THE EPLEY MANEUVER
The Epley maneuver is used to reposition BPPV crystals.
It is the first procedure of its kind to help with vertigo. Published in the early 90’s by the late US-based physician named, John Epley, since then, many healthcare providers and vertigo researchers around the world have developed a whole catalog of additional “particle repositioning maneuvers.”
In this blog, I discuss the top five reasons why the Epley maneuver may not be effective for vertigo treatment.
INCORRECT TECHNIQUE
First of all, many providers who are “dabbling” in vertigo care perform the maneuver incorrectly.
The Epley maneuver, the modified Epley, and all the particle repositioning maneuvers for BPPV require very precise, technically accurate performance to be effective. Unless the provider has studied the technique to reproduce precision and accuracy, they may be performing the Epley maneuver incorrectly.
In teaching this maneuver and other particle repositioning treatments to other providers, I have discovered certain predictable errors that are made by beginners. Those errors will reduce the effectiveness of the treatment.
TREATING THE WRONG EAR
It is important to treat the correct ear in order for the Epley maneuver to work. The first step to effectively treating BPPV is to determine which ear is involved.
The options are right ear, left ear, or both ears. This can be determined through BPPV testing by a skilled provider.
TREATING THE WRONG SEMI-CIRCULAR CANAL
There are three semi-circular canals in each inner ear. You must determine the canal that needs treatment.
The Epley maneuver is designed for the long arm of the posterior canal. If BPPV crystals are free-floating in the horizontal, anterior canal, or short arm of the posterior canal then the Epley maneuver will not likely resolve the complaint.
Those other inner ear canals require different treatments that have been developed after the Epley maneuver was first published.
BPPV CRYSTALS ARE STUCK
BPPV particles can get stuck. The Epley maneuver makes an assumption that the BPPV crystals are free-floating in the long arm of the posterior canal of the ear being treated. However, there is a possibility that the BPPV crystals or debris can adhere to the sensory apparatus within the semi-circular inner ear canal called the “cupula.”
This is a type of BPPV called “cupulolithiasis,” as opposed to the more common “canalithiasis” with free-floating crystals.
Cupulolithiasis is rare. In my experience treating literally thousands of people with BPPV, I have only found a small percentage of people so far who have BPPV crystals stuck on their cupula.
It is possible to break the BPPV crystals off the cupula and resolve the problem, but starting with the Epley maneuver will not be effective in this case.
Why Doesn’t the Epley Maneuver Work?
Another reason why the Epley maneuver may not work is that you may not be dealing with BPPV.
There are other conditions that can mimic BPPV, even causing positional nystagmus and positional vertigo symptoms.
Disclaimer
This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
great article, and very helpful.
Important reasons to seek help from an experienced professional .
Nice article, and highlights some additional issues I was not aware of in self diagnosing and treating my own BPPV for a second time, but then experiencing no initial change in symptoms..
I have a cochlear implant. I’m hearing impaired in my other ear. Epley Maneuvers are not working on me anymore.
I had vertigo come on suddenly 2 weeks ago, I went to my Dr who sent me a video of the Epley maneuver to do. It hasn’t helped at all. I feel like I’m permanently on a train, like the ground is always moving and every now and again it lurches up and I nearly fall, even lying in bed it feels like my whole bed is rocking and moving. I have terrible nausea with it and am now getting migraines. Is there anything I can do to get my life back?
Hi Katie,
If your doctor told you to do an Epley, then that doctor diagnosed you with BPPV. However, it sounds like the treatment was a failure.
I suggest consulting a vestibular specialty provider. The Epley maneuver only treats one type of BPPV but there are many other types of BPPV.
Also BPPV can cause chronic migraines, so addressing the BPPV with a specialist could be a good next step.
I hope you feel better soon!
Dr. Kim Bell, do have a referral for a vertigo specialist in Los Angeles/ Santa Monica area? Would be greatly appreciated.
Hi Janet,
In Newport Beach, I can recommend Dr. Howard Mango, AuD.
The university hospitals in LA may have Vestibular providers and there is the House Clinic in LA. I don’t know anyone personally in that area, so I cannot recommend anyone to you by name.
Many of my patients have previously seen various practitioners in LA, so I think there are options if you search around.
You can use the online directories in this blog to search for Vestibular providers in your area.
I have a lot of patients who travel to see me in Vista CA from Los Angeles County, as well as patients from Riverside County and Orange County. Patients from LA usually spend the night, so they can see me two days in a row and then drive back after the second appointment.
With my new office location off the 78, it’s easier for patients to access my care from across the SoCal region. Click here if you want to learn more about my expert care.
I hope that information is helpful! I wish you all the best.
Had vertigo really bad 7 years ago. Had it in 5 different canals at different times. Had 284 Epleys. It kept coming back. I got tired of maneuvers and decided to just live with symptoms. Developed 3PD as well. Four months ago it came back full force. Was hospitalized again. Couldn’t walk. Nystagmus in right canal right posterior and right anterior. Been treating g the right posterior with Epleys. Less and less nystagmus but still comes back upon waking. After a successful Epley I feel normal for rest of the day. Then I go to sleep in my recliner (45 degrees) and in the morning my symptoms are back again. I just keeps coming back. I think I only cleared it for 1 day and 1/2 at the most. I see a physiotherapist weekly. He keeps saying it’s almost gone. But it always manages to come back. What else can I do? Surgery? I do t have quality of life. Taking a shower twice a week is highlight of my life. Can’t stand at stove to cook. Hard to cut vegetables. Hard to walk. I’m married. No sex for 3 months now. HELP!!!!!!!
Hi Martha,
This sounds awful! I would be happy to work with you, but it sounds like you’re not in America. Patients travel to California from all over to work with me, since my expertise is in difficult in complex cases especially atypical BPPV.
Here are some things that come to mind…
You may need a different maneuver for the same canal.
For example, this is a maneuver for the posterior canal which treats the short arm segment of that canal.
Whereas the Epley maneuver treats the long arm segment of the posterior canal.
In this blog, I share about posterior canal BPPV variants.
Epley is not always the answer for everyone. Another maneuver with similar efficacy is the Semont maneuver, and now even the Semont plus can be used as a home program.
