What if the Epley manoeuvre does not relieve vertigo?

The Epley manoeuvre targets a specific form of positional vertigo. Continuing spinning can mean the affected ear was not correctly identified, particles are in a different canal, or the vertigo is related to migraine, an inner-ear condition or another balance problem. The word vertigo describes a sensation, not one single diagnosis.

Record whether turning in bed, looking up or standing triggers the episodes. Include their duration and any hearing change, ringing, headache, nausea or unsteadiness. These details help separate brief position-triggered attacks from symptoms that need a broader assessment.

Book an assessment rather than repeatedly performing the manoeuvre without guidance. Until then, rise slowly, hold a stable surface when walking and avoid driving or climbing if spinning is unpredictable. Keep hydrated if nausea has made drinking difficult, taking small sips as tolerated.

Bring a record of the manoeuvre, the side treated and the movements that provoke symptoms. A clinician may examine eye movements, balance and hearing before recommending another repositioning technique or a different plan.

Get emergency help for vertigo with facial weakness, one-sided weakness or numbness, difficulty speaking, sudden vision loss, fainting, severe new headache, chest pain or inability to walk. Seek prompt medical care for sudden hearing loss, severe vomiting, fever, a recent head injury or rapidly worsening symptoms.

Is this positional vertigo, and does the affected side need confirming? Could migraine or an inner-ear problem be involved? Do my hearing or balance need testing? Should I avoid any position or activity until the vertigo settles?