I tried the Epley maneuver but it didn’t work.

Although most people with BPPV can be treated with the Epley maneuver or a home treatment device.  About 5-12% of people cannot be treated.  There are several reasons which should be carefully considered.

1) You do not have BPPV.  There are many kinds of vertigo and only BPPV will respond to the Epley maneuver.  You should always get a proper diagnosis from a physician qualified to diagnose BPPV.  Several serious conditions can cause vertigo as part of their symptom complex and these other conditions should be ruled out.

2) You have BPPV but are doing the maneuver incorrectly.    This is actually the most common reason for treatment failure in people with BPPV.  This may be because you are treating the wrong side or may be because you are performing the maneuver too quickly, with the wrong angles or in the wrong order.  The maneuver is only effective when performed totally correctly.  A BPPV treatment device to assist in the correct performance of the maneuver is available and will visually guide a person through the maneuver.

3) You may have a resistant form of BPPV.  This may be due to the fact that the otoconia, or ear crystals, get stuck in the balance canal or that they get glued to the end of the canal. It is not clear which is true but it seems that some people don’t respond whatever they do.

4) You may have BPPV in both ears.  Due to the nature of BPPV if you have it in one ear it is certainly possible to get it in both ears.  Typically this will present with symptoms on both sides.  A physician can tell you if this is the case.  The Epley maneuver will still work but you will have to do it on both sides.  People often ask if doing one side and then the other will reverse the benefit of the first maneuver. It is not clear that this is true however, we always tell people to treat one side one week then the other side the next week.

With these issues in mind it doesn’t hurt to perform an Epley maneuver in a repeated fashion, it might help but this cannot be guaranteed.    The only caution is that if you have symptoms which do not seem related to BPPV such as weakness or confusion you should seek medical attention.

21 Responses

  1. Stu Cotner

    I have had constant vertigo since March 2018 it is daily the severity fluctuates but on my best day I still have too use a walker I have had MRI seen Audiologists Nuerologists physical therapists done the Epley maneuver without any improvement I can no longer work because standing and movement exacerbates the problem but the doctors ( VA) still tell me to do Physical Therapy which is clearly not working seems Doctors have a hard time admitting they don’t know what condition I have or why my vertigo is persistent and continual

  2. pooki

    quack quack quack
    fix yourself because the medical community

  3. Kayla

    Hi, I have constant reocurring dizziness, blurred and blotchy vision – with sometimes vision loss, fainting, nausea, and vomiting. I went to the ER yesterday and they told me I have vertigo caused by dislodged crystals in my inner ear (however never even t9uched or checked my ears out). This is 2 weeks of vertigo this bout. Causing my daily living activities to be extremely difficult. They gave me IV meds that knocked me out for 15 hours and I wake up to the same symptoms. They told me to do the epley maneuver and it will be better. I have had it done 3 times and still the same. My blood pressure dropped 12 points going from supine to standing at the hospital as well. Could there be another cause to this awful illness? Should I get an MRI?

  4. Rose

    I can be sitting on the couch and not even moving and my head starts to feel the spinning . I take a Tylenol because I start to get a headache . I feel pressure in the back of my neck . Doctor
    says it is vertigo. But I feel so dizzy I am afraid to go outdoors even to the store .
    I have to sleep sitting straight up in bed . My head feels full and now my eyes are getting blurry . Pray I am not having a stroke . I even try using ear medicine because I was told it as because of the ears went to ER ( four hours there ) they gave me Meclizine , it made me puke .

  5. Rob

    So far, I’ve had over four diagnosis’ first it was a stroke, then labyrinthitis,
    then BPPV, then occular vertigo.
    Then, it had something to do with the sensors in my feet, then something in my neck, or my hips, or my feet;
    (but not sensors)!
    Ian heartily fed up, this particular bout, has been going on since September 2016, although I have suffered from this in the past, starting in 2010.
    Please, can someone help, who isn’t going to build up my hopes, only to have them dashed, or someone taking me for a ride and charging a fortune, that I don’t have!
    I look forward

  6. Clearwater Clinical

    I am sorry to hear this. I would suggest you go immediately to the doctor and perhaps to the emergency room. Vision loss is not normally associated with BPPV and might be a measure of something concerning that you should get checked out. I hope you improve – good luck.

