation then that is common. If you have other symptoms speak to your GP. Good luck.

  27. Clearwater Clinical

    Off balance feeling after BPPV is normal. If you are still having sudden spinning attacks then yes you need another maneuver.

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