Many people complain of feeling dizzy after Epleys. The Epley maneuver is a common treatment used for posterior canal BPPV.

In this blog, I will share six reasons you may be feeling dizzy after doing Epley maneuvers for treatment of posterior canal BPPV.

Why You May Still Feel Dizzy After Epley Maneuver

Posterior Canal BPPV Not Fully Cleared

Even though posterior canal BPPV typically causes spinning vertigo in certain triggering positions, mild cases of lingering BPPV can cause dizziness without spinning.

Patients with mild posterior canal BPPV typically get dizzy during BPPV test testing and improve with traditional BPPV treatment.

The simple solution in this case is to do one or two more treatment sessions, or home exercise sessions, to completely resolve the posterior canal BPPV all the way.

Since BPPV has such a high success rate with proper treatment, the prognosis for this potential root cause of feeling dizzy after Epleys is good for a full resolution.

If Epleys don’t resolve the posterior canal BPPV entirely, patients may benefit from other maneuvers for posterior canal BPPV such as the Semont maneuver or Bow & Yaw maneuver.

Read more about Posterior Canal BPPV Variants.

Horizontal Canal Conversion After Epley

There are many potential complications to BPPV treatment, which is why I do not recommend for patients to attempt to treat themselves without professional supervision.

Some patients are left feeling dizzy after Epleys due to a “canal conversion.” This is one example of a BPPV treatment complication.

In this example, BPPV crystals can convert from the posterior canal to the horizontal canal during the Epley maneuver.

This is more likely if an Epley maneuver is done incorrectly by a novice clinician or a patient attempting to treat themselves without proper instruction. However, this complication can also arise during treatment with an experienced vestibular clinician.

A canal conversion into the horizontal canal is one possible cause of feeling dizzy after Epleys. In that case, an experienced vestibular clinician will be able to assess the patient for horizontal canal BPPV and use appropriate, different maneuvers to resolve that problem.

The prognosis for this case is still a full resolution with proper vestibular care.

Read More about Horizontal Canal BPPV.

Anterior Canal Conversion and Dizziness

While a patient has posterior canal BPPV, their normal activities of daily living can possibly convert some crystals from the posterior canal into the anterior canal.

Common activities that can convert posterior canal BPPV crystals into the anterior canal include flipping your head upside down to towel your head after a shower, blow drying or styling your hair upside down, forward bending all the way to touch your toes, doing back flips in pool, and bending way down to pick stuff up off the floor or clean up after a dog.

Anterior canal conversions have a good prognosis for full recovery, if the clinician is able to pick up on it, but may go undiagnosed.

One problem patients may have if they develop anterior canal BPPV during their normal activities is that many younger vestibular clinicians are not even aware it exists.

This can be a potential cause of feeling dizzy after Epleys. The posterior canal may now be all the way clear but patients can still have some crystals in the anterior canal which have not been identified or treated.

Unbelievable right?

I share more about anterior canal BPPV in this blog and explain why so many clinicians don’t think it exists.

Hint: It does exist!

Upper Cervical Dizziness Triggered by Epley Maneuvers

Another cause of feeling dizzy after Epleys is that this particular maneuver can cause or exacerbate upper cervical dizziness.

Upper cervical dizziness commonly co-occurs with BPPV. Upper cervical dizziness commonly results from BPPV treatments like Epley maneuvers and Semont maneuvers.

This can affect people with no prior history of neck pain or problems with their neck. I commonly find this as a root cause of dizziness after Epleys, especially in patients who have done a lot of Epley maneuvers – or repeated Epleys multiple times.

If patients have pre-existing neck stiffness, pain, or tension headaches, then Epleys are more likely to exacerbate upper cervical dizziness.

Patients with a history of whiplash, head trauma, and neck pathology, like disc issues or spinal stenosis, are especially susceptible to upper cervical dizziness after Epleys.

Learn more about Upper Cervical Dizziness.

Find out who can help with Upper Cervical Dizziness.

Maladaptive Neuroplasticity and Residual Dizziness

A patient can have residual dizziness for weeks after BPPV is successfully treated due to maladaptive neuroplasticity.

In this case of residual dizziness, patients are feeling dizzy after Epleys but they may not have any lingering BPPV.

Their symptoms are considered “motion sensitivity.”

This especially occurs in patients who have had chronic BPPV for years and carried on with normal life.

The brain has adapted to living with BPPV. The brain created new pathways to process vestibular input and stabilize the patient over the years while living with BPPV.

This process in the brain is called neuroplasticity. It’s the natural and beneficial process of building new pathways within the brain to accomplish certain tasks like movement, limb coordination, vision, balance, walking, etc.

However, when you are living with BPPV, your brain has created new pathways to adapt to “something bad.”

We call this process maladaptive neuroplasticity. It was necessary to continue to function while living with BPPV.

However, these new pathways in the brain are well worn in chronic cases, having been used for years. Then it will take days to weeks for the brain to change pathways again after BPPV is resolved.

In this case, the prognosis is still good over time, but daily movement is beneficial to drive neuroplasticity after the BPPV is resolved.

You kept moving with chronic vertigo, so keep going now that it’s resolved and the motion sensitivity should fade out as neuroplasticity is accomplished again without BPPV.

Vestibular physical therapy can help with habituation exercises if needed, but many patients can accomplish a full recovery through normal activities of daily living after BPPV is cleared.

Patients who sit in a recliner all day, or don’t move around very much, may never accomplish the neuroplasticity required to fully recover from leftover motion sensitivity after BPPV is resolved.

Therefore, maladaptive neuroplasticity can be responsible for residual dizziness lasting for weeks after BPPV is resolved.

For sedentary patients, this can last much longer.

For other possible barriers to vestibular recovery, click here.

Unrelated Medical Conditions Can Cause Dizziness After Epley

It’s important to keep in mind that patients often have more than one root cause of dizziness.

Therefore, I always recommend talking to your primary care provider about your current symptoms.

If you are still feeling dizzy after Epleys, you may have an unrelated medical problem.

For example, medication side effects, medication interactions, thyroid issues, cardiac issues, and dehydration are all potential unrelated medical causes of feeling dizzy after Epleys.

Talk to your doctor so you can rule out or get appropriate medical management for any unrelated medical problems.