What Is the Epley Maneuver?

The Epley maneuver is a simple technique used to treat benign paroxysmal position vertigo (BPPV), one of the most common types of vertigo. It is safe and easy to perform at home and often relieves the dizziness, spinning, and other symptoms that make vertigo so frustrating and even harmful to those at risk of falls.

A blurred view of trees from a dizzy perspective
Enrique R Aguirre Aves / Oxford Scientific / Getty Images

The Epley maneuver involves shifting your head in a series of rotational positions to dislodge calcium crystals (called otoliths) from the semicircular canals that cause vertigo. Some doctors recommend doing this several times daily until the symptoms fully resolve. Alternatively, a physical therapist that specializes in vestibular therapy can often do this with just one session.

Purpose of Test

The Epley maneuver was first described in 1980 by Dr. John Epley, an ear, nose, and throat specialist from Portland, Oregon, as an in-office procedure for the treatment of BPPV. Today, it commonly is taught as a self-help technique (given that a single in-office treatment may not fully resolve symptoms).

BPPV is caused when otoliths that normally reside in the utricle (one of the balancing organs of the inner ear) become detached and migrate to the nearby semicircular canal. When this occurs, the otoliths can interfere with the function of the canals, which is to orient you rotationally.

The Epley maneuver is one of the most effective techniques for moving otoliths out of the semicircular canal back to the utricle where they belong.

The Epley maneuver consists of four different head positions that are held for 30 seconds each. It is safe for children and adults, including pregnant women for whom other otolith-repositioning techniques may be difficult.

Risks and Contraindications

The Epley maneuver is generally considered safe as it does not involve bending or rapid head movements as other canalith-repositioning techniques do.

Even so, it may not be advised for people who may be harmed by the twisting and turning of the head. These include people with:

People with conditions that limit their ability to move may not be able to do the Epley maneuver safely or effectively on their own. These include those who are frail, physically disabled, or morbidly obese.

For them, the procedure may need to be done by a physical therapist trained in the technique or with the assistance of a friend or family member.

Before the Procedure

Even if you are able to perform the Epley procedure on your own, it is advisable to see a doctor to have your vertigo diagnosed and to have them demonstrate the technique so that you're able to do it properly and effectively at home. Prior to your appointment, gather together as much information as you can about your current health, medical history (including past injuries or surgeries), medication use (prescription, over-the-counter, or recreational), and any other symptoms you may have.

Timing

From start to finish, the Epley maneuver takes around 15 minutes to complete. If performed in a doctor's office, expect to be in and out within 45 minutes to an hour.

Location

In a medical setting, the Epley maneuver is performed in an examining room on an examining table. At home, it is best performed in your bedroom on a bed.

What to Wear

There is nothing specific you need to wear for the Epley maneuver, although it helps to dress comfortably with a loose-fitting top and a non-constricting collar.

Food and Drink

Some doctors will advise that you stop eating four hours before the procedure. This is especially important if you experience nausea during a vertigo episode. The shifting position of your head and body may cause vomiting.

If you are prone to vomiting during vertigo, your doctor may prescribe an anti-nausea drug, like promethazine or meclizine, to take an hour or two before your appointment.

Cost and Health Insurance

The Epley maneuver does not require any special equipment. When done in a doctor's office or physical therapy practice, the cost would be limited to the visit itself.

To reduce costs, always check that the doctor or physical therapist is an in-network provider with your health insurer. In-network providers are usually (but not always) cheaper than those that are out-of-network.

What to Bring

If the Epley maneuver is performed at a doctor's office, bring your insurance card, driver's license (or some other form of official ID), and an approved method of payment.

If performing the procedure at home, you will need a pillow and a watch or clock in addition to your bed.

Other Considerations

If your doctor gives you an anti-nausea drug to prevent vomiting, be aware that it may cause dizziness, drowsiness, and blurred vision.

If one is prescribed, have someone drive you to the appointment and back as these side effects can sometimes persist for hours.

During the Procedure

Because BPPV typically involves one ear, the Epley maneuver needs only to be performed on the affected side. Less commonly, the condition is bilateral (involving both ears) and requires you to use the technique on both sides.

If BPPV is related to your right ear, the following steps would be performed:

  1. Sit on the side of your bed. Position a pillow far enough behind you to support your shoulders when you lay back.
  2. Turn your head 45 degrees to the right.
  3. Immediately lie down on your back, keeping your head turned. Your shoulders should now be on the pillow, and your chin should be tilted slightly toward the ceiling. Hold for 30 seconds.
  4. Turn your head 90 degrees to the left, maintaining the position of your chin. You will now be looking 45 degrees to the left. Hold for 30 seconds.
  5. Turn your body and head 90 degrees to the left, resting on your side. Hold for 30 seconds.
  6. Return to a seated position, tilting your head down 30 degrees. Hold for 30 seconds.

If the left ear is affected, switch "left" with "right" and "right" with "left."

Some doctors recommend that you perform the Epley maneuver three times before going to bed and continue to do so every night until your symptoms are fully resolved for 24 hours.

After the Procedure

Stay seated with your head in an erect yet relaxed position for 10 minutes even if you feel a little dizziness.

During the course of treatment, you can benefit from propping your head 45 degrees while sleeping. Whatever you do, try not to sleep on the affected ear as this can prolong the need for treatment. To prevent yourself from turning, use pillows to bolster you on one side.

During the day, keep as upright as possible with your head in the proper position. People unable to do so should ask their doctor for a soft cervical collar.

Call your doctor if your symptoms get worse after doing the Epley maneuver. You may find that you are not doing the technique correctly or have a condition other than BPPV.

Outcomes and Expectations

Observational studies published in the International Journal of Otolaryngology suggest that the Epley maneuver is up to 95% effective in improving symptoms of BPPV, often with one treatment. Some people may require multiple treatments over several days or weeks to find relief.

The Epley maneuver is considered superior to other otolith-repositioning techniques, including the Semont maneuver, the Foster (half-somersault) maneuver, and the Brandt-Daroff exercise.

The Epley maneuver does not require bending or rapid movements of the Semont or Foster maneuvers, and, unlike the Brandt-Daroff exercises, aims to eliminate the symptoms of BPPV rather than increase your tolerance to it.

A Word From Verywell

In the same way that people experience BPPV differently, the response to the Epley maneuver can also vary. If you do not find immediate relief, try to remain patient and persevere with the exercises as directed.

If you do not have any improvement after a week or so, speak with your doctor about further investigations or ask for a referral to an ear, nose, and throat specialist called an otolaryngologist.

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