İhsan Eren1. Turn your head to the right
Sit on the bed with your legs stretched out in front of you. Have a pillow behind you, placed so that it will be under your shoulders when you lie down. Turn your head 45 degrees to the right.
Starting position2.4%People who have BPPV at some point in their lives
56%Whose vertigo cleared completely with the Epley manoeuvre; 21% without the manoeuvre
95%Recovery rate after one week in patients who learned to do the manoeuvre themselves
30 sMinimum wait at each step of the Epley manoeuvre
What is it?
Your inner ear contains three fluid-filled semicircular canals that sense balance. Tiny calcium crystals from another part of the inner ear can break loose and slip into one of these canals, most often the posterior canal. When your head changes position, the crystals move the fluid in the canal, and your brain senses a spinning movement that is not really happening.
It becomes more common with age and can also appear after a blow to the head. Often no clear cause is found.
Symptoms
- A spinning sensation that starts when you lie down, turn over in bed or get out of bed
- Triggered by looking up or bending forward
- Usually lasts less than a minute
- Nausea and a feeling of unsteadiness
- No hearing loss or other neurological symptoms
Diagnosis and treatment
It is diagnosed with the Dix-Hallpike test: a doctor or physiotherapist turns your head to a set angle, quickly lays you down on your back and watches for a characteristic movement of your eyes. The test also shows which ear is affected. The guideline from the American Academy of Otolaryngology–Head and Neck Surgery recommends against routine MRI or CT scans in patients who meet the diagnostic criteria.
Treatment uses repositioning manoeuvres, which move the crystals out of the canal and back to where they belong; the best known is the Epley manoeuvre. In a Cochrane review of 11 studies and 745 patients, vertigo cleared completely in 56% of those who had the Epley manoeuvre, compared with 21% of those who had a sham manoeuvre or no treatment, and no serious side effects were seen. A single Epley manoeuvre was more effective than Brandt-Daroff exercises done three times a day for a week.
The guideline recommends against routinely using vertigo medicines (antihistamines, sedatives) to treat BPPV. These medicines do not move the crystals back into place, can make your balance worse and can raise the risk of falls, especially in older people.
At home
Epley manoeuvre for the right ear: step by step
Once a test has shown which ear is affected, you can also do the manoeuvre at home. The steps below are for the right ear; for the left ear, follow the same steps but turn your head and body the opposite way. Because it can make you dizzy, have someone with you the first few times. The small circle in the top right corner of each drawing shows your head seen from above and the angle it is turned to.
2. Lie back quickly
Keeping your head turned to the right, lie back quickly. Your shoulders should be on the pillow, with your head tipped slightly back and resting on the bed. You may feel dizzy; wait for it to pass.
At least 30 seconds, until the dizziness passes3. Turn your head to the left
Without lifting your head, turn it 90 degrees to the left. You will now be looking 45 degrees to the left.
At least 30 seconds4. Roll onto your left side
Turn your body 90 degrees to the left along with your head, towards the middle of the bed. You will be facing down, towards the bed.
At least 30 seconds5. Sit up on your left side
Slowly sit up on the edge of the bed from your left side. Stay seated for a few minutes; do not stand up straight away.
3 times a day, until you have gone 24 hours without dizzinessBalance exercise
A feeling of unsteadiness can linger for a while even after the vertigo has gone. Holding on lightly to a kitchen counter, place one foot directly in front of the other and hold your balance. As it gets easier, hold on less.
30 seconds, 3 timesIn a study of 70 patients who learned to do it on their own, vertigo cleared within a week in 95% of those who did the Epley manoeuvre at home. If you have a neck or back condition, a blood vessel disease or a history of a retinal tear, talk to your doctor before doing the manoeuvre.
Frequently asked questions
My vertigo went away but has come back. Is that normal?
BPPV can come back. If the symptoms are the same, the same manoeuvre usually works again. If it keeps coming back or your symptoms have changed, you need to be reassessed; the guideline recommends a reassessment within a month of treatment.
How can I tell which ear is affected?
Only the Dix-Hallpike test can tell for sure. The vertigo is usually stronger when you lie turned towards the affected ear, but this alone is not enough. A manoeuvre done on the wrong side will not work, so it is best to have your first assessment done by a specialist.
Do I need to sit upright or avoid moving my head after the manoeuvre?
No. The guideline does not recommend restricting your movement after the manoeuvre; such restrictions have not been shown to improve the result.
Should I take medicine for vertigo?
Usually not. The guideline recommends against routinely using vertigo medicines for BPPV; these medicines do not move the crystals back into place. If you have severe nausea, you can ask your doctor about taking one for a short time.
When to seek help right away
In the following situations, your dizziness may be caused not by BPPV but by an emergency such as a stroke. Call 112 without delay:
- Dizziness together with slurred speech, a drooping face, or weakness or numbness in an arm or leg
- Double vision or difficulty swallowing
- Sudden, very severe headache or neck pain
- Being unable to walk or stand
- Dizziness that goes on non-stop for hours or days, whatever the position of your head
- Sudden hearing loss
Sources
- Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3 Suppl):S1-S47.
- Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014;(12):CD003162.
- Radtke A, von Brevern M, Tiel-Wilck K, et al. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology. 2004;63(1):150-152.
- von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710-715.
- Johns Hopkins Medicine. Home Epley maneuver.