How the Epley Maneuver Helps to Relieve Vertigo
Dr. Ryan Klopfer • April 29, 2022
The Epley maneuver is a common treatment of the vertigo associated with the inner ear disorder benign paroxysmal positional vertigo (BPPV).
BPPV is the most common cause of vertigo, a symptom that causes a spinning sensation and quality of life concerns if left untreated. The Epley maneuver is a safe and effective treatment method for BPPV. It’s even appropriate for at-home use as long as it’s modeled correctly first.
How the Epley Maneuver Works
Dizziness from conditions like BPPV is caused by a problem affecting the calcium carbonate crystals, also called otoconia or canaliths, in the inner ear. These calcium crystals, or “ear rocks,” relay your body’s position to your brain and help detect motion.
When these crystals are dislodged from the utricle and migrate to other areas of the inner ear canal, it can cause miscommunication within your vestibular system. The result is disorientation and extreme dizziness, or vertigo .
Canalith repositioning maneuvers work by moving those crystals back to where they belong. These maneuvres include the Epley maneuver, Semont maneuver, Brandt-Daroff exercise, and the half somersault.
When to Try the Epley Maneuver
The Epley maneuver is a good vertigo exercise to try if you have been diagnosed with BPPV or are experiencing symptoms of BPPV. Those symptoms include:
- Vertigo
- Nausea and vomiting
- Unsteadiness
- Lightheadedness
- Nystagmus (uncontrolled eye movements)
- Tinnitus (ringing in the ears)
The Dix-Hallpike test is a common diagnostic tool for BPPV. The test is similar to the Epley maneuver in that it works by triggering vertigo symptoms. If you’re not sure whether it’s your left ear or right affected by the condition, the test can help determine that.
If you’re not sure whether you have BPPV, talk to your doctor before attempting any canalith repositioning procedures like this one. Vestibular disorders like Ménière’s disease, inner ear infections, and even migraines can cause vertigo.
When it comes to BPPV, the Epley maneuver is considered very effective , particularly in elderly patients.
How long does it take the Epley maneuver to work? Many patients experience immediate results after one treatment. Some may need a few treatments for longer-lasting results. In others, BPPV can be a recurring condition. You may need to return to the Epley maneuver if symptoms return down the line.
How often can you do the Epley maneuver? You can do the Epley maneuver several times per day until symptoms subside. Some providers recommend attempting the maneuver up to 3 times per day.
Your healthcare provider will guide you in the treatment plan that works for you.
How to perform the Epley Maneuver
Before attempting the Epley maneuver, you’ll need to know more about your particular case of BPPV.
How do you know which side to do the Epley maneuver? To know which side to do the Epley maneuver, you need to identify the side that causes your vertigo symptoms. If you lie on your right side and vertigo symptoms occur, the right ear is the affected side.
You’re now ready for the Epley maneuver.
Here’s how to do it:
- Start seated on a bed or bench with your legs hanging over one side.
- Turn your head 45° toward the side affected by vertigo.
- Lie down on your back with your head reclined. Stay in that position for 30 seconds.
- Turn your head to the other side at a 90° angle. Stay in that position for 30 seconds.
- Turn your entire body to that same side.
- Hold the position for at least 30 seconds or until vertigo symptoms subside.
- Return to your original seated position.
You’ll know the maneuver has worked if your vertigo is gone.
Can I do the Epley maneuver myself? You can do a modified Epley maneuver by yourself, but you should not attempt the technique by yourself for the first time.
Your physical therapist, chiropractor, or other healthcare provider may show you how to do a modified version at home to treat vertigo symptoms.
If you’re considering self-treatment, you should know that the Epley maneuver done incorrectly could worsen symptoms. Severe side effects like stroke are exceedingly rare. In fact, there is only one reported case of stroke following the maneuver. It is generally considered safe and effective.
If you’ve tried the maneuver several times and your vertigo has not gone away, follow up with your doctor or therapist to make sure you’re doing the movements correctly.
After the Epley Maneuver
Following instructions from your therapist after your treatment will give you the best chance to prevent vertigo symptom recurrences.
What should you not do after the Epley maneuver? You should not drive for 10-15 minutes after the Epley maneuver because the treatment may trigger vertigo symptoms.
Here are a few more tips after the Epley maneuver:
- Avoid sleeping flat the night following your treatment. A recliner chair or pillow arranged up to a 45-degree angle works well.
- Sleep on the side not affected by BPPV symptoms for at least a week after the maneuver.
