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Epley Maneuver: How to Perform.

Epley Maneuver: How to Perform.


Hello, I’m I’m Bob Schrupp, physical therapist I’m Brad Heineck, physical therapist Don’t bother me, Bob. I’m looking up the Epley maneuver we’re talking about- Right, today we’re going to talk about the Epley maneuver- Basically were going to show you how to do it. It’s also called the Canalith Repositioning Maneuver and what it’s for is a type of dizziness and specifically we usually use it for Benign paroxysmal positional vertigo. -It’s a mouthful.
-It’s a mouthful. It’s a type of vertigo, a type of dizziness Basically what we would like to see is that you were diagnosed with this by your doctor now you were asked to do this type of maneuver or your physical therapist or somebody may be doing this maneuver with you. We’re just going to go over it with you, or maybe a professional who has to do this. It’s a good way– a review of that, so let’s go to it.
-Alright Okay After I interview a patient and I find out what’s going on and have confirmed that it is– [Brad] vertigo
[Bob] BPPV [laughing] If they’ve got vertigo symptoms, I just skip the big words and go right into it so it makes sense to the patient and it’s easy to communicate with Find out which way produces the symptoms and when I say which way, which direction and oftentimes they say, “When I lean or turn my head to the right, or when I’m in bed and I roll to the right”, and sometimes it’s to the left but in this case when Bob turns his head to the right or when he rolls to the right in bed thing start spinning. Is that right, Bob?
-That is correct It’s very uncomfortable.
Makes you feel very nauseous that can be different intensities as well So, once I determine which direction, that tells me which way to start the treatment and what I mean by that is which way to turn the head– so what I have someone do is get up on the table sit like Bob is sitting, and we get their back at approximately a 45 degree angle You don’t have to get the goniometer out and measure but just so– about Bob is now and then he’s going to turn his head to the right
and tilt back [murmuring] [Brad] I tilt back a little bit, Bob
[Laughing] Different therapists do this a little differently but– [Bob] Turn to the left, tilt back [Brad] Bob doesn’t like to tilt back yet I’ll do a little bit, depending on the patient’s response. Okay So, once we get to that point, we’ll hold it for 30 seconds to a minute and in this case we’re going to go for 30 seconds just to shorten it up. Okay, Bob, we just finished out at 30 seconds Now, we’re going to go to phase 2 of this treatment and what I’m going to have you do, I’m going to take a couple pillows I’m going to place them right here And you’re going to feel them right in your back right here So you’re gonna go down slowly.
Take your time. Now, you’re going to keep your head at that 45 degree
Adjust it as you need and you’re going to bring your head back while maintaining that 45-degree 30-degrees and that’s about 30 degrees right there How are you doing, Bob?
-Good This has to be done slow, And if you do it slow you shouldn’t have too many symptoms that are making you feel nauseous or real dizzy If you do, it’s too fast and too much too early We’re going to hold this for 30 seconds, okay? You’re going to time it.
A lot of times I like to use– I’ve got a clock on the wall in my– in the clinic And I just got a second hand and I look for 30 seconds or either that or you have someone come in and help me time if that’s not available right in front of me And then, we’re going to go slowly to the left Okay, so that we’re 45 degrees to the left and maintain that 30 degrees extension. How you doing, Bob?
[Bob] Good And I always communicate with the patient, see if they’re feeling dizzy and things are spinning but they let you know it. You’ll know it if you’re doing this to yourself. Hold that for the 30 seconds Bob, we’re done with this position, and now we’re going to go to the next position. So, what I’d like you to do is turn to your left side Bring your knees up.
Good, perfect Go over like that Now, while you do that, keep your head angled down towards the floor Good, bring the shoulder up
Okay, head down… there we go. Are you comfortable in that position? [yeah]
We’re going to hold that for 30 seconds Okay [Bob] We’ll jump ahead.
We don’t have to hold it. I mean– just pretend it’s been 30 seconds. Okay, now we’re at 30 seconds.
Bob, we’re the next position Now, what I want you to do is bring your knees forward so your feet and knees are up.
There, just that that. Now, let’s tuck your chin in towards your chest slightly and slowly go up [Bob] Look down at the floor
[Brad] Exactly As you go up, look more towards the floor Hold it steady. Nothing too fast. How are you feeling there?
-Good Good, okay? [Bob] We’re gonna to keep the chin tilted down
[Brad] Exactly, keep that down Now, this is the easy part of the treatment, Bob. After this 30 seconds, keep your head still… After this 30 seconds, the hard part of the treatment is the next 48 hours What Bob’s going to have to do is keep his head in a vertical position for 48 hours Now, what I’m going to give him to help him out– this means that you cannot look down, you can’t bend over to pick anything up, and you can’t lay down to sleep in bed That’s what makes us difficult. [Bob] You want me to come up now?
That’s been 30 seconds Ok, yep. Nice and slow, everything’s feeling good, you’re not spinning your anything?
-Nope, I’m good You get yourself a simple neck collar Velcro, cost about $10 at–
-A nice soft collar -Yup, a nice soft one at any pharmacy store. And we’re going to bring this around your neck You don’t have to use this but, if you want to maintain that
head vertical position for 48 hours This is a constant reminder
that you need to keep your head up I have some patients, and what they’ll do is actually
take a couple days off of work or do it on a weekend, because you’re not going to be able to do at work for most jobs. Okay, you okay with that, Bob?
-Very good? Again, this doesn’t have to be tight. When you’re sitting in a chair or standing and you want to take it off you’re welcome to do that at anytime
you can leave it off, but again it works great to hold that 48 hours because if you do bend over, or you look down you throw it off and you get dizzy again, It’s not a big deal, but you have to start the whole process all over again. And I think we should mention, Brad,
that you may need to do the process over again. -Yeah
-Some people have to do this, the Canalith repositioning maneuver, a number of times before it actually works
-Sure And the other thing is there was some debate online whether or not you need to do this part of it the 48 hours The mayo clinic advocates this this method. We’ve used it– When I was working at the Mayo Clinic
we did it that way so I think I feel pretty safe in saying that it needs to be done. -Right, and it’s been my experience in a clinic, that if you have to do a second time after the first time, and say you throw something off,
you will notice some gains Maybe, 25% improvement.
That’d be a good indicator to repeat it. But, if you do it right the first time,
hold that head up for 48 hours it’s your best chance for success
and use the neck collar And that’s it It’s not a real difficult treatment, but it is challenging
-One last thing, Brad I just want to tack this on at the end of the video here, if you are 40, 50 years old or older you’re going to want to subscribe to us because we are going to be covering videos that are going to help you as you get older, as you age. You know– stay fit and healthy We’re going to cover subjects like this and other things– on fitness So, subscribe! Because we both are kinda in that age range [Bob] In that age group, and we have been treating people of that age group for ever. -Right. Well you, forever… I’m a little younger than that. Very good

