Epley Maneuver – How many times should it take?

50 comments

Posted on 28th April 2009 by Clearwater Clinical in BPPV - Diagnosis - Treatment - DizzyFIX

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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.

  1. Do you have BPPV?
    1. 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.
    2. Posterior BPPV?
      1. 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.
  2. Did you do the maneuver correctly?
    1. 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).
  3. Do you have bilateral BPPV?
    1. 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.
  4. Do you have recurrent BPPV?
    1. 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.
  5. Are you ever going to respond?
    1. Do you have something else as well?
      1. 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.
    2. Do you have resistant BPPV?
      1. 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.
50 Comments

  1. Clearwater Clinical says:

    Thanks for your comments. What you describe seems a little atypical for BPPV. Although episodes can be severe, frightening and leave you with hours of nausea they are also short lived in the acute phase. Most people describe difficulty with certain movements (like lying down) but can move about freely so long as they avoid those movements. There are, of course, many other causes dizziness. It sounds like you have already seen an ENT doctor who was also a bit surprised at the severity of for symptoms if indeed you have BPPV. Betahistine (Serc) only really is supposed to work for Menieres disease not BPPV although many people do try it. Benzo’s like Cyclizine only sedate the patient making the vertigo a bit more tolerable. There are two other diagnosis that should be considered with peripheral vertigo which are labyrinthitis and Menieres disease. Make sure these have been ruled out. The Epley maneuver is very effective if you have BPPV and completely useless if you don’t. Getting the right diagnosis is important. If you haven’t reached a final diagnosis seek further medical attention with an ENT specializing in vertigo (a vestibular specialist). Keep us posted and good luck.

    22nd April 2012 at 8:08 pm

  2. Clearwater Clinical says:

    Ahh – what you may have done is convert a posterior BPPV into a Horizontal one. If you know which side you can do a “Log Roll Manuevuer”. This is quite simple and will get rid of the worse BPPV. The most important thing is the right diagnosis and the right side. The good thing about horizontal BPPV is that it is often short lived and is easier to get rid of. Sadly it is worse in terms of the vertigo is more intense. About 5% of people who treat Posterior BPPV will convert to the horizontal. It happens when some of the crystals fall out of one canal and right back down into another. Bad luck I am afraid. Look up the log roll maneuver.

    18th April 2012 at 6:30 pm

  3. steve says:

    had vertigo about 2 weeks ago. diagnosed as bppv. dr did an epley maneuver but symptoms did not clear. went to a new dr who cofirmed diagnosis and said i just had it in both ears. 1 had clears so he cleared the other. felt good for 4 days and woke up this morning with some vertigo again. thought it was in the left ear so i did the epley on that side. had virtually no symptoms as went through the epley, so though i just had the wrong side. i did the epley on the right side and am so much worse. i can barely move without triggering it. cannot call my dr until tomorrow. should i try the epley on the right side again?

    15th April 2012 at 6:50 am

  4. Tracey says:

    Hi, I am 43 and since 3/01/2012 I was diagnosed with bppv, I have never had this before and it has completely affected my ability to move around on a day to day basis. A number of doctors have been out to see me and I was prescribed betahistine and cyclizine, the vomiting and feeling sick cleared but I had a bad fall and hit my head and badley bruised my thigh, I was then prescribed antibiotics as the doctor said my thigh had got infected,I am due to speak with my doctor tomorrow and will be asking fo if another cause of antibiotics may be useful as 4 weeks later I still have a lump which is tender and still bruised on my thigh.I was referred to an ent specialist who advised my symptoms where very severe, he didn’t want to do the epley maneuver as he said it would make me feel worse,I advised I had been alot worse than I now was even though he was saying I was in a bad way. I slept over the next 48 hours sat up and I don’t feel any better, he advised that I was looking at months to get better not weeks and to only go back to see him if I got any worse.I am still off work and they are not helping me as I can only advise them of what my doctors and specialist have advised.whilst taking the medication at least I was not feeling or being sick and my left ear seemed to clear up, but my specialist advised me to only use the cyclizine as and when, but to stop the beta all together.I still feel alot of pressure in my right ear and when I get up and move around I am extremely unsteady and hold on to furniture, I can’t say I am not stressed as that would be a lie, work is not helping me as I feel they think there is a quick fix to this even though I have explained everything to them, I have read on here obviously if I don’t have bppv the epley won’t work, my employer wants me to ask to have it done again, he does not realize that if I don’t have bppv and have another type of vertigo this will not work, but also I have ostoarthritus which I have had to cancel various appointments for recently as I am unable to attend, the epley affected my hips and also my neck, please can you help.

