How to perform the Epley Maneuver to Cure Benign Positional Vertigo

I. What is the Epley Maneuver?

The Epley maneuver, also known as the canalith repositioning maneuver, was first described by Dr. John Epley in 1980. It is a very effective treatment for benign positional vertigo (sometimes call benign paroxysmal positional vertigo or BPPV). The Epley maneuver involves moving a person's head and upper body into several different positions. The purpose of the maneuver is to allow gravity to pull free floating calcium crystals (medical name = canalith or otolith) out of someone's inner ear balance canals so that these crystals do not cause the sensation of spinning any longer.

II. What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is a common cause of dizziness which can occur in any age group. It occurs when small crystals break free from their attachments to the walls of circular, fluid-filled canals in our inner ears. When we move our heads in certain directions, the crystals will float around for several seconds after our head stops moving. This floating of crystals triggers abnormal signals from our inner ear to our brain, which usually produces the sensation of severe spinning with nausea (sometimes vomiting). The severe spinning usually fades away within 5 minutes, but people may continue to feel unsteady, nauseated, or off balance for hours. The next time that person turns their head in the same way, the spinning and nausea will start again.

III. How do I know if I have BPPV?

BPPV is usually strongly suggested by the patient history. It is classically characterized by a spinning sensation associated with nausea that lasts seconds to minutes. These symptoms occur after certain head movements (common reasons are turning over in bed, turning head while driving). The diagnosis is usually confirmed by the Dix-Hallpike maneuver, which is actually the first part of the Epley maneuver (see below). Always see a licensed physician or other health provider before diagnosing yourself with BPPV or any condition.

IV. Can I perform the Epley maneuver on myself? Are there any risks?

The Epley maneuver is very safe in most people. Although not a true "risk," anyone trying the maneuver should know that it WILL trigger symptoms of dizziness and potentially nausea/vomiting if you truly have BPPV. If this occurs, it is actually a good thing and means the Epley maneuver is more likely to work. Because the maneuvers require head turning and laying down/sitting up, anyone with neck or back problems, elderly or frail people, or obese people should take caution and consult a physician.

V. What should I do first?

First, you should test if you are likely to have BPPV or not. This can be done via the Dix-Hallpike maneuver. Start by sitting on the end of your bed facing straight ahead with your feet flat on the floor. Keeping the rest of your body facing straight, turn your head 45 degrees to the left. Then, while keeping your head to the left, bend backwards at the waist until you are completely flat on the bed. You should lean back rather quickly (i.e. no more than 2-3 seconds from sitting straight to laying flat). After laying flat, stay still for 15-20 seconds at least. If you have BPPV affecting your left ear, you will notice a sensation of spinning which starts within 10 seconds after lying down and then fades away. If you do not feel dizzy, you presumably do not have BPPV in your left ear. At this point, sit back up. Repeat the same maneuver except this time, look 45 degrees to the right. This will test your right ear for BPPV. If you do not become dizzy on either side, you do not have BPPV.

VI. So I think I have BPPV. How do I complete the Epley maneuver?

Usually, the BPPV will only affect one ear. The Epley maneuver allows gravity to move the floating crystals to a different part of the inner ear where they will not cause problems. The Epley is essentially the same series of maneuvers for each ear: the left side is just the mirror image of the right and vice versa. I'll describe the Epley maneuver for the left ear in detail and then briefly for the right ear (as it is basically the same except in mirror image).

1. Repeat the Dix Hallpike maneuver exactly as in part V with your head to the left. After laying flat, stay still until the spinning sensation has gone away.

2. Then, while keeping your body still, turn your head 90 degrees so that you are now facing to the right. Turn your head completely within a 2-3 second timeframe. Ideally, this should again trigger the spinning sensation (spinning means the crystals are moving in the right direction!). If you do not feel the spinning, gently wiggle and tilt your head around until you do. Again, stay still until all spinning goes away completely.

3. Now, while keeping your head position the same (to the right), turn your body onto its right side so that your right shoulder and hips are resting on the bed. Try to complete the movement as quickly as it can safely be done. If done correctly, your face will be looking straight down at the surface of the bed. Again, try wiggling and tilting your head around as needed to trigger the spinning sensation. Stay still until all spinning goes away.

4. Finally, while keeping your head and shoulder position as stable as possible, sit up straight. Ideally, your shoulders should move to their left and your head should move backwards (if that makes any sense). Now, relax for a bit. You have completed the Epley maneuver!

For the right ear, the instructions are identical; just change every "left" to "right" and "right" to "left." If you don't feel the spinning sensation after every movement (including wiggling your head around), still complete the whole maneuver anyway. Be careful to avoid rolling off the bed.

VII. So I completed the Epley. What should I do now?

Consider doing the whole maneuver again once or twice. This will help reposition any straggler crystals. Also, you should hopefully notice that the dizziness is improved or completely gone the second and third time through (if not, you may still get better, so don't despair!)

Once you are completely done, try to avoid laying down or laying your head flat for 3-4 hours if possible.

VIII. It didn't work! Now what do I do?

While the Epley maneuver works well for most people, it does not work for everyone. The most likely reason would be that you don't really have BPPV. There are other conditions that can mimic BPPV. Unfortunately, even some people with BPPV don't respond well to the Epley. You should always seek the advice of a licensed physician if you continue to have problems or have any other concerns. In my opinion, the best doctor to see for this problem is an otologist (ear, nose, throat doctor who specializes in ear and balance disorders).

The above article is for educational purposes only and should not be construed as specific medical advice.