Also, you can consider if you have risk factors causing you to continually shed BPPV crystals such a gut related inflammation, chronic viral activity, or an upper cervical issue restricting blood flow to your ears.
I hope something I shared will give you a breakthrough! I hope you feel better soon.
I’ve had it for 20 years after a stroke. They say my symptoms are BPPV but none of the maneuvers work. I’m the worst in the mornings after waking up.
I know how you feel, just turning my head rocks me – let alone bending over or lying on my back.
Twice , years apart, and gave me a severe migraine and nausea. Three days later I still have a headache, and some dizziness three days after maneuver what can I do?
I will not let anybody touch my head again.
Hi Caroline,
You can talk to your doctor about medications that might help.
Best wishes
Did you get the epley maneuver for vertigo? Did they hit you head to knock the crystals back into place? Ever since they did that to me a week ago I’ve had a severe migraine could it be from that?
Hit You in the Head? Are you serious? Never do that for treatment…oh my goodness!
What???
I had BPPV in both ears right was worse everything went well then came left ear. Had it done on 6/2/26 and have been in a migraine since. Been to my primary dr., 3 Urgent Cares. 2 Neurologists and 4 ER visits with the last one being admitted for 4 days. Feel like the Epley Procedure caused more problems then I previously had. Warnings should be given I was not aware any of this could happen and I know am more educated but still don’t understand what it caused and regret having the maneuver. Have you ever heard of this and why am I still unstable? I just want my life back.
Hi Dawn,
I’m sorry to hear this!
This blog may help.
This blog discusses risk of BPPV treatment maneuvers.
I hope that helps!
Best wishes,
Kim Bell
Went to physiotherapy 5 times for Epley, passed out vomiting.
I apparently have vertigo in both ears, but the Epley has not worked.
One year of suffering – falls and unsteady.
I don’t know where to go from here.
I am also deaf.
Anyone have any suggestions? 😞
Hi Dian,
That sounds awful!
The Epley is only one possible maneuver that can help with BPPV-related symptoms of vertigo – the original BPPV treatment maneuver.
Some patients benefit from other BPPV treatment maneuvers to resolve vertigo, which a vestibular physiotherapist or doctor can figure out or determine by watching or filming any involuntary eye movement (nystagmus).
When my patients vomit during BPPV treatment, I usually suggest for them to pre-medicate with anti-nausea medication before the next treatment. That way, they can get through the treatment more comfortably.
Medications that we have here in the USA for nausea do not interfere with vestibular testing. I’m not sure about prescription options wherever you live, but you can talk to your doctor or physiotherapist about options to help you tolerate treatments better.
When people have BPPV in both ears, recovery can be rough! Until one side is cleared, people often feel sick after the treatment – even when the treatment is successful!
You can talk to your physiotherapist and doctor about what they recommend for you. It sounds like you would benefit from their skilled medical care and you deserve individual advice from someone who knows all the details of your health.
I hope you feel better soon!
I recently experienced vertigo and went to the ER. They did this maneuver to me and it was incredible how it worked. It has taken me a week to get over everything but it was quite an eye opener. I teach medical assisting and I had never experienced this before. I am going to teach my class.
I had vertigo when I woke up yesterday. Not the first time I have had it. I tested the left and I was dizzy. I decided to also do the right and it was worse. I assumed it must be the right ear. So I did the Epley for that and could not finish sitting up I was spinning so bad. Waited 5 hours and tried again. Same results and threw up. Late in the evening I thought maybe I was doing the wrong ear and did the left. If was bad at the end but completed it. Still not better after that. I did the left this morning and feeling a lot better. Will try the left one more time. So the question is if I made it worse doing the wrong ear or is it possible both ears had crystals?
I had the epley done twice after head injury. I am now 6 months post trauma and still have dizziness upon moving my head certain ways (right mostly and up and down). However both times after the epley I got extreme nausea for hours, and major dizziness ongoing for 3 days following so I am scared to try again. It also never resolved the issue. Any suggestions? Maybe it’s not bppv?
Hi Sarah,
I am sorry to hear about the head injury! That’s tough.
Any BPPV treatment can cause a “hangover effect,” even if it is effective. The BPPV patient should start to feel better overall after the hangover clears up.
BPPV after head injury is quite common; however, many patients have BPPV in multiple canals and/or both ears after head trauma. The untreated BPPV can cause a bad flare up after Epleys.
Epley maneuvers can also aggravate neck issues that may have been caused by the head trauma. Often the neck needs to be treated after Epleys by a specialty provider who can resolve dizziness and nausea from the neck.
This blog may give you some more insight into the potential complexity of your trauma-related symptoms:
Dizziness after Concussion
This blog has home remedies that may help while you are recovering from treatment.
For my patients with co-occurring BPPV and cervical spine injury after a head trauma, I shared how I sequence their vestibular PT and cervical spine care in this blog.
I hope that helps!
Best wishes
Went to specialist after having this dizziness 5 years. Started PT..doing Epley Manuevers. It made my dizziness much worse. They said I have crystals in more than one loop. Wish I had never gone for help. The dizziness is twice as bad now. I’m 72 yrs and keep falling.
Vertigo and dizziness contribute to falling. Vertigo has identifiable cause regarding the inner ear. What causes the dizziness? How can it be treated? Many falls are experienced from one or both conditions while wearing a helmet and using a four wheel walker.
Hi Will,
Yes, vertigo and dizziness definitely contribute to falling.
I have written this blog about what causes dizziness in the body.
There are many treatments for the various root causes of dizziness and vertigo.
On this page, I describe some of the treatments that are available today.
The key is to find a skilled provider to work with.
Sincerely,
Kim Bell, DPT
hey there ife had vertigo or what i think is vertigo for 3 months now i can’t go into stores because of how bad it is and worse i cant even go into a dr!!!!!!!!!!! the ground always is spinning and everytbint is moving and i feel confused …. i tried the epley maneuver at home two times and during it it was worse and terrible feeling in my head and didn’t help… any tips?
Hi Isabelle,
I am sorry to hear you are feeling bad!
I wrote this article about why I do not recommend treating yourself for vertigo.
My tip for you is to find a professional vestibular healthcare provider, maybe a physical therapist or doctor in your area.
This blog may help you find a local vestibular provider who can help you.
