Canalith Repositioning Procedure (Epley Maneuver): How It Treats BPPV Vertigo

Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review

Quick Answer: What is the canalith repositioning procedure?

The canalith repositioning procedure (CRP) is a series of guided head and body movements that moves loose calcium carbonate crystals out of an inner ear canal to treat benign paroxysmal positional vertigo (BPPV). The Epley maneuver is the best-known version, takes about 5 to 10 minutes and relieves symptoms in about 8 out of 10 people. [1]

What the research says

• The Epley maneuver clearly beats no treatment. A pooled analysis of 4 randomized trials (251 adults with posterior canal BPPV) found people treated with the Epley were about 7 times more likely to have their vertigo fully resolve at 1 week (odds ratio 7.19). Treating 3 people led to 1 extra cure, and no serious side effects were reported. (Khoujah et al., Acad Emerg Med, 2023) [2]

• The Epley ranks first among repositioning maneuvers. A network meta-analysis of 20 randomized trials (2,089 patients) ranked the Epley highest for overall effectiveness. The Epley and Semont maneuvers had the best cure rates, and nausea, vomiting and dizziness did not differ significantly between the Epley, Semont and Brandt-Daroff maneuvers. (Xin et al., Front Neurol, 2026) [3]

• A properly taught self-Epley worked as well as one done by a clinician. In a randomized trial of 64 patients, 90.6% of those doing a twice-daily self-Epley at home (after written instructions, a video and one supervised try) were cured at 1 week, compared with 87.5% of those treated by a clinician, with no significant difference. (Kulthaveesup & Bunnag, Am J Otolaryngol, 2023) [4]

Key takeaways

• CRP treats one specific cause of vertigo: BPPV, the most common type of vertigo.

• The Epley maneuver is the most widely used CRP and is often the first treatment tried.

• It helps about 8 out of 10 people with BPPV, and many feel better right away.

• One session takes about 5 to 10 minutes and may need to be repeated.

• You can learn to do it at home, but get shown the correct movements first.

• Ask your provider before trying it if you have neck or back injuries, retinal detachment or vascular disease.

Loose crystals in a semicircular canal cause BPPV. The repositioning procedure moves them back to the utricle, where they belong.

What is a canalith repositioning procedure?

A canalith repositioning procedure is a treatment for benign paroxysmal positional vertigo (BPPV) that uses a set of head movements to move displaced ear crystals back where they belong. [1]

BPPV causes short bursts of vertigo when you move your head and body. Common triggers include lying down, rolling over in bed or bending over. The best-known CRP is the Epley maneuver. Because it relieves symptoms in about 8 out of 10 people, it is often the first line of treatment for BPPV. [1]

To understand the condition itself, read our full guide to vertigo (BPPV): symptoms, causes and treatment.

What causes the vertigo that the canalith repositioning procedure treats?

BPPV vertigo is caused by tiny calcium carbonate crystals, called canaliths, that slip out of place inside the inner ear. [1]

These crystals normally sit in a part of the inner ear called the utricle. In BPPV, they move into one of the semicircular canals, where they don't belong. Once they are in a canal, changes in head position can set off episodes of vertigo. [1]

The Epley maneuver works by moving those crystals out of the semicircular canals. Learn more about how these balance organs work in our guide to the vestibular system.

What happens during the Epley maneuver, step by step?

During the Epley maneuver, a healthcare provider guides your head and body through six movements that shift the crystals back into place. After each key movement, you may be asked to hold the position for about 20 to 30 seconds. [1]

Step	Movement	What to know
1	Your head is turned at a 45-degree angle toward the ear causing vertigo	The affected ear is identified beforehand with the Dix-Hallpike test
2	You lie down quickly, with your head slightly off the edge of the exam table, in the same position	Vertigo may get worse during this step
3	Your head is turned slowly to the opposite side	This turn is done slowly
4	The rest of your body is rotated so it lines up with your head	You end up lying on your side
5	You stay on your side for a few moments	Hold the position as guided
6	You are helped back to sitting upright	The maneuver is complete

The six movements of the Epley maneuver. Each key position is held about 20 to 30 seconds.