- Try to avoid sudden movements or head positions that are common triggers for vertigo. This includes exercises that place you on your back or cause rapid head movements, like sit-ups.
Talk to your doctor If you’re dealing with persistent vertigo or other BPPV symptoms. If you experience more serious symptoms like problems with your speech or hearing, seek medical attention immediately. You may need a neurology or audiology consult.
Chiropractic care can also be an important component of your vertigo treatment plan. Problems with the upper cervical spine cause many cases of vertigo.
Ready to get to the root of your problem with chiropractic care? We’re currently accepting new patients at our Ball Ground office.
Sources
- Barozzi, S., Socci, M., Ginocchio, D., Filipponi, E., Martinazzoli, M. G., & Cesarani, A. (2013). Benign paroxysmal positional vertigo and tinnitus. The international tinnitus journal, 18(1), 16-19. Abstract: https://pubmed.ncbi.nlm.nih.gov/24995895/
- Gaur, S., Awasthi, S. K., Bhadouriya, S. K., Saxena, R., Pathak, V. K., & Bisht, M. (2015). Efficacy of Epley’s Maneuver in Treating BPPV Patients: A Prospective Observational Study. International journal of otolaryngology, 2015, 487160. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606415/
- Uz, U., Uz, D., Akdal, G., & Çelik, O. (2019). Efficacy of Epley Maneuver on Quality of Life of Elderly Patients with Subjective BPPV. The journal of international advanced otology, 15(3), 420-424. Abstract: https://pubmed.ncbi.nlm.nih.gov/31846923/
- Hughes, D., Shakir, A., Goggins, S., & Snow, D. (2015). How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo?. The Journal of laryngology and otology, 129(5), 421-424. Abstract: https://pubmed.ncbi.nlm.nih.gov/25816719/
- Moore, P., Le, T., Blakley, B., Beiko, J., & Meen, E. (2018). Hemorrhagic stroke after Epley maneuver: a case report. Journal of otolaryngology – head & neck surgery = Le Journal d’oto-rhino-laryngologie et de chirurgie cervico-faciale, 47(1), 25. Abstract: https://pubmed.ncbi.nlm.nih.gov/29631624/
Worried About Neck Pain?
What Are Sinus Headaches? Sinus headaches are often mistaken for other types of headaches, such as migraines or tension headaches. They are caused by inflammation and congestion in the sinuses, which are air-filled spaces in your forehead, cheekbones, and behind the bridge of your nose [1][2]. When these areas become inflamed due to infections, allergies, or other irritants, it can lead to the distinct pain and pressure associated with sinus headaches [3]. Recognizing Symptoms of Sinus Headaches Sinus headaches present with specific symptoms that help differentiate them from other types of headaches: Pressure and Pain: A feeling of constant pressure and pain around the forehead, cheeks, and eyes, often intensifying with movement or bending over [4]. Facial Tenderness: Tenderness and swelling in the face, particularly around the sinus areas. Nasal Symptoms: Nasal congestion, runny nose, and postnasal drip are common. These symptoms often coincide with a sinus infection or allergies [2][3]. Ear Discomfort: Fullness or pressure in the ears. Throat Symptoms: Sore throat or cough due to postnasal drip. Fever: Mild fever may be present in cases of sinus infections [1]. Unrecognized or Uncommon Symptoms Some symptoms of sinus headaches can be less commonly recognized, including: Tooth Pain: Pain in the upper teeth can be associated with sinus inflammation [4]. Bad Breath: Halitosis due to postnasal drip. Fatigue: Feeling unusually tired or lethargic during a sinus headache episode [2]. How Sinus Headaches Impact Different Parts of the Body While the pain and pressure are centered around the sinuses, the congestion and inflammation can affect other parts of the body: Respiratory System: Difficulty breathing due to nasal congestion. Ears: Fullness and pressure can affect hearing and balance. Throat and Chest: Postnasal drip can lead to a persistent cough and throat irritation [5]. Common Causes of Sinus Headaches Sinus headaches can be triggered by several factors: Infections: Viral, bacterial, or fungal infections can cause sinus inflammation. Allergies: Allergic reactions to pollen, dust, mold, and other allergens can lead to sinus headaches [2]. Deviated Septum: Structural issues within the nasal cavity can block sinus drainage, leading to inflammation and headaches. Environmental Factors: Dry air, pollution, and smoke can irritate the sinuses, causing headaches [4]. Differentiating Sinus Headaches from Other Headaches It is essential to distinguish sinus headaches from other types of headaches to ensure proper treatment. Common headache types include: Migraines Tension Headaches Cluster Headaches Sinus headaches are often mistaken for migraines because both can present with intense head pain. However, sinus headaches are typically accompanied by nasal symptoms