Best wishes,
Kim Bell, DPT
Hi there! Same thing happened to me! It turns out I needed to do a different maneuver. The professional I saw gave me my life back and I highly recommend going to a provider who is extremely knowledgeable in this field.
Happy to hear that.
I am getting the Epley treatments done now.
How long did it take to recover?
Which maneuver did they do with you?
I have been dealing with constant vertigo for 2 years now. which manuevar did you do just in case the epley one does not work, which I will be trying that one starting next month. But life is becoming unbearable and I will try anything at this point.
It’s important to note that vertigo can be caused by problems in the periphery i.e vestibular system or the central nervous system including the brainstem.
I was diagnosed with bppv right ear posterial canal ,have had Epley maneuvers and and dix halpike none helped ,I have balance issues with a back neck I can’t bend over and my eyes have something to do with it also
Hi Leanne,
It sounds like you have a situation that requires further investigation by skilled Vestibular provider.
You can use this blog to find a Vertigo Doctor in your area.
This blog on what to do when vertigo exercises don’t help may also be useful.
In this area of care, the most important thing is the results. I wrote this blog with three questions to ask when choosing a healthcare provider.
If your results are not satisfactory, then you may want to seek another opinion.
This blog and this blog outline the important reasons to seek skilled care without delay.
If you ever want to venture to San Diego, I would be happy to work with you in person.
I wish you all the best for a full recovery!
Sincerely,
Kim Bell, DPT
I have vertigo issues also. Trying the exercises with no effect.
It seems to be triggered with pain in my neck back/skull.
Please let me know what you found to help.
Dan
I am Menieres diagnosed. I had BPPV like spins when I would turn into my “bad” ear. The only treatment that helped to relieve my symptoms was treating it as a jaw\muscular issue. I know so many others who have been helped this way. I haven’t had vertigo for 32 months now and all the other miserable symptoms have gone too. Only tinnitus remains but livable. I think the medical community is doing a tremendous disservice by continually looking solely at these symptoms as vestibular or neuro. Look at the way we live. Our necks, heads , backs upper arms, front of chest are in positions day in an out that they are not meant to be in. When you turn into a muscle in spasm it causes spins. If you have them in spasm continually the messages delivered through the ear gets screwed up. Please, this needs to be considered and tested so that people stop suffering and get their lives back.
Hi Beth,
What a great story! I am so happy to hear that you haven’t had vertigo for 32 months now!
Perhaps soon, you will be counting in years instead of months?!
I completely agree with you about the disservice to people suffering with dizziness and vertigo by only treating it as a neurological or vestibular problem.
That is why I developed my own comprehensive, unique methodology of evaluating and treating these complaints, called “The Bell Method.”
With my patients, I perform a comprehensive, multi-system analysis to determine the root cause of their symptoms.
Sadly, many patients spend months to years going from one specialist to the next without ever determining the root cause of their problems. A lot of providers are subject to tunnel vision.
I am completely with you on the importance of considering the neck and jaw muscles, bones, and fascia in determining any musculoskeletal contribution to the cause of dizziness, vertigo, balance problems, and tinnitus.
Thank you for adding your input to this important conversation and sharing your success story!
With gratitude,
Kim Bell, DPT
Hi very interesting I have been searching for yrs as to y I have vertigo bought on by stress at times but I’m desperate for approx 10 yrs ago I had my first episode of complete muscle failure my witness was mum my daughter in her wheelchair and at that time my dad when he was still with us
I’m not there I remember just the end or beginning or not at all but I hallucinate slurred speech but continually falling my dr said it was long term trauma
We questioned it forgot about it just the same dad bouts of vertigo I got labyrinthitis yrs ago from flood water viral
But it’s happened 8 times putting me in hospital big scar on face waiting for surgery for pins of foot I destroyed while falling all over things for up to 30 hrs
But after the 5th time I was referred to public neurologist before COVID-19 began now it’s 8 times both my eldest daughter and son on 2 occasions saw me coming around I remember them all telling me to sit down or drunk legs I’m not ment to be driving I spent 11 nights in hospital when I did my foot and knocked my front teeth out but was discharged on crutches after some tests and scans all clear I don’t remember the ambulance or being admitted I was confused at first anyway has anyone heard of such a thing
I do have ptsd for very good reason but I’m 55 and I’m used to stress and vertigo plus other dreppeessive disorder all of those and long term trauma only should happen once in a lifetime maybe 2 but not 8 do you think it could be all related
Thankyou
Hi Jo,
Wow that is scary! You could work with your doctor to assess you for vasovagal syncope which can be triggered by severe emotional stress.
If you have not already consulted with a Vestibular Physical Therapist or Oto-Neurologist or Neurotologist, then one or more of those three options could be helpful in analyzing the root cause(s) of your situation.
You can organize your story by following the outline I suggest in this blog.
This blog is about the link between PTSD and vertigo.
I hope you can find answers and get relief soon!
Sincerely,
Kim Bell, DPT
I am located in Boston. I have been diagnosed with BPPV. I treated with PT at MGH for my right ear; and with only one Epley Maneuver treatment it was gone. A couple of months later, it came back but to my left ear. It is horrible. I have had two treatments of 2 adjustments each with the Epley Maneuver for my left ear. It has not worked and the Epley is really making me sick.
Hi Beth,
I know you made this comment almost two years ago, but I wanted to see if maybe you see this reply. I noticed you mentioned receiving jaw/muscular treatment for your dizziness. What kind of treatment did your doctor do for that and were you having bad jaw and muscle pain? I’ve seen so many different specialists who said I don’t have an inner ear problem. I also went to a TMJ specialist after researching everything else. He had me wear an appliance for almost a year because he thought that would alleviate the dizziness, but it didn’t. So, I’m wondering what you had done.
Thank you,
Sherry
Diagnosed with Ear crystals left ear. I cannot do Epley as I can’t stay in that position for 30 seconds too nauseous. is there sny other type of exercises to move yhe crystals? tks
Hi Marilyn,
There are a whole variety of maneuvers that can be used to treat BPPV, with Epley being the first maneuver that was published.
However, most maneuvers require the patient to hold uncomfortable positions for 30 seconds or longer.
