People often ask, “I have tried the Epley Maneuver, it didn’t work, should I keep trying?”
In general terms, it may take several attempts to fully treat BPPV and most people can expect to have some recurrences. We suggest that you need only perform the maneuver when you have an attack. If you are not having symptoms then you don’t need to to do the maneuver although it may prevent recurrences. It is always important to seek the advice of your own doctor to obtain a diagnosis and to monitor your condition.
With that said here are several important questions to ask yourself about failed BPPV treatment.
- Do you have BPPV?
- To achieve success with the Epley Maneuver or home treatment for BPPV you must be sure you have a correct diagnosis. These maneuvers do not work if you do not have BPPV. There are many other types of dizziness, although BPPV is the most common.
- Posterior BPPV?
- There are actually a number of sub-types of BPPV. Posterior canal BPPV (P-BPPV) is by far the most common. The Epley maneuver treats P-BPPV but not the others.
- Did you do the maneuver correctly?
- Although the treatment maneuvers for BPPV are very effective it is not yet clear how incorrectly you can perform them and still have success. The major reason for home treatment failure is an incorrectly performed maneuver . Home BPPV treatment devices are designed to minimized this problem. Careful attention to detail in the maneuver as well as ensuring the correct angles, side and duration will improve success. The most common mistake,..not putting you head back far enough (it can be too far though).
- Do you have bilateral BPPV?
- A small percentage of people will have BPPV on both sides and so after successful treatment on one side will still have symptoms. This can be confusing. We recommend that people treat one side daily for one week then switch to the other side.
- Do you have recurrent BPPV?
- BPPV treatment does not cure the problem it only removes the stimulus temporarily so as many as 60% of people will have symptoms more than once. Some people have highly recurrent BPPV so after they successfully treat one episode it can come back in a matter of days and make them think they failed in their maneuver. Daily maneuvers may control these problems. In rare cases of very symptomatic and resistant BPPV surgery can be performed to block of the balance canal which causes BPPV.
- Are you ever going to respond?
- Do you have something else as well?
- BPPV can be found along with any other disease which causes inner ear damage. Conditions like Menieres, head trauma, or inner ear infections may causes BPPV. As such it can be confusing as to which condition is causing the vertigo. Generally these symptoms can be sorted out by a skilled ear doctor. You might need help with this one.
- Do you have resistant BPPV?
- About 5% of people have BPPV which is resistant to maneuvers. This may be because the disease causing crystals are too large to come out of the posterior canal or that they are stuck to the inner ear somewhere. Regardless the Epley maneuver does not work for these people. Again in certain circumstances surgery may be indicated.
- Do you have something else as well?
daniel says:
Hello, this is the 3rd time I have had BPV. It’s been about 4 days now for this one.
I did the Epley maneuver last night, and felt much better.
I read on a website that I should do it about 3 times each night, so that’s what I did.
However, I didn’t sleep upright at a 45 degree angle..
This morning, I tried another maneuver. The Brandt-Darroff maneuever. This made me dizzier than before… I then proceeded to do the Epley again, 2 times.
3 hours later, I am still dizzy. What do I do now? Thank you!
28th April 2009 at 11:41 am
admin says:
I can only comment on your situation in generalities as your should discuss any particular situation with your own doctor. Most people find that a single maneuver, when done correctly, will relieve them of their BPPV symptoms. However, about 5-10% of maneuvers result in moving the particles from the “posterior canal” (P-BPPV) “horizontal canal” (H-BPPV). This results in continued symptoms rather than resolution. Often people report that these symptoms are worse than what they had before. The good news is that a different maneuver called the “log roll” will move these particles out of the horizontal canal back into the vestibule of the inner ear. You can look up how to do a log role, see your doctor, or just lay on the ground and roll over 360 degrees slowly (if you are getting dizzy on your right side – roll to the left or vice versa as may be the case – you can even try it both ways).
This conversion is often the case when symptoms don’t resolve or worse. However, it may be that you do not have BPPV and actually have another disorder or are doing the maneuver incorrectly. It is worth discussing these possibilies with your physician.
Just a not on the Brandt-Darroff – it will make you dizzy – this is normal. The Brandt-Darroff is not an effective treatment for BPPV as it requires that you do it frequently throughout the day for about 10 minutes for several weeks. Most people find this hard to do. The Epley and the DizzyFIX are much easier.
Finally, there is no evidence to suggest that sleeping at 45 degrees does anything beside make your neck stiff. In fact, there is evidence that it does nothing. So although you will read it everywhere I do not suggest it as worth while.
28th April 2009 at 7:17 pm
Robin says:
Hello!! I have recurring spontaneous vertigo due to a head trauma during my teen years. I am now almost 43. Right now, perhaps brought on by a bad head cold/virus, I have a powerful bout of BPPV. I wonder if the Epley Manuever and/or log rolls are appropriate treatment methods for my type of vertigo. I hope you can answer!
Thank you,
Robin
28th April 2009 at 8:10 am
admin says:
Thanks for the comments. What I can tell you is that the best treatment for BPPV is a particle repositioning maneuver. This can be done by yourself, with your doctor or by using a home BPPV treatment device. Good Luck.