and facial pressure, whereas migraines often include nausea, light sensitivity, and throbbing pain [3][4]. Diagnosing Sinus Headaches Diagnosing sinus headaches involves a thorough evaluation to rule out other headache types and identify the underlying cause of the sinus inflammation. Key diagnostic steps include: Medical History: Detailed patient history, including symptoms and frequency of headaches [1]. Physical Examination: Checking for tenderness and swelling in the sinus areas. Nasal Endoscopy: A procedure to look inside the sinuses using a thin, flexible tube with a light and camera. Imaging Studies: CT scans or MRI may be used to examine the sinuses for inflammation or structural issues [2][3]. Commonly Missed Symptoms and Signs Certain symptoms can be easily overlooked but are critical for a correct diagnosis: Postnasal Drip: Often leads to a sore throat or persistent cough [2]. Chronic Nasal Congestion: Constant stuffiness can be a sign of ongoing sinus issues. Recurrent Infections: Frequent sinus infections might indicate chronic sinusitis [3]. Typical Treatments for Sinus Headaches Treatment for sinus headaches typically involves addressing the underlying cause of the sinus inflammation. At Georgia Upper Cervical, we focus on comprehensive care that includes gentle chiropractic adjustments, thorough diagnostics, and personalized treatment plans. Treatment Options at Georgia Upper Cervical 1. Gentle Chiropractic Adjustments: We provide gentle adjustments to the cervical spine to improve sinus drainage and reduce inflammation. Our methods are precise and non-invasive, avoiding the cracking or popping commonly associated with traditional chiropractic treatments [6]. 2. Thorough X-Rays: Comprehensive x-rays help us assess the alignment of the cervical spine and the sinuses, allowing for a targeted treatment plan [1]. 3. Personalized Treatment Plan: Based on diagnostic findings, we create a customized treatment plan that includes chiropractic care, lifestyle recommendations, and stress management techniques [6]. 4. Allergy Management: Identifying and managing allergies that contribute to sinus inflammation through lifestyle changes and possibly allergy treatments [2]. 5. Hydration and Humidification: Encouraging proper hydration and the use of humidifiers to keep the sinuses moist and reduce congestion [5]. 6. Nasal Irrigation: Recommending saline nasal sprays or neti pots to clear the nasal passages and reduce sinus pressure [1]. 7. Lifestyle Modifications: Advice on maintaining a balanced lifestyle, including proper nutrition and regular physical activity to support overall health and reduce sinus headaches [7]. Preventing Sinus Headaches Preventive strategies for sinus headaches include: Avoiding Triggers: Identifying and avoiding known allergens and irritants. Hydration: Maintaining adequate hydration to keep mucus thin and flowing [6]. Humidification: Using a humidifier to add moisture to the air, especially during dry seasons [5]. Allergy Management: Regularly managing allergies with medications or lifestyle changes [2]. Proper Hygiene: Practicing good hygiene to prevent infections, such as frequent hand washing and avoiding close contact with sick individuals [4]. Importance of Chiropractic Care Chiropractic care at Georgia Upper Cervical is crucial in addressing the root causes of sinus headaches. By ensuring proper alignment of the cervical spine and improving sinus drainage, we can reduce the frequency and severity of headaches. Our approach is gentle, patient-centric, and focused on long-term relief [1][6]. Accepting New Patients in Ball Ground, GA Georgia Upper Cervical is now accepting new patients in Ball Ground, GA. Our team is dedicated to providing holistic, effective treatment for sinus headaches and other conditions. If you are suffering from sinus headaches, we invite you to visit us and take the first step towards lasting relief. Stop Sinus Headaches From Interrupting Your Life Sinus headaches are a common condition that can significantly impact daily life. Understanding the symptoms, causes, and treatment options is crucial for effective management. At Georgia Upper Cervical, we specialize in providing gentle, non-invasive chiropractic care tailored to each patient's unique needs. Our comprehensive approach includes thorough diagnostics, personalized treatment plans, and lifestyle recommendations to help patients achieve lasting relief from sinus headaches. If you are experiencing sinus headaches and are looking for a holistic approach to treatment, contact Georgia Upper Cervical today. Our team of experts is dedicated to helping you achieve optimal health and well-being through gentle, effective chiropractic care. Don't let sinus headaches control your life – take the first step towards lasting relief and improved quality of life with Georgia Upper Cervical. --- Sources 