Is it normal for the Epley (Epley maneuver) maneuver to cause dizziness?

Is It Normal for the Epley Maneuver to Make You Dizzy?

Yes, it is completely normal and expected to experience dizziness during the Epley maneuver, as the procedure deliberately moves the displaced otoconia through the semicircular canal to resolve BPPV. 1

Why Dizziness Occurs During the Epley Maneuver

The Epley maneuver (also called canalith repositioning procedure or CRP) works by:

1. Intentional provocation: The maneuver deliberately positions your head in ways that move the free-floating calcium carbonate crystals (otoconia) through the posterior semicircular canal.

2. Movement of otoconia: As these particles move through the canal during each position change, they stimulate the sensory hair cells, triggering vertigo sensations.

3. Therapeutic purpose: This temporary dizziness is actually a sign that the maneuver is working as intended - the particles are being mobilized to be repositioned back into the vestibule where they no longer cause symptoms.

What to Expect During the Epley Maneuver

The 2017 clinical practice guideline for BPPV 1 outlines that patients should be informed before the procedure that:

• Nausea may occur during the maneuver
• Occasional vomiting may happen
• A sense of falling might be experienced
• Dizziness is expected as part of the procedure

For patients who previously experienced severe nausea or vomiting with diagnostic testing (Dix-Hallpike), antiemetic medication 30-60 minutes before the procedure may be considered.

Common Side Effects and Their Duration

The dizziness experienced during the Epley maneuver typically:

• Is most intense during the position changes
• May continue briefly while holding each position (positions are typically held for 20-30 seconds)
• Should begin to subside after completing the full maneuver
• May include a feeling of imbalance that can last up to 24 hours after the procedure 1

Warning Signs vs. Normal Reactions

Normal reactions include:

• Temporary vertigo during and shortly after the maneuver
• Mild nausea (occurs in 16.7% to 32% of patients) 2
• Brief sensation of falling or imbalance

Concerning signs that are NOT normal:

• Severe, persistent vertigo lasting more than 24 hours
• Hearing loss
• Neurological symptoms (weakness, numbness, visual changes)
• Inability to walk due to severe imbalance

Potential Complications

While the Epley maneuver is generally safe, be aware of these possible complications:

• Canal conversion: In about 6-7% of cases, the maneuver may cause the otoconia to move into the lateral semicircular canal instead (canal switch), requiring a different treatment approach 1

• Postural instability: Some patients experience temporary balance problems for up to 24 hours after the procedure 1

The Cochrane review of 11 trials with 745 patients confirms that the Epley maneuver is safe with no serious adverse effects reported 2.

If you experience dizziness during the Epley maneuver, remember this is part of the therapeutic process and indicates the treatment is likely working to resolve your BPPV.