Still dizzy after Epley? What's normal and what isn't

Being still dizzy after Epley treatment is common, even when the maneuver worked. The big spinning spells stop, but you may feel off balance, a little motion-sick or touchy about movement for a while. The US ear, nose and throat doctors' society (AAO-HNS) says these milder symptoms can take a few days to a few weeks to fade, and that moving normally, as far as you safely can, helps. What isn't normal is spinning that keeps coming back with the same moves, dizziness that gets worse, or any new symptom. Those need your clinician, and some need 911.

Why am I still dizzy after Epley?

There are two different feelings here, and it helps to tell them apart.

The first is the spinning spell. It comes on when you lie down, roll over or look up, and VeDA says it normally lasts less than a minute. Loose crystals moving in an inner-ear canal cause it. If the Epley worked, those spells should be greatly reduced or gone.

The second is a background feeling. You may feel swimmy, unsteady on your feet, a bit queasy in the car, or uneasy when you turn your head fast. The Vestibular Disorders Association (VeDA) says that even after the crystals are back where they belong and the spinning has stopped, people often feel some mild sensitivity to motion and unsteadiness. The AAO-HNS says there can be significant leftover dizziness even after the crystals have been moved correctly.

So a background wobble on its own usually means you're recovering, not that the Epley failed. Your brain had weeks of false signals from one ear, and it takes time to trust that ear again.

How long does dizziness last after the Epley maneuver?

The AAO-HNS gives two time frames:

• Right after treatment, some people clear at once. Others have motion-sick feelings and mild unsteadiness for a few hours or a few days.
• Feeling a little sensitive to movement, or unsteady at times, can take a few days to a few weeks to go away.

Feeling dizzy the day after the Epley maneuver fits the first time frame. Being a bit off for two or three weeks fits the second. The AAO-HNS says to follow up with your clinician or physical therapist if the dizziness or unsteadiness isn't getting better in a few days to a couple of weeks. It adds that older adults who have fallen, or are afraid of falling, may need more exercises or balance therapy to clear it completely.

What helps leftover dizziness fade

Movement, done safely. The AAO-HNS says that once your symptoms are easing, you should go back to the normal activities you can do safely, because exposure to motion and movement speeds healing. So there's little to gain from keeping your head stiff or staying in bed.

Things that fit that advice:

1. Walk every day, indoors or out, starting with short, flat routes. Have someone with you at first if you feel unsteady.
2. Do your usual chores, slowly at first, and let yourself turn your head while you do them.
3. Ask about a vestibular therapist. VeDA says follow-up with a vestibular therapist matters here, because they can check the leftover dizziness and teach home exercises that usually correct it quickly. The 2017 US guideline lists vestibular rehabilitation, done with a clinician or on your own, as an option in BPPV treatment.
4. Protect yourself from falls while your balance catches up. Cleveland Clinic suggests moving slowly when you stand up or turn your head, turning on the lights if you get up at night, and using a cane if you feel you might fall.
5. Don't drive while you're dizzy. Cleveland Clinic says not to drive when you have vertigo.

Don't take anti-dizziness pills just to get through this stage unless your doctor prescribed them for you. The 2017 guideline recommends against routinely treating BPPV with these medicines. Medicine questions go to your doctor or pharmacist.

Feeling more dizzy after the Epley maneuver

Some people feel worse for a day after the maneuver. That fits the few-hours-to-few-days window above. But if the true spinning spells are still there after the first few days, with the same moves setting them off, the BPPV may not have cleared.

The AAO-HNS lists the usual reasons:

• Many people need more than one session to get the crystals back in place.
• There are several kinds of BPPV, and some need a different maneuver. The home Epley is designed for the most common kind.
• The crystals can be in more than one canal, or in both ears.
• It's hard to get the positions exactly right on your own.

VeDA says the Epley works for only four of the twelve typical kinds of BPPV, and that people sometimes try it without success and later learn they needed a different maneuver, or didn't have BPPV at all.

So don't keep repeating rounds or switch sides on your own. Call your clinician. The 2017 guideline tells clinicians to reassess you within a month of treatment and to check anyone with lasting symptoms for BPPV that hasn't cleared or for another inner-ear or brain problem. If you want to recheck the steps you were taught, the guide on the Epley maneuver at home explains why the side and canal must come from an exam.

When it means something else

BPPV has a clear pattern. VeDA says it does not cause constant dizziness that's there even when you keep still, and it doesn't affect your hearing or cause fainting, headache, numbness, pins and needles, trouble speaking or clumsy movements. If any of those show up, tell your clinician right away.

A few other patterns to report:

• Feeling lightheaded or faint, especially when you stand. That's a different feeling from spinning and has other causes your doctor should check.
• Dizziness or unsteadiness on most days for 3 months or more, worse when you stand, move, ride in a car or look at busy patterns or screens. VeDA describes this as persistent postural-perceptual dizziness, or PPPD, and lists BPPV as one of the problems that can set it off. It's a real condition, a doctor makes the diagnosis, and vestibular therapy is one of the treatments.
• Dizziness that keeps returning, with no clear cause. Mayo Clinic says to see a professional for any repeated, sudden, severe or long-lasting dizziness with no clear cause.

What to tell your clinician

Short, specific reports help your clinician tell leftover dizziness from BPPV that hasn't cleared.

• "The spinning still comes when I lie down on my right side, the same as before the Epley."
• "I'm more dizzy now than before the treatment, and it's been five days."
• "It's not spinning anymore. It's a rocking feeling most of the day, and supermarkets make it worse."
• "Could I see a vestibular therapist for the balance part?"

When to get help now

Mayo Clinic and Cleveland Clinic both list these signs alongside dizziness as reasons for emergency care. Cleveland Clinic adds that if no one can drive you, you should call 911.

Questions people ask

Is it normal to feel lightheaded after the Epley maneuver?

A swimmy, off-balance feeling for a few days is common. Feeling faint, as if you might pass out, is different. Sit or lie down, and tell your doctor. If you actually faint, call 911.

Can the Epley maneuver make vertigo worse?

The maneuver sets off spinning on purpose, and you may feel queasy or unsteady for a few hours or days afterwards. If you feel clearly worse after that, or the spinning has changed, call your clinician. Sometimes the crystals need another round or a different maneuver.

What exercises help residual dizziness after BPPV?

Daily walking and your normal safe activities are a start, according to the AAO-HNS. For targeted balance and head-movement exercises, ask for a vestibular therapist, who will choose the exercises and the dose for you.

How long does residual dizziness after BPPV last?

The AAO-HNS says a few days to a few weeks. If it isn't improving after a couple of weeks, follow up. If it's still there on most days at 3 months, ask about PPPD.