The Epley Maneuver is a common, non-invasive technique that uses a specific sequence of head and body movements to address a particular cause of dizziness. This procedure is designed to gently move tiny particles within the inner ear. It treats positional vertigo by relying on gravity to reposition these loose inner ear components, restoring the inner ear’s normal function and alleviating the sensation of spinning.
What Causes Vertigo Requiring the Epley Maneuver
The Epley Maneuver targets dizziness caused by Benign Paroxysmal Positional Vertigo (BPPV). This condition originates in the vestibular system of the inner ear, which is responsible for sensing motion and maintaining balance. The inner ear contains three fluid-filled semicircular canals that detect rotational movement.
BPPV occurs when small calcium carbonate crystals, called otoconia, become displaced from their proper location in the utricle. These crystals normally help sense linear acceleration and gravity. When the otoconia detach and migrate into one of the semicircular canals, usually the posterior canal, they inappropriately stimulate the nerve endings. The movement of these displaced crystals causes the fluid in the canal to shift incorrectly whenever the head changes position, sending false signals of movement to the brain.
Crucial Safety Checks Before Beginning
Before attempting the Epley Maneuver, ensure that the cause of your dizziness has been medically diagnosed as BPPV. Vertigo can be a symptom of more serious conditions, and performing the maneuver without a correct diagnosis may be unsafe. If your symptoms include double vision, severe headache, slurred speech, or weakness in a limb, seek immediate medical attention.
Certain physical conditions may make the Epley Maneuver risky, requiring consultation with a healthcare professional. These contraindications include recent trauma or injury to the neck or back, cardiovascular disease, or a detached retina. For individuals with limited neck mobility or those who are frail, the rapid head movements required may be difficult. Having a spotter present for the first attempt is recommended, and the maneuver should be performed on a soft surface, such as a bed, to prevent injury.
Performing the Epley Maneuver Step by Step
The effectiveness of the Epley Maneuver depends on correctly identifying the affected ear—the side that triggers the vertigo symptoms. If you are unsure which side is affected, quickly lie down with your head turned 45 degrees to one side and note which position causes the spinning sensation. Once the affected ear is determined, begin the maneuver on a bed with a pillow placed to support your shoulders, allowing your head to extend slightly backward.
To treat the right ear, start by sitting upright on the edge of the bed.
- Turn your head 45 degrees to the right, looking over your right shoulder.
- Quickly lie back, maintaining the 45-degree head turn, so your head is hanging slightly off the edge or resting on the pillow. Remain in this position for 30 seconds, or until the dizziness has fully stopped.
- Without lifting your head, slowly turn your head 90 degrees to the left, so you are looking over your left shoulder (45 degrees to the left). Hold this position for 30 seconds.
- Roll your head and body an additional 90 degrees to the left, moving onto your left side. Keep your head fixed relative to your body so you are looking down toward the floor. Hold this position for 30 seconds.
- Slowly sit up on the left side of the bed, keeping your chin tucked toward your chest as you rise.
For the left ear, the steps are the mirror image.
- Begin by sitting up and turning your head 45 degrees to the left.
- Quickly lie back while maintaining the head turn, holding this position for 30 seconds or until the vertigo subsides.
- Without lifting your head, rotate your head 90 degrees to the right, so you are looking over your right shoulder. Hold for 30 seconds.
- Roll onto your right side, turning your head and body an additional 90 degrees to the right. Your face should be looking down toward the floor. Hold this final lying position for 30 seconds.
- Complete the maneuver by slowly sitting up on the right side of the bed, keeping your chin tucked down.
Immediate Aftercare and Follow-Up
It is common to experience a brief wave of dizziness or nausea immediately after completing the Epley Maneuver as the crystals are being repositioned. Remain seated for 10 to 15 minutes before attempting to stand or walk. Avoid driving immediately after the procedure, as your balance may be temporarily affected.
For the remainder of the day, keep your head as upright as possible, avoiding sudden movements or positions that trigger vertigo, such as bending over. To help the crystals settle correctly, sleep with your head slightly elevated, using two pillows or sleeping in a semi-reclined position for the subsequent night. Avoid sleeping on the side that was treated.
If positional vertigo symptoms persist after 24 hours, the maneuver may be repeated up to three times a day until the dizziness resolves. If the Epley Maneuver fails to provide relief after multiple attempts or if your symptoms worsen, seek consultation with a specialist. Further medical evaluation may be needed to rule out other possible causes.