    14th February 2012 at 6:12 am

  5. [cluster headache|headache relief|headache sufferers|migraine cures|migraine headaches|migraine symptoms|natural headache remedies|naturopathic approach|pharmacy times] says:

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    24th January 2012 at 9:16 pm

  6. Clearwater Clinical says:

    We’re glad your son is feeling better. Although the nausea associated with BPPV can last for quite a while it is unusual for the spinning to last for more than a couple of minutes. I would again confirm the diagnosis you have with your physician.

    To clarify BPV is Migraine related. However, BPPV is the one more commonly found in adults for which the Epley maneuver is useful. If your son has BPV then the Epley maneuver will not likely have any impact. You should perhaps speak with your physician to clarify.

    13th November 2011 at 6:05 pm

  7. Clearwater Clinical says:

    We’re glad you are feeling better. There is no way for us to judge what is safe for you to do at this stage. Our best recommendation is to seek local medical advice, which it appears you have done already. BPPV, if that is indeed what you have, normally only comes on with motion such as sitting up, rolling over, bending under etc. Other forms of vertigo can come on at any time like Meniere’s disease.

    13th November 2011 at 6:02 pm

  8. jimlynch says:

    After reading the many comments by your readers I think I understand a little more what is happening to me. I woke up with vertigo when I got out of bed. The room spinning sweating and nausea. I performed the Epley. Didn’t seem to work. I went to the doctor and I was seeing double. I went to the E-room and had an MRI everything is OK. I’m a have been off work for 4 days. Unfortunately I drive a crazy Interstate for 37 miles to work. I think I’m in the lightheaded stage because the room didn’t spin after the first day. Is it safe to drive in this lightheaded stage or should you wait until you feel completly normal?

    13th November 2011 at 1:18 pm

  9. Aarthy says:

    Today my son( 12 years) is again attacked by vertigo. Before this, the attack continues for 24 hours. Today only we are trying Epley Manuver on watching http://www.youtube.com/watch?v=2L-wjO7Njio. After trying Epley Manuver , first stomach ache gone. After 15 minutes, he is completely recovered from vertigo.

    We are very happy and thank you for your answer. In your comment, you are asking “Is it a BPV or BPPV?” to our son . In his report, it says BPV. Now we are confused if he is attacked by BPPV or BPV?

    Thanks again for your kind reply.

    13th November 2011 at 2:40 am

  10. Clearwater Clinical says:

    Thanks for your comments. BPPV in a child is quite uncommon. So-called “Benign Paroxysmal Vertigo” (BPV) of childhood is actually different than BPPV. The disorder in children is more often related to migraine. You will have to clarify what your doctors told you. BPPV or BPV? They are different. Treatment for BPPV is with positioning maneuvers like the Epley. Treatment of BPV is the same as for migraine.

    In answer to your questions:
    1) The side on which you get vertigo when you lie down is the ear in which you have a problem.
    2) No there is no seasonal variation.
    3) Vertigo is a broad terms encompassing many different problems. First you need to find out what his problem is before you find a solution
    4) Yes food can certainly trigger migraine and some foods (alcohol, caffeine) can make vertigo worse. You might like to try a food log so you can correlate diet and symptoms.

    11th November 2011 at 2:36 pm

  11. Clearwater Clinical says:

    Yep smoking often makes vertigo worse. Log rolls only work for horizontal canal BPPV rather than the more common posterior form. You can expect that a correct maneuver for BPPV will come with vertigo (short lived) as you move the crystals back into the place where they don’t cause vertigo.

    11th November 2011 at 2:30 pm

  12. Minda Johnson says:

    I have just been diagnosed with this debilitating disorder. I tried the Epley and symptoms continue, if not worse. I am petrified to try it again as it had me screaming in discomfort. I’m going to try log roll you suggest. I see you think caffeine aggravates it and I’m wondering if nicotine does as well? What a nightmare, my sympathies to fellow sufferers and thanks for any help on this website.

    11th November 2011 at 10:04 am

  13. Aarthy says:

    My son has BPV for 3 months. He is 12 years old . It occurs once in a week. He couldn’t do anything during attack. Left ear is affected. He feels dizziness, vomiting and stomach ache. First 2 months the physicians are confused with migrine. He is given tablets for migrine. It didn’t work. We went to Neurologist . He found that he had BPV. After taking vertigo tablets, vomiting stopped. But now also vertigo continues in a severe way. we are decided to try Eplley Maneuver for our son.
    My questions are

    1, In which side he do Eplley Maneuver for affected left ear?
    2. Is it a winter seasonal disease?
    3. How should we protect him from vertigo?
    4. Is there any food diets?