For a visual walkthrough from a public medical encyclopedia, see this Epley maneuver overview. Health professionals can find a clinical summary in this Epley maneuver reference article.

How long does the canalith repositioning procedure take?

A canalith repositioning procedure takes about 5 to 10 minutes to complete. [1]

Sometimes your provider needs to repeat it a few times to get results. [1]

How is the affected ear found before the Epley maneuver?

The affected ear is found with a test called the Dix-Hallpike maneuver, which is done as part of the BPPV diagnosis. [1]

This test shows which ear is causing the vertigo. Knowing the right ear tells you which way to turn your head during each movement of the Epley maneuver. [1]

Can you do the Epley maneuver at home?

Yes, you can do the Epley maneuver at home once a healthcare provider has taught you the correct movements. [1]

Your provider may teach you so you are ready if symptoms come back. At home, you sit on the edge of your bed and follow the same steps your provider led you through in the office. [1]

	In the office	At home
Who guides it	Your healthcare provider	You, after being taught
Starting position	On an exam table, head slightly off the edge	Sitting on the edge of your bed
How many rounds	May be repeated a few times	You may need to do it 3 times for best results
How often	As your provider decides	Up to 3 times a day for several days
Best timing	During your visit	Many people prefer just before sleep, so they can sleep through any leftover vertigo

The most important step is learning the correct movements before trying it yourself. Doing the movements the wrong way could make symptoms worse. [1] The vestibular patient organization also explains the canalith repositioning procedure for BPPV in plain language.

What are the side effects and risks of the canalith repositioning procedure?

The canalith repositioning procedure has very few risks, but some people feel nausea or a short burst of intense vertigo afterward. [1]

Possible effect	How common
Nausea	Can happen after the maneuver
Intense vertigo	Can happen, especially when lying back
Vomiting	Rare

The procedure may not be the best option if you have:

• Neck or back injuries

• Retinal detachment

• Vascular disease

Your provider will check your medical history beforehand to make sure the procedure is safe for you. [1] If nausea is a problem, your provider may prescribe nausea or motion sickness medicine to ease symptoms. [1]

Key numbers, safety checks and when to call your provider.

What should you do after a canalith repositioning procedure?

There are no specific post-treatment instructions after a canalith repositioning procedure, but it is a good idea to avoid sudden head movements. [1]

How long does it take to feel better after the Epley maneuver?

Most people feel relief from BPPV symptoms right after the Epley maneuver, while others need a few days to feel better. [1]

When should you call a healthcare provider after trying the Epley maneuver?

You should call your healthcare provider if you have already tried the Epley maneuver and still have symptoms. Call 911 if dizziness comes with a sudden severe headache, double vision, slurred speech, weakness or numbness, or trouble walking, because these can be signs of a stroke. [1]

You may need tests to rule out other causes of vertigo, such as ear infections or migraines. The Epley only treats BPPV, so it will not fix vertigo that comes from another cause. [1] If your dizziness has a different source, our guides to dizziness and vertigo and vestibular migraine can help you prepare for your visit.

What is the difference between a canalith repositioning procedure and the Epley maneuver?

A canalith repositioning procedure is the general name for any set of movements that moves ear crystals out of the wrong part of the inner ear, and the Epley maneuver is the most widely used type. [1]

Term	What it means
Canalith repositioning procedure (CRP)	The umbrella term for movements that move crystals out of the part of the inner ear where they don't belong
Epley maneuver	The most widely used CRP for BPPV
Semont maneuver	Another CRP used to treat BPPV
Brandt-Daroff maneuver	Another CRP used to treat BPPV

None of these maneuvers treat vertigo that has a cause other than BPPV. [1]

Canalith repositioning procedure at a glance

Question	Answer
What does it treat?	Benign paroxysmal positional vertigo (BPPV)
How well does it work?	Relieves symptoms in about 8 out of 10 people
How long does it take?	About 5 to 10 minutes
How long is each position held?	About 20 to 30 seconds
Can it be done at home?	Yes, after a provider shows you how
How often at home?	Up to 3 times a day for several days
Possible side effects	Nausea, intense vertigo, vomiting (rare)
Who should check first?	People with neck or back injuries, retinal detachment or vascular disease
When will I feel better?	Most people right away; some in a few days

Conclusion

The canalith repositioning procedure is a quick, low-risk treatment for BPPV that moves loose ear crystals back where they belong. The Epley maneuver, its best-known form, helps most people, often in a single 5 to 10 minute session. You can repeat it at home, but only after a provider has shown you the right movements and checked that it is safe for you. If the spinning does not stop, see your provider so other causes can be ruled out.

