Vertigo and the Epley Maneuver: Why It May Not Work and What to Do Next

Experiencing vertigo can be disorienting and distressing, as the sensation of spinning can severely impact your daily life. For many, the Epley Maneuver is a go-to treatment for vertigo. However, the Epley Maneuver is usually effective for only one type of vertigo: benign paroxysmal positional vertigo (BPPV). So what happens when the Epley Maneuver doesn’t work? In this blog, we’ll explore the reasons why this might occur, discuss the different types of vertigo, and delve into alternative approaches like upper cervical chiropractic care that can provide relief when the Epley Maneuver fails.

Understanding Vertigo and Dizziness: Not the Same Thing

Before discussing why the Epley Maneuver might not work, it’s essential to understand the difference between vertigo and dizziness. While these terms are often used interchangeably, they refer to distinct sensations:

• Vertigo is the sensation that you or your surroundings are spinning or moving, even when you are still. This sensation is usually caused by issues within the inner ear or the vestibular system, which controls balance.
• Dizziness, on the other hand, is the feeling that you are lightheaded, unsteady, or that you might faint. The world around you seems stable, but you feel off-balance or as though you are on a rocking boat.

The Epley Maneuver is specifically designed to treat a type of vertigo known as BPPV. If you’re experiencing dizziness rather than vertigo, the Epley Maneuver won’t be effective because dizziness and vertigo have different underlying causes.

 

The Epley Maneuver and BPPV: A Specific Solution for a Specific Problem

BPPV is one of the most common causes of vertigo, accounting for around 85% of cases involving the posterior semicircular canal, one of three canals in the inner ear that help regulate balance. BPPV occurs when tiny crystals (otoconia) in the inner ear become dislodged from their usual position in the vestibule and move into the semicircular canals. This displacement causes the sensation of spinning when you move your head.

The Epley Maneuver is a series of head and body movements that aim to move these crystals back to their original position, where they no longer cause vertigo. While the Epley Maneuver is highly effective for BPPV, it doesn’t work for all cases of vertigo. Here’s why:

1. It’s Not BPPV

Not all vertigo is caused by BPPV. Other types of vertigo can result from different conditions, such as vestibular neuritis or Meniere’s disease. These conditions do not involve dislodged crystals, so the Epley Maneuver won’t help. Proper diagnosis is crucial to determine whether your vertigo is due to BPPV or another condition.

To diagnose BPPV, healthcare professionals use a combination of tests, including the Dix-Hallpike Maneuver, the Roll Test, and the Bow and Lean Test. A key indicator of BPPV is nystagmus, a rapid flickering of the eyes that occurs when the head is moved in a way that triggers the dislodged crystals. If nystagmus is absent, it might indicate that your vertigo is not caused by BPPV, or that the condition has resolved but other issues are contributing to your symptoms.

2. BPPV in the Wrong Canal

While 85% of BPPV cases involve the posterior semicircular canal, vertigo can also be caused by dislodged crystals in the anterior or horizontal semicircular canals. The Epley Maneuver is designed specifically for the posterior canal. If the crystals are in one of the other canals, the maneuver won’t work effectively. In such cases, different maneuvers might be necessary to reposition the crystals in the correct canal.

 

What If It’s Not BPPV? Exploring Other Causes of Vertigo

When the Epley Maneuver doesn’t work, it’s time to consider other potential causes of vertigo:

1. Viral Infection (Vestibular Neuritis):

Vestibular neuritis is an inflammation of the vestibular nerve, often caused by a viral infection. This condition can lead to vertigo, but it typically resolves within a few days to a week as the inflammation subsides. Antiviral medications are usually ineffective because the primary issue is swelling, not the virus itself. In such cases, a short course of prednisone, a corticosteroid, may help reduce the inflammation and alleviate symptoms.

2. Structural Issues (Chiari Malformation or Cerebellar Ectopia):

In some cases, vertigo may be caused by structural issues within the brain, such as Chiari malformation or cerebellar ectopia. These conditions involve the displacement of brain tissue into the spinal canal, which can affect the function of the cerebellum—the part of the brain that helps control balance. Symptoms can include vertigo, headaches, and nausea, particularly when extending the neck. If these conditions are suspected, an MRI may be necessary to rule out or confirm the diagnosis.

3. Concussion or Whiplash:

Concussions and whiplash injuries can also lead to vertigo, although symptoms might not appear until weeks or even months after the initial trauma. Injuries can also happen with as little as 10mph! These injuries can disrupt the function of the vestibular system or cause damage to the upper cervical spine, which can, in turn, affect balance and coordination. In these cases, treating the underlying injury is crucial for resolving vertigo symptoms.

When the Epley Maneuver Fails: The Role of Upper Cervical Chiropractic Care

If the Epley Maneuver doesn’t work for you, or if your vertigo is caused by something other than BPPV, upper cervical chiropractic care may offer a solution. The upper cervical spine, which consists of the atlas (C1) and axis (C2) vertebrae, plays a critical role in maintaining balance and equilibrium. Misalignments or injuries in this area can disrupt the flow of information between the brain and the body, leading to vertigo and other balance issues.

1. The Connection Between the Upper Neck and Balance:

The balance centers of the brain require a large amount of information from three primary sources:

1. The vestibular system (including the semicircular canals)
2. The eyes
3. The proprioceptive input from the body (especially from the ankles, temporomandibular joint (TMJ), and upper neck).

When the upper cervical spine is misaligned due to injury or wear and tear (or a connective tissue disorder such as Ehlers-Danlos Syndrome), it can transmit incorrect information to the brain, leading to dizziness, vertigo, and other related symptoms.

Upper cervical chiropractors specialize in identifying and correcting these misalignments without the use of forceful twisting, cracking, or popping. Techniques like the Blair method focus on restoring proper alignment to the upper cervical spine, which can help resolve vertigo and balance issues by allowing the brain to receive accurate information from the body.

2. Cerebrovascular Flow and Vertigo:

Misalignments in the upper cervical spine can also affect blood flow to and from the brain. The internal carotid artery, vertebral artery, and internal jugular vein are all located near the upper cervical spine. If these structures are compressed or otherwise compromised due to a misalignment (including a condition known as Eagle’s Syndrome), it can lead to abnormal fluid flow or pressure within the cranial vault, making the vestibular system more susceptible to injury. In such cases, correcting the misalignment can improve cerebrovascular flow and reduce vertigo symptoms.

3. Comprehensive Testing and Treatment:

To determine whether upper cervical chiropractic care is right for you, a thorough evaluation is necessary. This includes balance tests to identify the side and cause of the problem:

1. Neurological tests to assess the function of the neck
2. Diagnostic imaging (such as digital motion X-rays or CBCT scans) to pinpoint the exact location and direction of the misalignment.

Once the underlying issue is identified, a personalized treatment plan can be developed to restore normal function and alleviate vertigo symptoms.

Conclusion: Finding Relief When the Epley Maneuver Doesn’t Work

While the Epley Maneuver is an effective treatment for BPPV, it isn’t a one-size-fits-all solution for vertigo. If the maneuver doesn’t work for you, it’s essential to explore other potential causes of your symptoms and consider alternative treatments. Upper cervical chiropractic care offers a non-invasive, targeted approach to resolving vertigo by addressing underlying misalignments in the upper cervical spine that may be contributing to your symptoms.

If you’ve been struggling with vertigo and the Epley Maneuver hasn’t provided relief, consider consulting with an upper cervical chiropractor. With the right diagnosis and treatment, you can find the relief you need and regain your balance and stability.

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