    Because he is good in studies . He couldn’t go to school on an attack. Please help him.
    Thanks for your time.

    9th November 2011 at 10:33 pm

  14. Boyd Pebsworth says:

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    11th October 2011 at 10:32 pm

  15. Clearwater Clinical says:

    Great question. It is not uncommon to feel ‘tippy’ for a while after an Epley maneuver. We discuss this on our blog elsewhere. Follow this link: Still Feel Dizzy

    5th October 2011 at 5:19 pm

  16. Evelyn says:

    I had an acute episode of positional vertigo recently followed by mini-episodes all weekend and went in for the epley maneuver yesterday. I was dramatically better post treatment! Last night, I forgot to keep my head up, and I reached down a couple of times to get something off of the floor before I remembered the post-treatment instructions and stopped that movement. Since that treatment I have not had any reoccurance of the spinning sensation, but I do feel kind of “tippy”. Is this a normal post-treatment response or have I undone the benefit of the repositioning treatment?

    5th October 2011 at 11:04 am

  17. Pattie says:

    I was 12 the first time i had a concussion and got very spinning dizzy. Then when i was 19, i fell off a tail gate of a moving truck and split my skull open..and hence had vertigo and migraines all my life..and to make matters worse, i had ear problems, excess fluid build up and had 4 Myringotomies throughout my 20s, early 30s and just a month ago..I am 64. I have BPPV…when i turn over in bed i get dizzy..and when i get up, it lasts all damn day. I am miserable all the time. I can’t look up or down or turn my head side to side. I am going to the ENT next week for testing to see if i have BPPV..but i know i do..i would rather just have the surgery and have it done with rather then keep doing maneuvers..This is so disabling and frightening..

    18th September 2011 at 12:42 am

  18. admin says:

    Answers:
    1) There isn’t really much point in doing the maneuver again if the spinning symptoms are gone. Feeling hazy after treatment is quite common. If you are still experiencing the same symptoms then you might try the assistive device or seek other help. If nothing seems to work you might have the wrong diagnosis and I would suggest seeing your own doctor again.
    2) How often it recurs is like asking how many snow flakes are there in a snow globe. It depends. If you have more snow flakes then it recurs more often.
    3) Blocking you ears has no effect on BPPV whatsoever.
    4) There is no proven way to prevent recurrence, but it is an interesting question. Perhaps daily Epley maneuvers? Hard to know.

    13th August 2011 at 6:08 pm

  19. Asha says:

    Hi,

    Thanks so much for your comment. Thanks to this blog i came to know there was actually an exercise that helped. I was surprised that the doctors here dont even know of something as simple as this, to save a patient of undergoing this trauma. You wont believe, he told me that bed rest was the solution and sleeping 10 days gave me no relief.

    I did the Epley Manuever yesterday after seeing how it done a million times on youtube. I am feeling much better. Although here and there i still feel a little hazy.

    I still have a couple of more questions if you can answer too:

    1) Should I keep doing this till its totally gone?

    2) Also once its gone, how often is it likely to reoccur?

    3) Also should i follow steps of blocking my ears with cotton while bathing/travelling long distances in the cold etc?

    4) How do I prevent this from re-occuring?

    Thanks again and kindly reply….

    13th August 2011 at 5:37 am

  20. admin says:

    Thanks for your comment. BPPV is a very common cause of vertigo and is characterized by spinning dizziness when you roll over. Your doctor can diagnose you with BPPV by doing a Dix-Hallpike maneuver and checking for eye movements when you are feeling the dizziness. He is right that there are no medications to make it go away, nor is there a permanent cure, BUT there are very effective treatment maneuvers which will make the episodes of dizziness virtually disappear after just one or two minutes of treatment. These maneuvers are called the Epley maneuver. You can read about these maneuvers but they are sometimes hard to do correctly if you have never done them. Many doctors, even ENT doctors, don’t do the maneuvers since they worry they are not able to do them correctly. If this is the case there are devices available which will help anyone perform the maneuver. You can read about these devices online. BPPV will likely return eventually but you can alway repeat the maneuver.

    If you do in fact have BPPV then flying is safe, but if you get airsick then you might have two reasons for feeling ill.

    Good luck. If you develop any unusual symptoms or if things get worse please check with your own physician or attend the ER as the comments above are intended as generalities only.