My suggestion is for you to talk to your provider about pre-medicating with a prescription that can reduce your discomfort. That allows many of my patients to get through it!
I hope that helps!
what treatment is there for jaw/mascular issue
For my patients, I typically recommend care from someone certified in ART.
You can learn more and search for a provider here.
I’m very surprised to hear you have only seen 4 cases of cupulolithiasis. We see it on a fairly regular basis in our practice in both the horizontal and posterior canals.
Hi Margaret,
Thank you for sharing your clinical experience treating patients at your PT clinic in Pennsylvania, USA.
In fact, I just had two more recent patients with cupulolithiasis, so my total is now up to 6. (I will go ahead and update the blog now to reflect that number.)
Six is still a very low number in a sample size of somewhere around 5,000 cases of BPPV that I have treated to date.
You may be also interested in reading this webpage by Dr. Timothy Hain, MD who reports only 8 confirmed cases of cupulolithiasis in his practice database of 25,000 patients as of 2019.
I think your point illustrates the importance of avoiding the use of anecdotal evidence to drive our understanding of epidemiological trends and population data.
Although we are treating a similar population, we have clearly had different patients come across our path.
The good news is that they have arrived at the right place and the right time to receive our skilled Vestibular care!
It is a pleasure to be out here in the trenches alongside you changing lives, one at at time!
Warmest regards,
Kim Bell, DPT
Hi Dr. Bell,
I had issues with dizziness for almost 30 years. Recently as of January 2022 it has accelerated to a point where there are days I cannot drive. I have osteoporosis and have had a kyphoplasty in 2017 for a fractured vertebrae. My hearing has diminished in my left ear where it sometimes feels like I’m in a tunnel. It eventually goes away but comes back the following day usually. If I sleep on my left side and try to get up in the middle of the night I’m literally pushed back down the vertigo is so bad. I will then wait a few minutes sitting up and stumble my way into the bathroom where I start vomiting because I’m so dizzy. I’ve had a brain and ear mri which shows a cyst in the hypoglossal canal. My neurosurgeon wants to due a second mri with contrast and include the saggital and coronal views. My husband is a chiropractor and has helped but like I mentioned lately it has gotten much worse. I would love to come to Cali and see you but the thought of flying makes me panicky.
I live in Illinois and am 67 y/o. When I was 9 I was in a car accident where I flew out through the windshield and fractured my skull. I’m wondering if arthritic changes have occurred resulting in my dizziness.
I am on many supplements and follow a vegetarian diet. If you could refer me to anyone in my area it would be greatly appreciated.
Thank you for your time.
Hi Barbara,
I suggest you consult with Janet Helminski, PT, PhD in the Chicago area. You can search for her online by name.
You can also use this article to find another vestibular physical therapist in your area.
Best wishes!
” It is possible to break the BPPV crystals off the cupula and resolve the problem, but starting with the Epley maneuver will not be effective in this case. ”
What should be used to break them free?
Hi Berat,
There are a few treatment techniques that can be used to break them free.
I cannot advise you which would be best, because each case is different.
My suggestion is to find a skilled Vestibular Provider to evaluate the situation in person, then recommend the most appropriate treatment.
You can use this link to find a Vertigo Doctor in your Area.
Best wishes,
Kim Bell, DPT
Have you experienced a patient having downbeating nystagmus without having anterior canal BPPV, but instead having multiple other canals affected by crystals?
If so , can you give me an example?
I have downbeating nystagmus/slightly horizontal left due central reasons probably, but i also have BPPV.
When put in Dix-hallpike position right side my nystagmus ( downbeating ) increases very, but left on the left side it decreases even tho it`s still there. I go to one of the best vestibular therapist in my country, but even he struggles a little because of the intensity of the DBN.
I have been treated on the left anterior, right anterior with no relevant results.
I got treated in the horizonal-right canal with huge results, but the DBN still remains even tho it has decreased sometimes it spikes. I got a little bit of horizontal- nystagmus left that indicates that the right-horiszontal canal is not clear of crystals yet.
My question really is if it is possible that the DBN can come from having crystals in the posterior canal also or maybe both posterior canals?
Sorry for this long comment, but my case is really difficult so i was hoping you maybe have some answers that can help.
Hi Berat,
I am so happy to hear that you are working with a highly skilled Vestibular Physical Therapist!
The answer to your question is yes, I am very familiar with all types of nystagmus presentations, both typical and atypical.
If you would like to consult with me on your individual case, I invite you to travel to San Diego so I can evaluate you in person, establish a therapist-patient relationship with you, and subsequently offer individual medical advice regarding the details you described.
You can learn more about my services, along with answers to frequently asked questions here.
All my best,
Kim Bell, DPT
Hey. 7 days ago i had same thing and i went to doctor she gave some sleeping pills.
I have still same symptoms after 7 days.
I watch epley exercise and I have done but it made worst spanning
Hi Seema,
I am sorry to hear this!
I do not recommend for people to try to treat themselves using online videos.
It is ideal if you can use this blog to find a vertigo doctor or vestibular physical therapist in your area to evaluate you.
That way you can be sure to get the correct treatment.
I hope you feel better soon!
Dizziness when bend over or move my head downward. Is it related to BPPV or not ?
Hi Ali,
That specific motion is certainly on my list of BPPV symptoms. Check out this blog to learn more.
You can use this blog to find a provider in your area.
I recommend an exam by a vestibular physical therapist to determine if you have BPPV or something else going on.
Best wishes,
Kim Bell, DPT
If you have a nystagmus and the eply works, does that mean it is vestibular related, however if the eply maneuver does not work it maybe because it is not vestibular related?
If you have nystagmus and the Epley works, then it was likely posterior canal BPPV. That is the condition treated by Epleys.
If the Epley maneuver does not work, then it may not be vestibular OR you may still have BPPV – but it may be another type of BPPV that does not resolve with Epleys.
I mention the different types of BPPV in this article.
I suggest finding a vestibular physical therapist using this article.
Dear Kimberly Bell,
Can you recommend a good DPT in the Indianapolis or Lafayette, IN area? I am fighting terrible vertigo episodes, & my GP has given me the Epley exercise for the right side. I am doing this exercise 3 times a day, & each time it throws me into worse vertigo episodes. Thank you, Jayne from Indiana.