28th April 2009 at 9:40 pm
Laura says:
My husband has been diagnosed with possible bppv. Is tinitus a symptom? He has been dealing with vertigo and ringing in his ears for many years. Thank you.
28th April 2009 at 9:18 am
admin says:
Great question. Tinnitus can be associated with a number of ear and brain related problems. In order to sort out the cause of the tinnitus your husband should be evaluated by his physician. With that said tinnitus is not normally associated with BPPV, but they can both be present at the same time. Most commonly tinnitus is a result of some high frequency hearing loss.
28th April 2009 at 9:40 pm
wendy says:
I’ve been diagnosed with BPPV and have been dealing with it for 6 weeks. After a week of meds it was 85% gone and then came back worse. This all happened after a severe allergy seasonal time of year. I’ve had the Epley done each time with some improvement noticed. I’ve done it at home (up to 8 repetitions) and have gotten some temporary improvement, but nothing long lasting. How many times (in a row) can you do the Epley? Also, I’ve noticed that loud music and bright lights really aggravate things and my head seems to be pounding. Is this common to BPPV? I’ve noticed my ears popping and had issues before a storm front came through. I’ve already spent a lot of $$ for the GP, ENT, and now PT. Are these symptoms also assoc with BPPV? I’m trying to figure out whether to do more therapy or ask for a 2nd opinion if these things are not commonly associated with BPPV. thanks.
28th April 2009 at 6:01 pm
admin says:
BPPV can be highly recurrent, so having it back after it going away is not unusual. Unfortunately no medicines really work for BPPV. The only treatment is the Particle Repositioning Maneuver (Epley Maneuver). There is no limit to the number of times you can perform the Epley maneuver but it does “fatigue” meaning if you repeat it time after time (right after each other) the symptoms will go away for a few minutes but it isn’t really treated more by repeated again and again. Most people recommend only 1-2 per day so you can track what is actually happening. On a day to day basis some people find they need to do it once daily to keep the symptoms away. There are no side effects from repetition specifically. However, there only thing which can happen is that you convert one kind of BPPV into another. This other kind, called horizontal BPPV feels worse, but actually goes away much quicker. Also you should keep in mind that if you are having strange symptoms and the treatment is not working that you may not have BPPV. You should discuss these types of questions with you own doctor who can properly examine you. In general terms anything which causes stress makes dizziness worse. Some of the symptoms you describe like, headache, light and noise sensitivity and symptoms before a store sound a little like migraine associated vertigo (MAV). There is lots to read about that on the web. Again – ask your doctor if this could be the cause.
28th April 2009 at 7:09 pm
Debbie says:
Thanks for being there. I am 41 with no classic causes for BPPV and can only guess that it was due to severe seasonal allergy symptoms this past month. The MD I sought care for this was absolutely of no help other than giving my the name, BPV. This is my query: I am unsure which is the affected side, left or right. Can I do the modified Epley on both sides during the same treatment time or does the second maneuver invalidate the first? Thank you for your time.
28th April 2009 at 11:36 am
admin says:
You can, in fact, try one side followed by the other. It would make sense that doing the reverse maneuver might undo the first maneuver – but due to the anatomy of the inner ear it is unlikely that this would happen. With this said, we generally recommend that people do one side first for a week then do the other side the next week. This is so it becomes clear what side you had BPPV on and which maneuver worked for you. If you do both sides in the same sitting you will never discover which side is the bad one. Some people can’t tell which side they have BPPV on because they might have it on both sides. This happens about 10% of the time. However, in general you can detect the affected side by laying down flat (or with your head hanging over the end of the bed) and turning one ear down toward the floor and waiting for a bout 30 seconds. If you get dizzy in that position then you have BPPV in that ear. Try on each side and see which side has BPPV. Hope that helps. As always it is important to discuss your condition with your own physician and follow their advice.
28th April 2009 at 8:34 pm
Karla says:
HI, what if the vertigo is when you sit up? I have had bppv many many times, once lasting about 4 months. I am aware of how to do the at home epleys, but i have tested both sides and I am only dizzy when I sit up. Sever foggy and unsteadiness along with sinus headaches…. thanks!
28th April 2009 at 2:46 pm
admin says:
Thanks for the comment. As usual you should be evaluated by your own physician for a diagnosis. In general, vertigo related to BPPV occurs while both laying down AND when sitting up. Most people comment on the laying down part, but you usually get dizzy on the sitting up part as well. It is unusual to get it only when sitting up. In some cases low blood pressure can cause what is called “postural hypotension”. In this condition you get light headed when sitting up or standing up suddenly. Having someone look in your eyes when sitting up might help you to identify nystagmus – this would confirm BPPV. Have your doctor perform a Dix-Hallpike maneuver to diagnosis you situation. Regardless, using a repositioning maneuver is essentially harmless but symptoms which do not fit the usual picture should be evaluated by your physician. Headache can can be migraine associated vertigo. Usually there is vertigo lasting hours with this condition, so that might not fit. Best of luck.
28th April 2009 at 8:21 pm