What Is the Epley Maneuver?

The Epley maneuver is a series of head movements used to relieve symptoms of benign positional vertigo, a typically short-term condition that makes you feel as if your head is spinning in circles.

Caused by an inner ear problem, benign positional vertigo—also known as benign paroxysmal positional vertigo (BPPV)—is mainly treated with head repositioning maneuvers that help move particles within the ear canal that can cause brief episodes of mild to intense dizziness.

This article explains what the Epley maneuver does, how it is performed, and the possible risks and complications of this effective, at-home treatment.

Purpose of the Epley Maneuver

The Epley maneuver is one of several head repositioning movements used for BPPV, alongside the Semont maneuver and Brandt-Daroff exercise.

As a group, these movements are referred to as canalith repositioning procedures because they are used to reposition calcium crystals in the ears known as canaliths.

Under normal circumstances, canaliths, also known as otoliths, are housed within a fluid-filled chamber in the inner ear called a utricle. As these crystals move about the utricle, they rub against hair-like cells that send signals to the brain that orient the position of the head.

If canaliths become detached, they can migrate to the nearby semicircular canal and send incorrect signals to the brain about your position, leading to the symptoms of vertigo.

How to Do the Epley Maneuver

The Epley maneuver consists of four different head positions that are held for 30 seconds each. From start to finish, the maneuver takes around 15 minutes to complete.

No equipment is required, and it can be performed at home or in an office by a healthcare provider like a physical therapist or an otolaryngologist (ear-nose-throat specialist).

Because BPPV is typically unilateral (one-sided), the Epley maneuver only needs to be performed on the affected ear. On rare occasions, BPPV can be bilateral (involving both ears) and require use of the technique on both ears.

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, the above-listed right and left instructions would be switched.

Once completed, stay seated with your head in an erect yet relaxed position for 10 minutes.

Tips and Advice

Some healthcare providers 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 a full 24 hours.

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 alter the position of the inner ear and cause canaliths to spill back into the semicircular canal. 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 an upward but relaxed position. People unable to do this may consider using a 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.

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.

It is safe for children and adults, including pregnant people for whom other canalith repositioning procedures may be difficult.

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:

• Neck or back problems, such as cervical spondylosis
• Unstable heart disease, including unstable angina
• Orthostatic hypotension (dizziness when standing or getting up)
• A history of cervical (neck) surgery or a prior cervical spinal fracture
• A history of a detached retina
• Ongoing treatment of stroke or transient ischemic attack (TIA)
• People with a history of falling or who are at risk of falling

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 have morbid obesity.

For these individuals, a physical therapist trained in the technique may be needed.

How Effective Is the Epley Maneuver?

A 2015 study published in the International Journal of Otolaryngology suggests 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 canalith repositioning techniques, including the Semont 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, it aims to eliminate the symptoms of BPPV rather than increase your tolerance to it.