99 thoughts on “Epley Maneuver: How to Perform.

  1. there are many ways to do the epley maneuver. just saw my doc yesterday and he did a different version of this.  but i never heard the part about not moving your head for 48 hours! that doesn't seem right, i wouldn't do that.

  2. before you made this video, you guys should have come to an agreement in opinion so people don't get confused. It looks like you guys don't have the same views

  3. Hie! my mom had a problem of dizziness since few days.. but this happens only when she looks above and but otherwise she doesnot face any such problem. After taking x ray (as per consulted with doctor) there is no problem at joints of head and back. But still she is facing the same problem is this dizziness due to positional vertigo?

  4. Greetings….I just came home from the Physical Therapist's office where I was diagnosed with BPPV.  After a lengthy positional evaluation, she recommended that I do the Epley Maneuver 3 times a day every day for a week.  This seems a bit extreme, but I'm not the Professional.  By the end of the week, I'll either be cured or spinning like a top….!!
    .

  5. I have this condition,it's very scary.i Love exercising at the gym.but feel dizzy. I feel so frustrated.how often should i do these exercises per day ?

  6. Great video.. .Thank you so much… Reading it up in textbooks and then watching this video helped me a lot. Guess I will be able to do it for my patients.. 🙂 Thank you again.

  7. Re:  48 hour stationary position – How do you work in bathroom breaks & eating, etc.   Presume that short breaks are OK, so long as you maintain the 45 degree downward position, etc. then resume your position in the recliner or pillow thingey?
    Mike

  8. My doctor says that I have Meniere's disease as I have ringing, fullness, hearing loss in only my left ear and I also get vertigo.  I've had 8 vertigo attacks in less than a month.  Most attacks last less than an hour.  Will this technique work for me?  None of my ENT doctors have mentioned this.  Is this because I have Meniere's, not BPPV?  