1. National Headache Foundation. Sinus Headaches. Full text: https://headaches.org/2020/07/16/sinus-headache/ 2. Mayo Clinic. Sinus Headache. Full text: https://www.mayoclinic.org/diseases-conditions/sinus-headache/symptoms-causes/syc-20351996 3. Cleveland Clinic. Sinus Headache. Full text: https://my.clevelandclinic.org/health/diseases/9637-sinus-headaches 4. WebMD. Sinus Headaches: Symptoms, Causes, and Treatments. Full text: https://www.webmd.com/migraines-headaches/sinus-headaches 5. Healthline. Sinus Headaches: Symptoms, Causes, and Treatment. Full text: https://www.healthline.com/health/sinus-headache 6. Harvard Health Publishing. Sinus Headaches. Full text: https://www.health.harvard.edu/a_to_z/sinus-headaches-a-to-z 7. American Migraine Foundation. Sinus Headache. Full text: https://americanmigrainefoundation.org/resource-library/sinus-headache/
What are Cluster Headaches and What Do They Mean? Cluster headaches are one of the most severe types of headaches, characterized by intense pain on one side of the head, often around the eye. They occur in cyclical patterns or clusters, hence the name. These headaches can significantly disrupt daily life due to their severity and frequency. Unlike other types of headaches, cluster headaches are known for their excruciating pain and sudden onset, making them a debilitating condition for those affected. Symptoms of Cluster Headaches Cluster headaches present with a distinct set of symptoms, some of which are often unrecognized or uncommon. Common symptoms include: Intense Pain: Severe, burning, or piercing pain typically located around or behind one eye. This pain can radiate to other areas of the face, head, neck, and shoulders [3]. Redness and Tearing: The eye on the affected side may become red and tear excessively [4]. Nasal Congestion or Runny Nose: Often on the same side as the pain [3]. Swelling Around the Eye: The eyelid may droop, and there can be noticeable swelling [3]. Restlessness: Patients often feel agitated and unable to sit still during an attack [2]. Sweating: Excessive sweating on the forehead or face [3]. Pupil Constriction: The pupil may become smaller on the affected side [3]. Uncommon Symptoms Some symptoms of cluster headaches are less commonly recognized but are crucial for diagnosis: Horner's Syndrome: A condition that includes ptosis (drooping eyelid), miosis (pupil constriction), and anhidrosis (lack of sweating) on one side of the face [5]. Ear Fullness: A sensation of fullness or pressure in the ear on the affected side [3]. Facial Flushing: Reddening of the skin on the affected side of the face [3]. How Cluster Headaches Affect Different Parts of the Body While the primary pain is concentrated around the eye, cluster headaches can cause a ripple effect throughout the body. The intensity of the pain can lead to tension in the neck and shoulders. The autonomic symptoms (like tearing and nasal congestion) can affect the sinuses and respiratory system. Additionally, the stress and anxiety associated with anticipating an attack can have widespread effects on overall health, including cardiovascular and mental health impacts. Factors / Causes of Cluster Headaches The exact cause of cluster headaches remains unclear, but several factors are believed to contribute: Hypothalamus Dysfunction: The hypothalamus, a part of the brain that regulates biological rhythms, is thought to play a role [3]. Genetics: A family history of cluster headaches can increase the likelihood of developing the condition [3]. Triggers: Alcohol, tobacco, strong smells, and high altitudes can trigger attacks [3]. Differentiating Between Cluster Headaches and Other Types Cluster headaches need to be distinguished from other types of headaches to ensure proper treatment. Other common types of headaches include: Migraines Tension Headaches Sinus Headaches While migraines and tension headaches can be debilitating, the intensity and cyclical nature of cluster headaches, along with their specific symptoms, set them apart. Sinus headaches involve pressure and pain in the sinus areas but do not typically include the severe eye pain and autonomic symptoms seen in cluster headaches [3]. Diagnosing Cluster Headaches Diagnosing cluster headaches involves a thorough evaluation, as their symptoms can sometimes overlap with other conditions. Key diagnostic steps include: Medical History: Detailed patient history, including the frequency, duration, and nature of the headaches [6]. Symptom Assessment: Evaluation of specific symptoms, particularly those unique to cluster headaches [6]. Physical Examination: Checking for autonomic signs and other associated symptoms [3]. Imaging Studies: MRI or CT scans to rule out other potential causes of the headaches, such as tumors or vascular abnormalities [3]. Commonly Missed Signs and Symptoms Certain symptoms can be easily