Have BPPV or think you might? Save or print this guide and bring it to your next appointment so you can ask your provider to confirm the affected ear and teach you the home Epley. Then keep learning with our step-by-step guide to vestibular rehabilitation therapy and explore more plain-language, research-backed health guides on Rinnit.com.

Frequently asked questions

How many times a day should you do the Epley maneuver?

At home, you may need to do the Epley maneuver up to 3 times a day for several days. If your symptoms don't improve, contact a healthcare provider.

How do I know which ear needs the Epley maneuver?

Your provider finds the affected ear with the Dix-Hallpike test during diagnosis. That result tells you which way to turn your head during each step.

Does the Epley maneuver work for all types of vertigo?

No. The Epley maneuver treats BPPV only. Vertigo from other causes, such as ear infections or migraines, needs a different evaluation and treatment.

What should I avoid after the Epley maneuver?

There are no specific aftercare rules, but it is a good idea to avoid sudden head movements.

Can the Epley maneuver make vertigo worse?

Vertigo may briefly get worse while you lie back, and some people feel nausea afterward. Doing the movements incorrectly at home could also make symptoms worse, so learn them from a provider first.

When is the best time to do the Epley maneuver at home?

You can do it anytime, but many people prefer just before bed, so they can sleep through any vertigo that follows.

Who should not have the Epley maneuver?

It may not be the best choice if you have neck or back injuries, retinal detachment or vascular disease. Your provider will review your history first.

How quickly does the Epley maneuver work?

Most people feel relief right after the procedure. Others feel better within a few days.

Is it safe to do the Epley maneuver at home?

Yes, once a healthcare provider has shown you the correct movements. Check with your provider first if you have neck or back problems, a detached retina or blood vessel disease.

What does the Epley maneuver feel like?

You may feel a short burst of spinning and some nausea as you change positions. This is common and usually passes quickly.

Related Reading

Vertigo (BPPV): Symptoms, Causes, and How It Is Treated explains BPPV symptoms, causes and treatment options.

The Dix-Hallpike Maneuver: How the BPPV Test Works and What Your Results Mean explains the test used to confirm BPPV and find the affected ear.

Vestibular Rehabilitation Therapy: Managing Dizziness and Balance covers exercises that retrain balance and reduce ongoing dizziness.

Dizziness and Vertigo: Symptoms, Causes & Treatment Guide explains common causes of dizziness and vertigo and when to get help.

References

1. Cleveland Clinic. Epley Maneuver (Canalith Repositioning Procedure). Cleveland Clinic. Last updated September 21, 2025. https://my.clevelandclinic.org/health/treatments/17930-canalith-repositioning-procedure-crp

2. Khoujah D, Naples JG, Silva LOJE, et al. Epley maneuver for benign paroxysmal positional vertigo: Evidence synthesis for guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med. 2023;30(5):501-516. PMID: 37186435. https://doi.org/10.1111/acem.14739

3. Xin H, Fang N, Wu M. Comparative efficacy and safety of repositioning maneuvers for posterior canal benign paroxysmal positional vertigo: a network meta-analysis. Front Neurol. 2026;17:1762375. PMID: 41704888. https://doi.org/10.3389/fneur.2026.1762375

4. Kulthaveesup A, Bunnag K. Comparison of outcomes of the Epley and self-Epley maneuvers in PC-BPPV: A randomized controlled trial. Am J Otolaryngol. 2023;44(6):103995. PMID: 37459743. https://doi.org/10.1016/j.amjoto.2023.103995

Medical disclaimer

This article is for general education and does not replace medical advice, diagnosis or treatment. Do not try the Epley maneuver at home until a healthcare provider has confirmed BPPV, identified the affected ear and shown you the correct technique.