After your Epley manoeuvre — patient information leaflet

 What this leaflet tells you

This leaflet explains what to expect after the Epley (canalith repositioning) manoeuvre for posterior-canal BPPV, what you should and shouldn’t do, and when to seek help.

 

1. Quick summary — what the Epley did

The manoeuvre moves tiny particles (otoconia) out of the balance canal of your inner ear and back into a place where they don’t cause spinning (vertigo). Most people feel much better after one or a few treatments. However BPPV can come back (recurrence is common).

 

2. How you may feel immediately afterwards

You may feel dizzy or off-balance for a few minutes to a few hours; nausea is possible.

 Some people feel better straightaway; others get gradual improvement over days.

 Rarely ,you may have brief recurrences of vertigo — this does not always mean the manoeuvre failed.

 

3. Activity and posture — what the evidence says

Good news: High-quality studies and recent guidelines show that strict head-position or bed-rest restrictions after a successful Epley are not routinely necessary and do not clearly improve long-term outcome. You do not have to remain upright all day or wear a neck collar. 

Some older studies suggested sleeping with the head slightly elevated or avoiding the affected side might reduce early recurrence; overall evidence is inconsistent. Simple, reasonable precautions can be offered, but rigid restrictions are generally unnecessary.

 

4. Practical post-Epley advice 

Return to normal activities as you feel able. Gentle walking and light household activities are fine.

 Avoid dangerous activities while dizzy: don’t drive, operate heavy machinery, climb ladders, or swim alone until your balance and symptoms have settled. If you feel dizzy, get help with the stairs.

 Sleep: no strict rule — you may sleep normally. If you prefer, sleeping with a small extra pillow to keep your head slightly elevated for 1–2 nights is reasonable, but not required. Avoid sleeping on the side that caused your vertigo if that feels safer to you. 

Avoid rapid head-turns and sudden bending for 24–48 hours if it makes you feel dizzy; otherwise, gentle movements are fine.

 Medication: anti-nausea medicines (e.g., cyclizine) or short-term vestibular suppressants may be used if necessary for nausea/dizziness, but they do not treat the underlying BPPV and should not be used long-term.

 

5. If symptoms persist or recur

If vertigo or severe balance problems continue after 1–2 weeks, contact the clinic for review — you may need repeat repositioning or further tests.

BPPV recurs in a significant minority of patients; if it comes back the same treatment is usually effective. Typical recurrence rates reported ~30–40% over months to years.

 

6. Home exercises (if you have ongoing mild positional dizziness)

Brandt–Daroff exercises can be done at home to reduce positional dizziness if symptoms persist between clinic visits or while waiting for a review. Your clinician can show you how; if you’d like, we can give you illustrated instructions. Guidelines recommend these exercises as an option for ongoing symptoms.

Brandt–Daroff Exercises

These exercises help your brain get used to changes in head position and reduce dizziness.

1. Sit upright on the edge of your bed.

2. Quickly lie down on one side, nose pointed up at about 45 degrees. Stay for 30 seconds.

3. Return to sitting for 30 seconds.

4. Repeat on the other side.

5. Do 5 cycles, 2–3 times daily. 

7. When to seek urgent help

Call your clinic, your GP or emergency services if you have any of the following after the manoeuvre:

Severe, new-onset headache, double vision, weakness, numbness or difficulty speaking.

Sudden significant change in hearing (rapid loss), severe vomiting you can’t control, or fainting.

If you are unable to walk safely on your own because of dizziness.

These symptoms are uncommon but need assessment to exclude other causes.

 

8. Follow-up

We usually ask patients to return after 1–4 weeks if symptoms continue, or earlier if symptoms are severe. If you improve but later have recurrent vertigo, you can return for another assessment — repeat canalith repositioning manoeuvres work well.

 

9. Short list of things that may increase the chance of recurrence

Medical conditions such as migraine, neck/spine problems, low vitamin D, cardiovascular disease, or prior head injury have been associated with higher BPPV incidence or recurrence in some reviews. Managing general health and any treatable risk factors may help overall, but recurrence is still common even without these.

10. Questions or concerns

If you’re unsure about any symptoms, or want a leaflet with diagrams of Brandt–Daroff exercises or the Epley manoeuvre, please contact:

Mr Gaurav Kumar

Consultant Ear Nose Throat Surgeon

Consulting at 

Spire London East, Spire 

Hartswood Brentwood, 

Nuffield Health Brentwood 

Queens Hospital Romford East London.

 

We are also offering Telephone consultations.

 To book an appointment, visit https://entsurgeonclinic.co.uk/

Evidence & guidance used to make this leaflet (selected sources)
Cochrane Review: Epley (canalith repositioning) manoeuvre for posterior canal BPPV.
Cochrane Library
 AAO-HNS / Clinical practice guidance on BPPV (diagnosis & management).
AAO-HNS
Studies and meta-analyses on post-manoeuvre postural restrictions show limited/ inconsistent benefit.
PMC
Lippincott Journals
Recent systematic reviews/meta-analyses summarising efficacy and recurrence.