The Epley maneuver is a simple, non-invasive technique used to address vertigo caused by dislodged inner ear crystals. This series of controlled head movements aims to guide these tiny crystals back to their proper location within the ear’s balance system.
Understanding Benign Paroxysmal Positional Vertigo
Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear problem causing brief, intense episodes of dizziness or a spinning sensation. It occurs when small calcium carbonate crystals, called otoconia or canaliths, detach from their normal position in the utricle and drift into the fluid-filled semicircular canals. These canals are responsible for sensing head movements and helping with balance.
When displaced, these crystals send incorrect signals to the brain, leading to the sensation of spinning or unsteadiness. Common triggers include lying down, turning in bed, or looking up or down. While BPPV can cause nausea or vomiting, it is generally harmless. The Epley maneuver is specifically designed to treat BPPV by relocating these displaced crystals and is not effective for other types of dizziness.
Essential Preparations
Before attempting the Epley maneuver, determine which ear is affected by BPPV. This is often the side you turn towards when dizziness occurs, such as when rolling in bed. Identifying this side is crucial for performing the maneuver with the correct starting head turns.
Consult a healthcare professional before performing the Epley maneuver, especially if symptoms are severe, accompanied by neurological signs like double vision or weakness, or if you are unsure if dizziness is due to BPPV. A doctor can confirm the diagnosis, often using a Dix-Hallpike test, and rule out other conditions.
For safety, ensure a clear space around you to prevent injury if dizziness occurs during the maneuver. Having someone nearby can be helpful, especially for your first attempt. Avoid driving immediately after, as temporary dizziness may linger. The Epley maneuver is generally safe, but it is not recommended for individuals with severe neck or back problems, recent neck injuries, detached retina, or specific vascular conditions. These conditions require medical evaluation.
Step-by-Step Epley Maneuver
The Epley maneuver uses a series of precise head and body movements. Place a pillow behind you, positioned to rest between your shoulders when you lie down, allowing your head to tip back slightly. Hold each position for about 30 seconds, or until any dizziness subsides, plus an additional 30 seconds.
Right Ear Affected
Sit upright on a bed with legs extended. Turn your head 45 degrees to the right.
Quickly lie back, maintaining your head turned 45 degrees right. Your head should hang slightly off the edge or be supported by the pillow. Hold until spinning stops, then wait an additional 30 seconds.
Without raising your head, turn it 90 degrees to the left, so it looks 45 degrees left. Hold for 30 seconds after any dizziness resolves.
Roll your entire body onto your left side, keeping head and body aligned, looking downward at a 45-degree angle. Hold for another 30 seconds after dizziness subsides.
Slowly sit up, keeping your head turned left until fully upright, then straighten your head forward.
Left Ear Affected
Sit upright on a bed with legs extended. Turn your head 45 degrees to the left.
Quickly lie back, keeping your head turned 45 degrees left. Your head should hang slightly off the edge or be supported by the pillow. Hold until dizziness passes, then wait an additional 30 seconds.
Without lifting your head, turn it 90 degrees to the right, so it looks 45 degrees right. Hold for 30 seconds after any dizziness resolves.
Roll your entire body onto your right side, maintaining head and body alignment, looking downward at a 45-degree angle. Hold for another 30 seconds after dizziness subsides.
Slowly sit up, keeping your head turned right until fully upright, then straighten your head forward.
What to Expect After the Maneuver
After the Epley maneuver, temporary dizziness or nausea is common as crystals resettle. These sensations typically subside quickly. Most people report immediate relief from BPPV symptoms, though some may have mild residual symptoms for a few weeks. The maneuver has a high success rate, often 80% to 90% after one or more attempts.
To support recovery and prevent immediate recurrence, avoid sudden head movements, especially bending or rapidly tilting your head. For the first night, sleeping with your head elevated, perhaps using two pillows or in a semi-reclined position, can be beneficial. Avoid sleeping on the affected side for several days.
Multiple repetitions may be needed for complete relief. Your healthcare provider can advise on frequency, often recommending it once daily until symptoms are gone for at least 24 hours. If symptoms persist, worsen, or if new concerns arise like severe headache, vision changes, or weakness, seek medical attention. While BPPV can recur, repeating the Epley maneuver often provides relief.