    12th August 2011 at 4:29 pm

  21. Asha says:

    Hi,

    I was diagonised with BPPV in my right ear. Its been 10 days now and i feel dizzy only when I sleep and turn left/right. THe ENT doc i went to said there is no medicine to cure this and said only time will heal…it may take even months. THere were no excersises given. I was not satisfied and hence went online and found this blog.

    Can you pl advise if I can do the epley manueuver although he has not mentioned anything about it?

    I need to travel by air next week for 5 days? Is it advisable?

    I need help here as this is driving me up the wall…..Pls HELP!

    12th August 2011 at 4:49 am

  22. admin says:

    You can read more about this post maneuver feeling here.

    25th July 2011 at 9:03 pm

  23. admin says:

    Thanks for your question. Please see this Blog posting for a more detailed answer.

    25th July 2011 at 8:59 pm

  24. Teresa says:

    I was diagnosed with BBPV about six weeks ago. Did the maneuvers my ENT gave me at home for about a week, and still suffered extreme spinning and dizziness. Then found the Epley’s maneuver. Did 3x each day. After the first or second time. I’ve not experienced spinning, dizziness or nausea since. However, the feeling of “lightheadeness” and what I call “swimmyheadedness” still occurs at some point each day. Should I continue the Epley’s, or just not do any treatments? I try and not lay down at least 30 min. after each treatment. I want to make sure I’m not doing anything to cause a new problem. THANKS

    25th July 2011 at 3:16 pm

  25. admin says:

    Thanks for your comments. Your story is not uncommon. Average duration to diagnosis is measured in years. In answer to your final questions about how to do the maneuver: The most common description is to hold each maneuver position for 30 seconds. This gives enough time for the particles to migrate along the posterior semi-circular canal but is short enough to be well tolerated by the individual. Your second question about speed is more complicated. The answer is it depends. Conducting the maneuver slowly will result in less obvious symptoms and findings. By this I mean the dizziness may be less and the observable eye findings (nystagmus) will be less obvious to anyone watching. It may also be the slow speed is less successful due to a lack of momentum but this has never been studied. Fast maneuvers make the dizziness worse (during the maneuver) but also make the eye findings more obvious to an observer. Also speed is essential to the Semont maneuver but not so much to the Epley maneuver. There are devices out there like the DizzyFIX which help with the speed and angle. Finally, as always, it is important to discuss your condition with your own health care provider to ensure you have the correct diagnosis.

    5th June 2011 at 9:00 pm

  26. George Alexanian says:

    My story. The first time I had vertigo was in 1971 after I had sat writing for four hours without looking up. I got dizzy for a few seconds then was lightheaded with occasional vertigo for the next 30 years. Had to watch how fast I sat down, got out of bed, bent over, looked to the side. Had all types of tests, all negative.Thought I was dying of something, but what? Finally after years figured out that the spinning occured during the night when I turned my head in bed or getting up too fast. Lived with it for 30 years. Finally constant lightheadedness went away, only returning for a few days after turning my head too fast. About 5 weeks ago, I made two mistakes. Because I have tinnitus and the sound of running water in the shower helps, I shampooed my hair for several minutes and rubbed my head with my hands for a couple of minutes to continue hearing the sound of the water near my head. After I got out, I felt somewhat lightheaded. Then a week later I went to play slot machines and because I was going to be there only a couple of hours, played two machines at one time, with my nead going back and forth, up and down hundreds of times. I stood up and flet more light headed. Went to eat lunch and going to my table mad a U turn to sit. A few seconds later was dizzy (spinning) for a few seconds, but the lightheadedness has been even more prounounced since, and if I look left or right, or down, or turn without moving my body, feel like I will get dizzy. Refused the maneuver to confirm BPV because every time I get dizzy, the lightheadedness gets worse. I am fairly certain I have BPV, but not sure which ear, suspect both. I have an appointment with a neurologits who specializes in dizziness in two months. Meanwhile, may try the laying down and turning my ear to the ground to see which ear is affected, then try the Epley maneuver. However, I have read that each position should be helld in place anywhere from 20 seconds to 3 minutes, also to do the maneuver briskly to slowly. Which is the best?