overlooked but are critical for a correct diagnosis: Restlessness and Agitation: Unlike other headaches where patients prefer to lie down, those with cluster headaches often pace or move around [2]. Autonomic Symptoms: Redness, tearing, and nasal congestion are key signs that differentiate cluster headaches from other types [2]. Typical Treatments for Cluster Headaches Treatment for cluster headaches typically involves managing acute attacks and preventing future episodes. At Georgia Upper Cervical, we emphasize the importance of chiropractic care in treating cluster headaches by addressing the root of the problem. Treatment Options at Georgia Upper Cervical 1. Gentle Chiropractic Adjustments: We provide precise, gentle adjustments to the upper cervical spine to relieve tension and improve nerve function. Our methods avoid the cracking or popping commonly associated with traditional chiropractic treatments, focusing instead on subtle corrections that yield significant results. 2. Thorough X-Rays: Comprehensive x-rays help us assess the alignment of the cervical spine and tailor a treatment plan specific to the patient's needs. 3. Personalized Treatment Plan: Based on diagnostic findings, we create a customized treatment plan that includes chiropractic care, lifestyle recommendations, and stress management techniques. 4. Stress Management Techniques: Guidance on stress reduction methods such as mindfulness, relaxation exercises, and time management strategies to help prevent cluster headaches. 5. Posture Correction: Assessment and recommendation of ergonomic adjustments to reduce muscle strain and tension. 6. Physical Therapy: Targeted exercises and stretches to strengthen neck and shoulder muscles, reducing the frequency and intensity of headaches. 7. Lifestyle Modifications: Advice on maintaining a balanced lifestyle, including proper hydration, nutrition, and regular physical activity to prevent headaches [1]. Preventing Cluster Headaches Preventive strategies are essential for managing cluster headaches: Avoiding Triggers: Identifying and avoiding known triggers such as alcohol and tobacco. Maintaining a Routine: Keeping a regular sleep schedule and meal times. Stress Management: Implementing techniques to manage stress effectively [4]. Importance of Chiropractic Care Chiropractic care at Georgia Upper Cervical is crucial in addressing the root causes of cluster headaches. By ensuring proper alignment of the cervical spine and improving nerve function, we can reduce the frequency and severity of headaches. Our approach is gentle, patient-centric, and focused on long-term relief [1]. Accepting New Patients in Ball Ground, GA Georgia Upper Cervical is now accepting new patients in Ball Ground, GA. Our team is dedicated to providing holistic, effective treatment for cluster headaches and other conditions. If you are suffering from cluster headaches, we invite you to visit us and take the first step towards lasting relief. Find Relief for Your Cluster Headaches Cluster headaches are a debilitating condition that requires a nuanced approach for effective management. Understanding the symptoms, causes, and treatment options is crucial for those affected. At Georgia Upper Cervical, we specialize in providing gentle, non-invasive chiropractic care tailored to each patient's unique needs. Our comprehensive approach includes thorough diagnostics, personalized treatment plans, and lifestyle recommendations to help patients achieve lasting relief from cluster headaches. If you are experiencing cluster headaches and are looking for a holistic approach to treatment, contact Georgia Upper Cervical today. Our team of experts is dedicated to helping you achieve optimal health and well-being through gentle, effective chiropractic care. Don't let cluster headaches control your life – take the first step towards lasting relief and improved quality of life with Georgia Upper Cervical [7]. --- Sources 1. National Headache Foundation. Cluster Headaches. Full text: https://headaches.org/2020/07/16/cluster-headache/ 2. American Migraine Foundation. Cluster Headache. Full text: https://americanmigrainefoundation.org/resource-library/cluster-headache/ 3. Mayo Clinic. Cluster headache. Full text: https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080 4. Cleveland Clinic. Cluster Headache. Full text: https://my.clevelandclinic.org/health/diseases/9638-cluster-headaches 5. Silberstein SD. “Cluster Headache.” UpToDate. Full text: https://www.uptodate.com/contents/cluster-headache 6. Dodick, D. W. (2018). Cluster headache. BMJ, 361, k1652. Full text: https://www.bmj.com/content/361/bmj.k1652 7. Burish, M. J., Pearson, S. M., & Shapiro, R. E. (2021). Cluster headache is one of the most painful conditions. BMJ, 374, n2025. Full text: https://www.bmj.com/content/374/bmj.n2025
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