Hi Jane,
I definitely suggest for you to find a vestibular physical therapist.
You can use this article to look for providers in your area.
I cannot recommend anyone specific near you, so I definitely suggest for you to read their online reviews.
Best wishes,
Kim Bell, DPT
Good afternoon – I’m at a loss … have had Epley maneuvers at my ENT office, dizziness hits me hard!! They even had me get a brain MRI thinking I had a tumor, but thankfully I did not. After a few more visits and more maneuvers, the ENT Dr suggested making a hole in my ear drum and leaving it open …. I declined!! She then said I should see this place that helps people “work through their spats of dizziness” – what? How do you do that when you’ve been tossed to the ground and cannot function?? Then I was told “I’m sorry, there is really nothing more I can do for you” … So now I live with it and it’s terrifying. I did many years ago, LONG BEFORE Vertigo started, had to have neck surgery, after a nasty fall … and had 3 discs in my upper neck replaced. I now have 2 metal cages and 6 screws. Sometimes I have pain in that area …. And some motion in that area is limited. I’ve had nasty bouts with vertigo …. Can’t sleep on right side at all – can’t turn head to the full right and cannot look UP. I don’t know who to talk to – where to go. I’m feeling SO DEFEATED. Appreciate you letting me go on and on.
Cheri I know how you feel I have had 3 attacks of vertigo so bad that the last one I felt would kill me. Maybe that sounds like an exaggeration but it lasted 16 hours with the room spinning around me. I threw up 3 times and had diarrhea as well. I had to crawl on the floor to get back to bed. I was alone and way to sick to even attempt the Epley maneuver. I live afraid every day it will happen again. I cannot look up or turn on my left side without feeling queasy. Believe me you are not alone.
What could it be if it’s not BPPV?
My ears pop when I swallow and feel slightly painful at times. The physical therapist has done the epley but I don’t get the eye flickering but do feel nausea.
Hi James,
You may want to check out these additional resources:
Symptomatic BPPV
More on Symptomatic BPPV
Eustachian Tube
Best wishes,
Kim Bell, DPT
I recently sufffered my worst episode of vertigo to date. I was diagnosed by my Primary Care doc 15 years ago, when I was in my early 40s. He had performed one quick check, laid me back with my head hanging over exam table, and looking at my eyes. By the time he got the words out “try not to close your eyes” they were closed, so thinking back, I can’t imagine he witnessed much nystagmus, but he stated it was BPPV, “not big deal, no need to see a specialist, it should go away quickly, not worries driving….etc.” I accepted that, and have just dealt with it over the years, by attempting exercises I’ve found online. I’ve had long stretches of no episodes, but I’ve noticed that when they do occur they’re much worse than previous ones. However, it has seemed like performing the exercises really helped. This time I thought I was being clever, and proactive attempting to get a jump on lessening the symptoms, when I was experiencing mild symptoms; BUT the first rep of the exercise created such severe nystagmus I thought I felt my own eyes about to jump out of my head, and had to close them immediately (which if I understand things correctly defeats the purpose of the exercises…) and of course became severely nauseated. I kept thinking if I’d been able to throw up, maybe it would have been better, but I didn’t, and I became so terrified of how awful it felt, I laid on one side in the bed, afraid to move.
Everytime I’d reach out on the other side for something on the night stand it would be unbearable. I’d muster the courage to attempt the somersault maneuver, (because dang – I can’t just lay in the bed for god knows how long!?!?) Each attempt resulted in my feeling like I’d never be able to open my eyes again. I did this a couple of times with high hopes that I’d miracuoulously feel better, Didn’t happen. This was Sunday evening. I didn’t eat anything but saltines, and drank diet ginger ale until late Tuesday. I attempted some soup but could only stomach a bite or two. I managed to get an appointment with a new ENT in town on Tuesday. By the time he educated me on all the details of the different kinds of vertigo, etc… and performed the Epley, when he turned my head to the left, (which was the side that was the worst) Nothing! Apparently I’m like every car I’ve ever owned…having symptoms until I’m taken to the mechanic, and then there’s no noise. I was so flabbergasted, and disappointed. How am I suppoed to get a real accurate diagnosis, if the worst of the symptoms calms down by the time I can see a doc?? He was able to see a mild nystagmus on the right, but what the heck?!?! I DID feel much better after the appointment, but i’m not sure if it was a result of his treatment, or my just being up and moving, and sitting up for longer than I had the past few days. Anyway – I’m not satisfied with letting this drop, and I’m wondering are there any diagnostics out that can determine the side/canal, etc… without my attempting to run to the docs office at a time when I can barely crawl to the bathroom?? Apologies for the length of this message, but I really want to get some kind of real accurate diagnosis, and help with this. I beleive he’s leaning towards it being the Neuropathia vestibularis or vestibular neuritis, rather than BPPV, because he’s prescribed me an antibiotic (believing there’s an ear infection) AND Prednisone because he advised that even if the infection is cleared, there would be inflammation that will just continue to cause me issues. Any thoughts on this would be greatly appreciated.
Hi Deana,
I love your analogy about the car mechanic! So true!
First of all, I do not recommend for people to attempt exercises on their own unless they have been instructed by a Vestibular Physical therapist.
There are just too many things that can go wrong, and only really one way it can go right. You can easily see the odds are not in your favor without proper instruction!
I discuss this concept in more detail in this blog.
One consideration is the time of day that you saw the doctor. Symptoms usually dissipate later in the afternoon.
A morning appointment is best to pick up any remaining BPPV, if your symptoms are more mild.
Another consideration is that your self-treatment may have been successful. I am not sure if you considered that possibility.
You can still get sick during or after a successful BPPV treatment. That is not uncommon.
If you feel that you would like to seek another opinion, I suggest the following.
The type of doctor who specializes in dizziness is called either an Otoneurologist or a Neurotologist. Those are sub-specialties within Neurology and ENT medicine.
You can use this blog to find a Vestibular provider in your area.
A Vestibular Physical Therapist will probably also be a good resource for you now or in the future. Those are physical therapists with special training in treating BPPV and vestibular neuritis.
This blog discusses recovery from Vestibular Neuritis.
This blog is about what to do when vertigo exercises don’t help.
