Epley maneuver

BPPV occurs when small pieces of bone-like calcium (canaliths) break free and float inside small canals in your inner ear. This sends confusing messages to your brain about your body's position, which causes vertigo.

The Epley maneuver is used to move the canaliths out of the canals so they stop causing symptoms.

To perform the maneuver, your health care provider will:

• Turn your head toward the side that causes vertigo.
• Quickly lay you down on your back with your head in the same position just off the edge of the table. You will likely feel more intense vertigo symptoms at this point.
• Slowly move your head to the opposite side.
• Turn your body so that it is in line with your head. You will be lying on your side with your head and body facing to the side.
• Sit you upright.

Your provider may need to repeat these steps a few times.

Your provider will use this procedure to reposition the canaliths to treat BPPV.

During the procedure, you may experience:

• Intense vertigo symptoms
• Nausea
• Vomiting (less common)

In a few people, the canaliths may move into another canal in the inner ear and continue to cause vertigo.

Tell your provider about any medical conditions that you may have. The procedure may not be a good choice if you have had recent neck or spine problems or a detached retina.

For severe vertigo, your provider may give you medicines to reduce nausea or anxiety before starting the procedure.

The Epley maneuver often works quickly. For the rest of the day, avoid bending over. For several days after treatment, avoid sleeping on the side that triggers symptoms.

Most of the time, treatment will cure BPPV. Sometimes, vertigo may return after a few weeks. About half the time, BPPV will come back. If this happens, you'll need to be treated again. Your provider may teach you how to perform the maneuver at home.

Your provider may prescribe medicines that can help relieve spinning sensations. However, these medicines often do not work well for treating vertigo.

Canalith repositioning maneuvers (CRP); Canalith-repositioning maneuvers; CRP; Benign positional vertigo - Epley; Benign paroxysmal positional vertigo - Epley; BPPV - Epley; BPV - Epley

Chang TP, Zee DS, Kheradmand A. Technological advances in testing the dizzy patient: the bedside examination is still the key to successful diagnosis. In: Gleason AT, Kesser BW, eds. Dizziness and Vertigo Across the Lifespan. St Louis, MO: Elsevier; 2018:chap 2.

Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 167.

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.