    5th June 2011 at 8:23 am

  27. admin says:

    Childhood BPPV is quite unusual. I must first say that if you are unsure about your diagnosis or are looking for more support you should seek specialist referral in your closest tertiary care center. I can certainly answer your questions in generalities but again you must primarily rely on your own physician for specific medical advice.
    1) BPPV is a chronic condition – however some people experience it only for short periods of time and in some people it never comes back. It is not proven what happens to the loose crystals when the symptoms go away – perhaps they dissolve, perhaps the patient gets used to it.
    2) You can perform the Epley maneuver as often as you like – there are a few rare complications like moving the crystals into other ear canals but this usually is self limited and will go away by itself.
    3) I would perform the maneuver as soon after onset of symptoms as possible to reduce the time in which you have to suffer. This has no impact on the overall clinical course as far as we know however. Although the current episode may be resolved it may still come back.
    4) You can, and some do, perform the maneuver daily/weekly/monthly. There is no evidence that it prevents onset of symptoms but it would seem to make sense. It cannot induce BPPV by doing the maneuver too much.
    5) If you are unsure as to how you are doing the maneuver devices exist – such as the DizzyFIX to help you through the maneuver.

    Again – if you are not sure of your diagnosis or believe other symptoms not characteristic of BPPV are occurring seek further medical attention.

    26th April 2011 at 10:02 am

  28. dale says:

    My 6 yr old son was diagnosed with BPPV after a concussion on his forehead. This happened 14 months ago. About every 6-8 wks he has classic, but severe symptons of BPPV. Dizzy feeling in the morning, bouncing eyes, loss of balance, up to and including vomiting. The symptons only last 2-3 days then disappear for another 6-8 wks. I only discovered the epley maneuver the last time it occcurred — the doctor only diagnosed, did not provide or discuss treatment. As it was the 3rd day I wasn’t sure if it was the epley or the typical time that let it elapsed. My son had another vertigo spell starting yesterday. I performed the epley twice yesterday and his symptons are less severe today but still exist. A couple of questions—
    Is it likely he will have this for the rest of his life?
    Should I be performing the epley more often?
    Should I perform only when symptons first start?
    Should I perform in between symptons? once a week? once a month?

    I live in a small town without much access to physicians who understand this with kids. I called the doctor again today and the earliest he could get a physical therapist appointment would be tomorrow— most likely the symptons will be gone by then.

    Thanks for any help.

    25th April 2011 at 12:11 pm

  29. Susan says:

    I’ve had an off balance feeling since 3/5. I was initially treated through the emergency room with a prednisolone pack and valium BID for a week to no avail. After the seeing the ENT and being diagnosed with BPPV (right posterior vestibular canal) and treated with an Eply maneuver the vertigo continued. I endured balance rehab twice/week for four weeks and was treated with Fiorcet (vasoconstrictor) during this four weeks for tension headaches brought on by the stress of the whole situation… trying to work, etc… I finally saw an Otoneurotologist who recommended getting off Fiorcet and other sources of caffeine which reportedly aggravate BPPV. I also had a repeat Eply maneuver at his office before leaving and then sat straight up for 72 hours. I felt some better, but I still feel “not in control” yet. I cannot do anything fast and turning is especially “dizzying”. As for the tension headaches which worsen the BPPV sensation I saw my primary care physician who gave me a 60 mg shot of Toradol (vasodilator, NSAID) and provided me with three days worth of Toradol followed by 800 mg Ibupofren TID after those three days. I got some relief, but not enough to feel completely relaxed. So, after three days I sought out help from an eye doctor who administers Botox “ale carte” and had 90 units injected into my scalp. This helped tremendously, but my ears still have this full feeling and the sensation of swaying continues as well as difficulty turning or moving quickly. I, also, am bothered by extraneous noise and prefer complete quiet. Someone above mentioned migraine associated vertigo. I have not seen a neurologist because the MRI of my brain and ear structures were normal. I don’t know what a migraine feels like. The headaches I have feel like a tight swim cap and symptoms of TMJ only confuse what is causing what. Any suggestions. I have been unable to work. I have 3 weeks to get better or I’ll be out on short term disability. Unfortunately, my career involves lots of bending and turning. I also work twelve hour shifts and carry a pager which becomes unnerving at times. I’m open to any suggestions. Thank you.

