3 Reasons Why You Still Feel Terrible After the Epley Maneuver
The Epley maneuver is one of the most recognized treatments for positional vertigo. It provides fast relief for the majority of people dealing with the right type of inner-ear dizziness. It is so well known that many people even attempt to do it at home without professional help. Sometimes it works but it can also backfire with people feeling much worse.
A key point to remember is that vertigo is a symptom, not a diagnosis.
The Epley only works when the underlying issue is a very specific disorder of the inner ear: Benign Paroxysmal Positional Vertigo, also known as BPPV.
What Does the Epley Maneuver Treat?
To understand BPPV and the Epley Maneuver we have to first go over some inner ear anatomy. Specifically, the utricle and semicircular canals. To keep it simple, there are calcium carbonate crystals (otoconia) that rest in an inner ear structure called the utricle. What happens in BPPV is that these crystals fall out of the utricle into another structure we call the semicircular canals. This happens for reasons we still don’t quite understand.
The crystals being in the wrong place essentially disrupts inner ear function leading to short bouts of intense vertigo lasting seconds to minutes that are provoked by certain head movements. BPPV can be highly distressing but the good news is that it is typically very easy to treat. We essentially move the head through a series of positions, such as the Epley, to guide the crystals from the semicircular canals back into the utricle where they belong.
But we have to keep in mind that there are three separate semicircular canals per ear:
- Posterior Canal
- Horizontal Canal
- Anterior Canal
1. You Treated the Wrong Canal
The Epley maneuver was specifically developed to treat posterior canal BPPV which accounts for 90% of BPPV cases. The results are amazing but it only works if:
- You have BPPV
- You have posterior canal BPPV
- The affected ear is correctly identified
If the crystals are in the horizontal or anterior canals, the Epley is the wrong treatment and may worsen your symptoms. Additionally, it’s important that the correct ear is identified for proper treatment.
This is one of the most common reasons people feel terrible after attempting it at home.
2. You Experienced a Canal Conversion
A canal conversion happens when crystals start in one canal but move into another during the Epley maneuver. The most common conversion is from the posterior canal into the horizontal canal. Horizontal canal BPPV tends to be more intense so a canal conversion often leaves people feeling worse.
This happens because the canals are interconnected and the maneuver intentionally moves the head through angles that shift the crystals. Occasionally, the debris overshoots or drops into a neighboring canal.
The Epley does not treat horizontal canal BPPV. Clearing this type requires completely different maneuvers such as the BBQ Roll or the Gufoni. Most general clinicians don’t know these techniques well so conversions often go untreated or misdiagnosed.
The good news is that vestibular specialists see canal conversions frequently and can fix them quickly once identified. Canal conversions are oftentimes unavoidable but with the right technique is still very easy to treat.
3. It Wasn't BPPV At All
It bears repeating that vertigo is a symptom and not a disorder. If the Epley did nothing, there’s a strong chance you weren’t dealing with BPPV in the first place. Many other disorders cause dizziness and vertigo and treatment trajectories can vary greatly.
Conditions that cause vertigo are known as vestibular disorders. Some common vestibular disorders, besides BPPV, include:
- Vestibular neuritis
- Labyrinthitis
- Ménière’s disease
- Vestibular migraine
- Mal de Débarquement Syndrome
- Persistent Postural-Perceptual Disorder
None of these respond to the Epley maneuver.
Signs your vertigo may not be BPPV include dizziness lasting longer than a few minutes, constant symptoms not tied to position changes, vertigo with headache or migraine features, hearing loss or ear fullness, and severe imbalance.
Doing repeated Epley maneuvers in these cases often worsens symptoms or adds unnecessary stress.
Tips & Advice
Avoid self-treating unless you have a confirmed diagnosis. Vertigo can sometimes be due to serious conditions, including stroke, so getting properly assessed and screened truly is in your best interest. If the Epley made you feel worse, stop repeating it as you may have the wrong canal, a canal conversion, or a completely different diagnosis.
Finding a vestibular specialist can make all the difference although they are in short supply. Working with a vestibular specialist can help identify what’s going on and get you the right treatment.
Still Not Sure What's Causing Your Vertigo or Dizziness?
If you’ve tried the Epley without relief, it’s probably worth taking a deeper look.
By answering just a few questions, I can develop a free custom treatment plan tailored specifically to you. Outlining how we’ll methodically test, assess and determine the right treatment direction so you can feel better as soon as possible.