  7. Louise butler

    I am struggling with the basic things in life,even typing this out.I am so tearful because I am losing my eyesight and balance most of the time.I have just got back from Greece and been diagnosed and it is getting worse rapidly

  8. Clearwater Clinical

    Great question. Sadly there is no non-surgical permanent fix. You can have a posterior semi-circular canal occlusion which will block off the offending canal but will make you very dizzy for about 2 weeks. However, after that you will never get posterior BPPV in that ear again. Obviously you can still get it in the other ear.

    There is no evidence that “preventative” Epley maneuvers work, however, it would make sense that they should. Might I suggest that a daily part of your Yoga could be an Epley maneuver? Why wait for an episode when you can prevent one from happening. There is also no evidence that doing an Epley when you don’t have BPPV causes any kind of harm. If you have treated BPPV then you should not get dizzy during an Epley maneuver. If you still have BPPV then you will get dizzy every time.

  9. Lisa

    I have BBPV and my physiotherapist has taught me to do the Epley Maneuver successfully at home. I know I am doing it properly because when I have a bout of dizziness, I can do the manuever and feel far less dizzy almost immediately. However, the dizziness keeps recurring. A recurrent is always precipitated by a head movement that knocks the crystals loose, like looking up, or lying back in a dentist’s chair.

    My question is, is there any more permanent fix for BPPV? Or will I have these recurrent bouts of dizziness for my whole life? I find them so upsetting. I used to LOVE doing yoga and now I am terrified to do it because every time I try, I get dizzy.

    I just want my normal life back.

    Any advice or information you can provide would be appreciated. Thanks.

  10. Clearwater Clinical

    Thanks for your comments. I think it is fair to say that all situations are a little different and anything out of the ordinary should be discussed with your own physician. With that said it is not uncommon to have more than one thing going on at a time. It is quite common to have residual symptoms after the actual BPPV is gone. This may present as a non-spinning kind of sensation – not as acute as BPPV attacks but certainly you don’t feel normal. Usually this resolves within 2-4 weeks. People often have BPPV due to vestibular damage (age, trauma, infection) which may also be causing the ongoing symptoms. In some cases, sorry to say, we never really find a reason. We call this vestibulopathy. So in answer to your first question it is very difficult to say why you in particular are having ongoing symptoms. In answer to your second question – No neither the Epley nor BPPV cause continuous ongoing symptoms. It is possible that you haven’t recovered quickly due to the lack of VRT (or other activity). This does speed recovery – in particular if you have be avoiding activity due to the dizziness it can slow down recovery. Sorry that I can’t be of more help. Good luck.

  11. SLB

    I had the Epley done on me for BPPV, and it seemed to resolve the vertigo. But, I experienced horrible residual dizziness – rocking/heavy head/dizziness. The rocking and heavy head feelings have gone after a month of VRT, but I’m still dizzy and off balance two months later. Can you tell me why I might be having such bad residual problems for so long, when most people are fine in a week or two. One other note – I had BPPV for more than a month before I got diagnosed and treated with Epley. Could that be the cause? I also didn’t start VRT for three weeks after the Epley; I only started it when I realized the exercises the doctor gave me were not working, so it’s been just 5 weeks of VRT. I’m desperate for this dizziness to go away…Thank you.

  12. Clearwater Clinical

    DizzyFIX treats posterior BPPV only. However a “log roll” maneuver can treat horizontal BPPV. You should be able to do this quite easily. I would discuss this with your doctor first.