  9. I was just diagnosed yesterday day with this condition and I am in nursing school, more specific 20 wks to the end and taking time off is not an option nether is staying in a vertical position due to studies,clinical rotation ect. Is there anything I can do for the nausea in the mean time. On a side note: after seeing my new doctor, we went over my history and I had this same problem/symptoms in the beginning of my nursing program and went to an ER here in Jax, FL and was diagnosed with my symptoms. (dizziness,nausea,vomiting). Thanks for your assistance and I'm just reaching 40 as of Nov of this yr. and I'm looking forward to more from you
    April

  10. Just my 2 cents after having vertigo issues for 20 yrs and eventually ending my aviation career early. Most has been covered but 1st get a vision test. I used those cheap reading glasses which did the job but after time they were making me sick. Having a eye exam and getting a proper pair made specific for me helped greatly. Then get away from that monitor or tv and go outside one in a while. Lay out all your medicines and one by one "with a doctors permission" and starting with the ones known to cause vertigo stop one and see if the issue goes away. Then stop another. Record any changes. I was on Gabapentin for back nerve pain which was causing all sorts of issues including vision and balance problems. Stop alcohol and caffeine products. In my case strong coffee was causing ear ringing and headaches.Try to isolate each one singly to see if its a cause. Good luck.

  11. Is there any high level evidence supporting the 48 hours of neck collar? That's quite a commitment on the patient's behalf, so there should be better evidence than the Mayo Clinic to support it in providing significantly better results

  12. I heard you say you can't even put your head down to sleep during the 48 hours.   But I did NOT hear you talk about how you are expected to accomplish that.  Any advice?

  13. head vertical position for 48 hours without laying down on the bed? how will he supposed to go to sleep? will he have to stay awake for 48 hours sitting down and or standing up? are you crazy?

  14. i had a vertigo since i was 6 yrs old it triggers when i don't eat that usual do i hate vertigo the sensation sucks at least 4  to 6 attack in a year when i look up or lay down, I never took any medicine just eat and lay down for one side for an hour and it goes away  

  15. Hi there. I did this last night, and went to sleep as normal. I won't up feeling worse than I've ever felt. An ER doctor told me to this. He just gave me meclizine and epley maneuver instructions, and sent me off. I finally tried it last night, and the dizziness is way worse now that I've women up. I was unaware of the 48 head position though. Is this normal to Feel worse after this?

  16. Thanks very much for this demo. I found another video that shows an animation of how the crystal in the inner ear moves around with this manoeuver. I've asked my physio if she knows how to do it, so we can try it, as my dizziness/vertigo is getting worse with age.

  17. hello Doctor, I am 26 and i got a very bad attack this morning. I showed to Doctor and he recommend me to do this exercise for at least 5-6 times a day and you saying to keep pause for 48 hours. its really scary and i don't know whom to trust? I really dont want experience that again while sleeping. so i am scared to put my head down even, Can you please suggest whats the right way to do it?

  18. I'm dizzy for days after looking down to read or draw, and generally feel dizzy when turning my head, turning my body, walking around, looking back to the left or right, and worse if I lay on my stomach with my head turned to the left. Which Maneuver would you recommend for this? The neurologist diagnosed BPVD and did nothing.

  19. I've ha this problem for about 25 years..finally found some help..went to my chiropractor and watched video with him and cleared it up for about a week, went back for 3 more treatments and now have been clear for 3 months..I didn't expect to be CURED,..much BETTER than walking around DIZZY…he preforms this Maneuver on me when I request it… thanks very much…

  20.   try them all..what have you got to loose??  if something works ,  all the Better for you..these are treatments..won't fix everyone, but it they help someone , you've won…

  21. My husband did this and I was VIOLENTLY dizzy on my affected side.  It was not fun! 🙂  Does that mean he moved the crystal?  Should we try the technique again? Or do we just do 1 time? This isn't the way I wanted to spend my Valentine's Day.
    Thanks for making the video.  
    I am going to buy the brace.  I never heard of that part of the treatement.  

  22. When he was on his side, his head should of been turned 45 degrees again from the vertical plane (so his nose would be close to the mat).In the position you had him before raising him from his side, it didn't seem like his head was turned sufficiently.

  23. I don't have vertigo or Meniere's Disease. I just wanted to write "my support and thoughts are with all of you that suffer with any form of this". I've had my trials, from epilepsy to brain surgery to cancer. Godspeed.

  24. I do this myself about every two weeks. Keeps me going. gets rid of about 90% of my dizziness. If I wait to long I really get dizzy when I do it. I think the crystals build up over time. and get worst as they go.