    17th April 2011 at 7:21 am

  30. lorraine says:

    I am an exercise intructor and this BPPV is driving me nuts! I also have the spinning, out of body feeling, lights affect my vision.. seen two doctors (One anENT)

    16th April 2011 at 8:53 am

  31. admin says:

    Yes and no. No if the type of nystagmus you have during the hall pike maneuver is the “geotropic torsional nystagmus”. This kind of nystagmus is only typical of BPPV. During this type of nystagmus the fast phase of the nystagmus beats toward the floor. There is a minor horizontal component, with a more significant upbeat component and a small rotational component. No other disease causes this type of nystagmus in the hall pike position. However, yes you can have other forms of nystagmus which are present in the hall pike position such as congenital nystagmus. In this situation you always have nystagmus and it doesn’t change in in the Hall Pike position. Also there are few other causes of central nystagmus which will still be present in the hall pike position or rarely can be exacerbated by gaze or increased intracranial pressure (such as SSCC dehiscence syndrome). So again – the simple answer is no – no other condition causes torsional nystagmus, but yes rarely other types or nystagmus can also be present. So as usual it is important to discuss any findings with your own physician.

    22nd March 2011 at 7:26 pm

  32. admin says:

    This is a common after affect of a successful maneuver. It usually lasts 1-2 weeks. It is generally thought that this experience is a re-adaptation to the crystals being moved out of the balance canals.

    22nd March 2011 at 7:21 pm

  33. admin says:

    That depends on what you mean by “Dizzy”. Many people use the term dizzy to encompass all kinds of symptoms like “off balance” “light headed” and “vertigo”. Vertigo is a true spinning sensation. This is the type of dizziness associated with BPPV. The main characteristics of BPPV are “Vertigo” which occurs only when moving (such as laying down or rolling over) which lasts only seconds. Also your physician may note “Nystagmus” or rhythmic eye motion during a test for BPPV. If you have these symptoms the Epley maneuver (which does cause more vertigo during the maneuver and sometime a week or two of off balance feeling after a successful maneuver) is effective about 80-90 percent of the time. If you do not have BPPV then the maneuver is completely ineffective. It cannot really make BPPV worse if it fails except in rare circumstances where you convert one type of BPPV into another. The treatment maneuver cannot cause BPPV. There are devices out there to help you do your own correct maneuver if you feel you do have BPPV but the maneuver failed the first time around. It is important to communicate your symptoms with your physician and to discuss any treatment options with them.

    22nd March 2011 at 7:20 pm

  34. Susan says:

    My doctor says I have BPPV on the right side, butI don’t have the symptom of feeling the room spin, mine is more a feeling of off balance when I move my head or bend. When he did the Epley manuever I was extremely off balance and dizzy after it. Because I was so dizzy does that mean I definetly have it? Would a person with out BPPV get dizzy after it? I didn’t see any help from the manuver, that is why I am questioning it?

    22nd March 2011 at 6:49 pm

  35. Karen says:

    I am going crazy!!! I had the epley maneuver and it worked. I could lay down without the room spinning and I did not wake up several time a night with it. I can also bend down to empty the dishwasher,make the bed etc. The only problem is that I feel like I am light headed and I am somewhere else. I just do not feel like myself yet. It has been two weeks since my treatment. I feel like I am walking around with a outer body experience. Should I be felling like this? Is this normal after the treatment. Please tell me I am not going crazy and that it just takes time to feel back to normal!!!

    24th February 2011 at 7:24 am

  36. admin says:

    That depends on what you mean. Some people have nystagmus all the time. Clearly they will still have it during a Dix-Hallpike maneuver. However, if there is no nystagmus with any other situation and only with the maneuver then it is usually diagnostic for BPPV.

    9th January 2011 at 8:07 pm

  37. Christine Igne says:

    Are there any other reasons why a person would have nystagmus with the Hallpike besides BPV?

    7th December 2010 at 1:45 pm

  38. Florn says:

    Thank you administrator. This website has been extremely helpful. Trying the Epley Manuever and the Brandt-Doroff at home have made me dizzier, but I will not give up.
    A note for sufferers: I agree with another commenter- keep your blood sugar levels up. This will help you feel better. Also, taking a quarter of a valium is helpful, but I wouldn’t recommend everyday as it can be addictive.

    18th August 2010 at 1:58 pm

  39. 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.

    14th August 2010 at 8:21 pm

  40. 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!

    12th August 2010 at 2:46 pm

  41. 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.

    21st May 2010 at 8:34 pm

  42. 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.

    21st May 2010 at 11:36 am

  43. 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.

    16th May 2010 at 7:09 pm

  44. 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.

    16th May 2010 at 6:01 pm

  45. 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.

    12th March 2010 at 9:40 pm

  46. 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.

    12th March 2010 at 9:18 am

  47. 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 February 2010 at 9:40 pm

  48. 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

    15th December 2009 at 8:10 am

  49. 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.

    30th August 2009 at 7:17 pm

  50. 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!

    27th August 2009 at 11:41 am

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