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