  13. Donna

    Have suffered with BPPV for two months. Three sessions of various Epley maneuvers with hospital PT. They say I have the horizontal canal kind. Nothing is working and I still feel horrible. Looking for alternatives because this is taking too long!

  14. Paul Bishop

    I was trying this method for 2 months before a MRI discovered a tumor that had reached the midline of my brain. get an MRI just to be safe

  15. Clearwater Clinical

    Here is the link to a home device.

  16. Clearwater Clinical

    Assuming you have BPPV then the Epley usually does work. However, there are 4-6% of people for whom it does not work. There are a variety of reasons including having the wrong diagnosis, doing the maneuver wrong, having highly recurrent BPPV or having BPPV crystals which are jammed up in the Canal. Usually these can be clarified with a detailed clinical exam by someone familiar with BPPV. I suggest seeking out a vertigo expert in your area. Failing that there are two options 1) perform correct maneuvers at home with a home device and see if repeated maneuver helps or 2) consider surgery where the canal causing BPPV is plugged “Posterior Canal Plugging”, not many surgeons do this as it is reserved for the worst cases, but if you can find a neurotologist they can usually perform this. Good luck.

  17. Chantall Du Toittt

    Hallo, about a year ago i woke up one morning and the room was spinning violentley, went to a specialist and he said i have the crystyls in my ear and the rapoed eye movement in my right eye, tryed the eply menuever and im still not beter. Every day i live with dizzyness and the feeling of not beieng my self. It is terrible and no medicines seem to work. The dockters are just to expencive to go back.What do u do with this terrible thing.

  18. Clearwater Clinical

    There are a number of possibilities. One – that you are over the acute BPPV and now have a post treatment off balance feeling which will go away in a couple of weeks or two – you have BPPV on the other side, or three – you have converted to horizontal BPPV. Usually – horizontal BPPV is worse feeling but does resolve quickly. You should speak to the person who diagnosed you to confirm what is going on.

  19. Sabet

    Dear Dr,
    I have left posterior ear bppv and eply was very effective but this time it does not work
    When I lie down I feel not dizzy in 45 degrees but when I sit back I fell dizzy

    As well as I roll in bed please help me what I should do

  20. admin

    Sadly the best thing to do is to seek medical attention to get a proper diagnosis. Once you know if you have BPPV or not then it is possible to pursue effective treatment at home. The initial episode you describe “two weeks of spinning dizziness” sounds like labyrinthitis. Sometimes this type of infection can cause subsequent BPPV episodes. You describe short episodes of spinning in a particular position. This certainly sounds like BPPV but should be diagnosed by your doctor. Following those episodes of BPPV you describe an off balance feeling. This can sometimes be caused by re-adaptation to a successful treatment maneuver – what I mean is that you may have become used to the crystals which cause BPPV – now that you have moved them out (the spinning is gone) you feel sea-sick. Usually this resolves on its own. Again if you are having strange symptoms you should seek the advice of your own physician.

  21. manda

    I have been diagnosed with BPPV 6 months ago. I woke up spinning violently and went to ER immediately. They had no idea what was wrong and sent me home. I lived off of Gravol (which really didnt help) and had to take almost 2 weeks off from work. Once back to work I still had dizzness when I moved my head but could function. After 2 months I was directed to a Physio who preformed the epley maneuver and I was 100% before within 24 hours. It’s been 6 months since I have been dizzy and 5 days ago I woke up spinning.. again. It was the same feeling I remember. This time tho I noticed it was the other ear. When i leaned towards the left I would spin but not violently. The room was moving a lot slower then I had remembered, Spinning none the less and no rapid eye movement. Since now I live in an area where I would have to fly out to seek medical attention I have been tring this maneuver on my own. But it’s not working. Im worried maybe something else is going on. I find now after a week the spinning has stopped and now im very off balance. Im having troble walking and head movements do not cuz me to spin but rather feel extreamly sea sick. I have started doing the log roll in the morning and once at night. Any advice?

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