If you have not already found this blog, I share some Home Remedies that may help you while you are trying to figure out your next steps.
Of course, I suggest that you take all medications as prescribed by your doctor.
I hope the information I shared was helpful.
I hope you feel better soon!
Best wishes,
Dr. Kim Bell, DPT
I have been having symptoms of vertigo that are just getting worse. Afraid to try Epely manuver for fear of it getting worse. Where do I start for help? An ENT doctor? This has been going on for three months. Please help!
Hi Lorraine,
I am sorry for what you are going through! It sounds like you need professional vertigo care.
You can use this article to find a Vestibular Doctor or Vestibular Physical Therapist in your area.
This article has Vertigo Home Remedies that may help you while you are waiting to get treated.
I hope that helps!
Best wishes,
Kim Bell, DPT
Hi – great informative article – you have a new reader from the UK.
I have been diagnosed with BPPV following a vertigo episode 6 days ago
My ENT specialist did the Pike-Hall manoeuvre on me to dyer one which “SIDE” is the problematic side, triggering my symptoms, however, I emphasise the word “SIDE” because he said that while these types of tests can determine which “SIDE” is triggering, it doesn’t necessarily establish which “EAR” is the problematic one.
Is he incorrect in his assertion then as it runs counter to the remarks in your article here about “treating the wrong ear”.
Hi Niki,
Yes I agree with your ENT because there are “atypical” types of BPPV. In some of these atypical cases, the symptoms show up on one side, but the involved ear is actually the opposite ear.
The statement that I made still holds true that if you “treat the wrong ear,” then the maneuver will not work.
I hope that helps!
Best wishes,
Kim Bell, DPT
The experience is frightening due to excessive imbalance during the act and it may not suit all.
My wife has hydrocephalus normal pressure and a shunt fitted she has developed or already had we dont know Vertigo we have been to specialists who administered the epleys maneaver but after 3 sessions it only made the balance and walking worse ,prior to her developing hydrocephalus she was an international stadard swimmer and now cannot swim any advice.
Hi Geoffrey,
This represents a complicated situation. I am sorry to hear what you are going through!
It is important to find a Neurologist who is skilled and knowledgable at managing normal pressure hydropcephalus.
Also, you may need to find a Vestibular physical therapist using this blog.
I wish you two all the best! She is lucky to have such a supportive and caring husband.
Best wishes,
Kim Bell, DPT
I have been having on and off vertigo for the past three years. I visited ENT who recommended me to do Epley Maneuver at home if vertigo attacks again. The past weekend I had a vertigo attack and I find out myself both my left and right side are affected by BPPV – I feel dizzy if I turn my head to the left and vice versa, also bend down or high up my head.
I am confused how to perform correct Epley Maneuver. If I do the right side AFTER doing my left side consecutively in a session, will the ear crystals roll off its correct position as the left side is fixed. Or should I start doing 3 times on the affected left side for a few days first, wait for a few days to ensure no dizziness for the left turning head, and then, move on to do the affected right side? Most sources do not specify the proper sequence and frequency which worries me to do it wrong. Some even advises to do Epley Maneuver by specialist/doctor only.
Any advice is appreciated!
Hi Raccoon,
If you were able to successfully resolve your vertigo on your own, then I would say “Bravo!”
But it sounds like you have a lot of unanswered questions, resulting in confusion and uncertainty. That is common when people attempt to treat themselves, so my suggestion is to seek a consultation with a Vestibular Physical Therapist.
This article describes the reasons I suggest seeking professional help to resolve vertigo.
I am in alignment with the sources that advise to have this treatment done by a professional. In my experience hearing the stories of many people who have attempted self-treatment, there are so many ways it can go wrong.
You can find a Vestibular provider in your area using this article.
This article has Home Remedies that may help in the meantime.
I suggest you seek professional vertigo care!
Beware of misinformation online. You never know who is posting the content. They do not specify because they may not know!
In addition to my websites, reliable sources include Vestibular.org and Dr. Timothy Hain’s website.
Best wishes,
Kim Bell, DPT
I have suffered with BPPV for around 17 years. Initially it was bad, being sick for days and gradually it became better, I have went months and then years between episodes, that could last a day or two.
This latest episode has lasted 5 months. I went to a balance therapist who could see (from the goggles I wore) that it was my left side that was affected and I had 5 separate Epley manoeuvres. The only thing that improved was that I stopped being sick whilst he was performing them.
I have tried acupuncture (3 sessions so far) which is helping a little but it has not gone away.
The only relief I get is to sleep with 2 pillows, but that in turn doesn’t give me a great nights sleep and also is starting to give me neck pain.
I try during the evening to lie on my bed flat to see if the vertigo is still there and it is…. tonight after trying I just feel really sick.
I am so sick of this now it has taken over my life. Starting to feel I will never be back to normal.
Anyone else had this this long?
I’m sorry Alison. Have you read the studies on Vitamin D deficiency? Taking Vit. D every day [if you are deficient in Vitamin D] can reduce re-occurrence by a large % and help your body re-absorb the loose crystals more quickly.
I wrote this article on the topic of Vitamin D and BPPV recurrence. Matthew makes an excellent point!
I was diagnosed with BPPV in my right ear and referred to a Dr. Of PT with experience in this area. They had me doing the Eply but no improvement, then they had me doing the Brandt/Daroff bit again no improvement. For the Epley after doing the rotations and then sitting up I become extremely hot and nauseous. Similarly for the Brandt/Daroff I became extremely nauseous after the 4th cycle. It usually takes 30-90 minutes to recover from either one.
Not sure if this provides any insight but I’m at a loss and have had this for over 4 months straight. I have to sleep sitting up and can’t turn my head right.
Thanks so much.
I have attacks of BPPV every few years mostly after a dentist visit. My former ENT showed us how to do the Epley and usually within one or two maneuvers it’s corrected. This time we have done five and it brings on the vertigo so intense I almost throw up. Does this mean we are doing the correct ear because it is triggering it? I am not sure how many more times we should try before trying to get into a doctor . It is usually my right ear that’s affected. I haven’t been able to do anything in a week.
Hi Kimberly,
I recommend for you to consult with a vestibular physical therapist, who can answer your individual questions.
There are a lot of possible answers to your question, so I cannot speculate without seeing you in person.
This article may help you find someone local.
This article has home remedies that may help.
This article and this article may help you regarding the connection between vertigo and teeth.
Best wishes,
Kim Bell, DPT
The doctors still can not figure out what is going on with my dizziness. At one point, I was bedridden for a month. I just want these episodes to stop. I have severe migraines including vestibular. Ct Scan and MRI came back normal. I feel like I am in constant motion even when sitting.
The doctors can not even agree as to what is wrong. All I know is that Ativan helps me with the spinning, this happens once a year.
I’m so frustrated and it impacts my quality of life. I feel like it is my ear that is the issue. I went on a flight a long time ago and my eardrum turned inside out…had lots of pressure. The ER doctor said he has never seen anyting like that. I need help
Hi Veronica,
I am sorry to hear what you are dealing with! I will share a few articles that may be helpful.
How to Find a Vertigo Doctor in Your Area
Vertigo Home Remedies that Help
Frustrated by Vertigo: What to do
I hope you find answers and relief soon.
Sincerely,
Kim Bell, DPT
I have been diagnosed with bppv very recently. Physio in the hospital (not specialists) attempted to perform the epley maneuver on me. It did not work at all. In fact my vertigo is still very intense. I can feel it on both sides but definitely a lot worse on my left. Also if I look up and down it is very intense. Is that normal for bppv? It has left me unable to do any simple day to day tasks. Does anyone know if this will go away on its own? I am walking around like a robot trying to avoid any head movement haha it’s funny but it’s also really not funny you know? Lol any tips would be appreciated. Thanks
I would also like to add that I have been prescribed cinnarizine. It has stopped me from feeling as sick but now my vision is blurred as well as the vertigo. Do u think this is a good idea to continue to take this medication?
Hi Gary,
I am sorry to hear about this!
Most of the time, you will need to see a vestibular physical therapist, otoneurologist, otologist, or neurotologist.
Hospital staff is generally not the provider of choice for vertigo care, unless you are having a medical emergency.
Here are some blogs that will help to answer your excellent questions:
Medications for Dizziness and Vertigo
Why do I get Dizzy Lying Down?
Dizziness Looking Up
Reasons why the Epley maneuver does not work
Vertigo Home Remedies
What is a Vestibular Physical Therapist?
How to Find a Vertigo Doctor
I hope you feel better soon!
Sincerely,
Kim Bell, DPT
Look for simple things Gary. I once mixed some ‘organic glycerine’ into my face oil and I was applying it never thinking it could send me to Hell but it did. It took me a while to work out what was causing it because I thought you couldn’t get anything safer than simple organic glycerine. Not so. Beware all sensitives of leaving anything on your skin. We are subjected to so many chemical poisons, in hand creams, shampoo, face creams, makeup, food, drinks ad infinitum. Make sure it isn’t something like this causing your vertigo. Also I live in a freezing area and get neuralgia so I have to wear a hat all the time. I have to be vigilant with cleaning my ears, in and all around with vinegar because fungus can grow on/in ears which are covered by caps/hats all the time and that can cause vertigo. I always avoid medication as much as possible because they always have side effects and sensitives react to everything. REALLY hope you find the cause because I know the suffering vertigo causes, it is Hell. God bless you.
The Epley maneuver has always worked for me in the past, however this time I get severe spinning when sitting up upon completion. Could this mean it’s now in a lateral canal? Continue Epley or try Gufoni?
Hi Karen,
There are a few different things that can cause vertigo when sitting up after an Epley maneuver.
My suggestion is that you seek a professional evaluation and treatment with a vestibular provider that you can find using this article.
Best wishes
Hi! I had a bad episode the other night. First time it made me
Puke after 10 yrs.
I do get mild ones from time to time. I’ve been diagnosed with Meniere’s disease as I’ve lost hearing in my left ear and tinnitus but I’m used to the mri gong now.
The Dr tried the maneuver but did work for me.
Is it possible to fix this having Meniere’s??
Hi Dawn,
I’m sorry to hear about the puking!
This blog has some home remedies.
I’m not clear what you are saying – if the manuever helped or did not help?
Either way, I’ll link up some resources on Meniere’s to help answer your question:
Article 1
Article 2
Glossary term 1
Glossary term 2
I hope that information helps!
Sudden onset of dizziness/nausea at work. Never having had vertigo I did not identify it as such. Helped to a couch to lie down with my eyes closed, and a family member picked me up.
Next day 8 hours in an ER. Loads of blood work. Abdominal CT scan. No Hx of changes in bowel. Ultimately never could explain to me what was going on.
IV fluids probably helped rehydrate me.
But the medications they gave were no help.
Released to follow up with Primary on Monday, “You probably have a virus”.
By Monday I realized I was not hearing well out of one ear.
New Primary (My Dr of 22 years had retired). Grudgingly looked in my ear -Told me “Nothing unusual, here’s an antihistamine for the vertigo.”
I am beyond upset. I was sick with BAD Vertigo for a week. I missed work.
No One bother to check my neurological status.
No One thought to do a simple 3 minute test for BPPV.
Two doctors never even suggested the Dix Hallpike test for BPPV.
Everyone is saying “Probably Viral” They ran a bunch of tests – negative.
I am a NICU Nurse.
It seems adult medicine has changed – don’t examine your patient, don’t listen to her history.
What kind of idiots do they have running the show?
Our medical system is a disaster.
Where are these clowns coming from?
Yes great advice that the only help you’ve got is not going to work necessarily UNLESS you happen to live in a remote area where there are no doctors. You can’t help yourself with vertigo; it is the most terrifying illness you can have because you are so ill, you can’t even go across the road to get help much less ‘find a very particular specialist doctor’ who don’t even exist in Australia, let alone the huge remote area I and many others live in. I wish there was some magic cure. I once mixed some ‘organic glycerine’ into my face oil and I was applying it never thinking it could send me to Hell but it did. It took me a while to work out what was causing it because I thought you couldn’t get anything safer than simple organic glycerine. Not so. Beware all sensitives of leaving anything on your skin. We are subjected to so many chemical poisons, in hand creams, shampoo, face creams, makeup, food, drinks ad infinitum. Make sure it isn’t something like this causing your vertigo. Also I live in a freezing area and get neuralgia so I have to wear a hat all the time. I have to be vigilant with cleaning my ears, in and all around with vinegar because fungus can grow on/in ears which are covered by caps/hats all the time and that can cause vertigo.
Hi I know this is an old blog but seeing if anyone can help! I’m in the uk and had the epley done after seeing a neurologist!
I had dizziness before hand but after one epley my ear was so bad! I’ve had whistling, it hurts when I talk, ringing in the ear pressure on that side sometimes it makes me feel like I’m going nuts with it!
The second time was slightly better but I was still having problems!
I’m having acupuncture to help it but what else can I do epley has made it worse.
I am in worried I’m stuck with it it’s been 2 months since I had it done.
Hi Rebecca,
I am sorry to hear all this!
This blog and this blog may help.
Best wishes!
Hello, I had my first episode of BPPV a few years back. It was relatively mild but the Dix-Hallpike would elicit some brief, minor vertigo and it was successfully treated with an Epley maneuver. Since that time I have had a few episodes of what I presume is BPPV but the Epley maneuver and Foster Half Somersault have not been effective. I think that it is BPPV based on the fact that it is always after I am changing position i.e., bending over and then standing up quickly and I will feel the vertigo sensation that will then last for 1-2 wks. Once it begins, it is very mild to the point that I don’t often have room spinning sensation, vomiting, etc. It is more a general feeling of disorientation for 1-2 weeks with occasional brief feeling of being off balance if I turn my head quickly. However, Dix-Hallpike does not induce this feeling so it is difficult to localize to one ear or even say if it is BPPV. If anything a quick vertical head movement will induce the feeling more than horizontal movement. I went to an ENT and he performed a hearing test that was normal. He said that my story didn’t sound like BPPV because it is not reproducible with Dix-Hallpike and I do not have any nystagmus, but I’m still unsure because the intermittent and positional nature of it make me think that it is. He referred me for further testing but at this point my symptoms resolved spontaneously so it was not worth going. I am just wondering if this is a presentation that you have ever encountered before, if it sounds like BPPV to you, and if there are any other maneuvers that you would recommend to try and treat it. Sorry for the lengthy comment and thanks so much!
Hi Ben,
One key factor for vertigo analysis is the duration of symptoms.
BPPV typically lasts for less than a minute.
Dizziness that lasts for days to weeks can be cervical or migrainous, or even viral.
Another key point is that you have motion-activated symptoms on top of the baseline feeling you described.
The BPPV maneuvers you described treat only certain types of BPPV, but patients with other types of BPPV may not get relief with the maneuvers you listed.
BPPV typically shows nystagmus during testing, but type 2 BPPV may occur without nystagmus.
Type 2 BPPV can still respond to correct treatment.
I suggest you use this blog to write up a case summary for the providers you consult.
It would be ideal to get evaluated in person by local professionals who specialize in dizziness.
You can use this blog to look for a vestibular PT.
You can use this blog to learn about who might me able to assess you for cervical dizziness.
This blog talks about vestibular migraines.
Additionally, I have over 100 more blogs on related topics at BetterBalanceInLife.com.
I hope that information is helpful!
Best wishes
Hello, there is not a lot of information on vertigo caused after flying. The plane was descending for a landing and my right ear began to hurt, my hearing became foggy, and my head felt a little funny. The cabin pressure was very high. I got symptoms of vertigo the next day and went to the doctor and chiropractor. I’ve done the Epley 6 times now. Is there a difference from getting vertigo due to changes in cabin pressure from a flight? My symptoms have not seemed to be reduced much after 6 days.
Hi Lindsey,
This article might be helpful.
I hope you feel better soon!
I have had vertigo/dizziness for a month following mild Covid. I just started the Epley maneuver with a local therapist skilled in vertigo treatment. About 2 hours after a successful Epley in the morning I experienced a fast head rush followed by dizziness while working at my computer. It was quite unsettling. Are head rushes like this common?
Hi Robert,
I am sorry to hear this! It is not a common reaction, but I have seen it before with patients I have worked with.
You may be interested in this blog and this blog.
The Epley maneuver can sometimes aggravate neck tension, pain or stiffness for some patients.
Also, I wrote a very long and detailed blog on what I am seeing in Covid related dizziness cases. You can find that here.
I hope you feel better soon!
I am a healthy 72 yr F. For the first time ever, I woke up yesterday with severe vertigo and resultant vomiting. After hours of confusion, alarm and no improvement, I consulted “Dr Google” and eventually tried home application of the Epley (right ear.) It worked once I able to complete all movements. (Interrupted several efforts due to vomiting.) I am lucky & grateful. It’s only been 34 hrs but I am symptom-free.
My questions:
– Would you advise I see a specialist now anyway?
– Plus, I have planned a SOLO journey this April to a far distant and undeveloped country. Do you think it’s safe for me to go?
– How worried should I be about a recurrence??
Hi Lauren,
Wow! That sounds like a major vertigo experience. I’m so glad that you are feeling better.
After such an experience, I always suggest notifying your primary care provider.
Your primary care provider can advise you about the answers to rest of your questions. You can ask if you need to see a specialist and discuss your upcoming travel plans.
I wish you all the best!
Woke up 2 days ago with vertigo after turning on both side while sleeping experiencing dizziness. Went to the chiropractor yesterday thinking my neck or back was out of whack but as he was adjusting me the room started to spin when my head was tilted downward on my side. He gave me the diagram with instructions to do the Eply Maneuver. I ve done the maneuver 3 times and felt some improvement but still have symptoms. My question is as I’ve read that you must treat one ear at a time just wondering how many times should I do exercise in each ear and how long should I wait in between ? So far I ve done 3x on my right ear was going to wait till next week to start left ear. I’m hoping this works soon .
Thanks for your time
I started experiencing vertigo about three weeks ago, went to see a doctor who said my ear were clear, but there was a presence of tinnitus on the left and slight soreness from time to time. She told me to do the Epley maneuver, which I did today, and it is worst then before. I suppose it was perhaps the wrong ear. In the past, I had fluid in my ear, and the ENT doc asked me to use decongestant but I didn’t have any vertigo, just pain. Then, I don’t know where I stand, but I decided no more Epley maneuvers!