  25. Hi, i have one question. My 12 years old son just start feeling vertigo, it started on thursday and it doesn't disappear, the dr give him a shot yesterday and it helped a little but today he waked up again with the vertigo. My question is: Does this maneuver can help him to feel better and, can i do it myself? is heart breaking to see my boy like this, he can't eat because he's afraid to vomit and is really miserable because he can't do anything. Thank you  

  26. I did not really understand the last part.. do I just have to keep HEAD in vertical position but i can lie down on my back or bend forward?? or i have to stay on my feet or sit the wholw time?? and should i also sleep without lying on my back?? please answer

  27. Is there an alternative treatment for various types of vertigo? This seems highly specific to BPPV. I've seen another treatment but now cannot remember the name of it

  28. I can't bear the spinning.  I went to see a therapist a few days ago and he performed the "deep head hanging" maneuver. I literally screamed with terror due to the violent spinning. I literally felt like I was being flung off the face of the earth. It was horrible and everything in me is balking at going back again. He laid me down VERY fast. I don't understand why he needs to do it so fast. I feel like I can deal better if I ease into it but he won't allow that. I did do the Epley at home a few years ago after being diagnosed with BPPV but the instructions I received didn't say to use a pillow. I ended up with a very bad neck ache and headache so I stopped. I'm going to follow the instructions in this video because it's a little different.  How do I keep myself from freaking out when the spinning begins? I literally cry just thinking about it.

  29. I have had 3 episode of dizziness which included listing to one side.  They last 5-10 minutes.  Is this treated with the epley as a proventive?  I did not experience dizziness when the doctor did it.

  30. When i lay on my left side i get the spins or laying on my back and turn head to left., i cannot do it most times because i get so dizzy! Not sure i can do this excercise because my back is hunched.

  31. I just tried this on myself tonight. I think that next time I will go to a professional though to help guide me through the process as it's a bit hard to do this fluidly on your own. At least it was for me. I did get a bit of a neck ache when performing the tilting of the head while laying on my back. I really hope this works and also hope that I can keep my head straight for the next 48 hours! I don't have a neck brace but if I try this again I will be sure to pick one up.

  32. Hi I have gone to the re for dizzines,they say I have nothing,second time I went cause I was at work and felt like passing out,and felt so out of energy,they told me is cause of my anxiety and high stress life,I was wondering if this meneuver would work for me

  33. Thank you for sharing your knowledge and making it fun while sharing it. My question ,,why 48 hours ? Can the body/mind know the difference if you were to say 30 hours or is there  evidence of 48 hours.

  34. I was told I have an inner infection and when I went to the pharmacist he told me based on the medication I was given I have vertigo. Is there a cure, I will be doing this exercise as I can't stand the dizzy feeling. I'm taking gravol for the tummy issues. Rooms are not suppose to spin LOL

  35. I was just diagnosed with BPPV. But, my question to you is, how in the world can ANYONE keep their head up for 2 solid days without going to bed?!!! I would fall over from sleep deprivation before 24 of those hours!! I have other medical issues dependent on proper sleep! Sitting upright for 2 solid days is impossible! What???? Please explain if a person can GO TO BED!!!

  36. Hey. So in a few days I'm going back the doctors because I personally believe I have bppv. I've had these symptoms since I was about 4 years old I'm now 17 and my symptoms last about a week then disappear completly. After about 4-5 months it's comes back again. I have these attacks off dizziness which last no longer than 6 seconds and during those 6 seconds the room is completly spinning and my stomach turns. If I sit down I can turn my head and I feel fine it's just walking bending down ect which seem to make me dizzy. Walking up the stairs feel s impossible without getting an attack even if I go very slowly. Does this sound like bppv?

  37. Thanks for replying to my reaction of staying up vertically for 2 days! Monday I have an audiogram and the ENT. I may have Menieres because I have vertigo attacks, tinnitus, ear fullness, and tinny, uncomfortable, distorted hearing. I'll try to remember to keep you posted! I'm wondering if you could do this video over, because it sounds like Bob can never sleep for two days straight!

  38. Oh, wow!! I just read an earlier post by you two and if I have Menieres, this will not work at all!!! Hmmm. I have BPPV, but the other symptoms are like Menieres or it is Menieres!!

  39. i talked to a doctor and saw a couple other videos about this maneuver. this is the first ive seen that said to stabilize the head for two days. my understnading is that there are little crystals that form in the ear canals that can shift around and trigger the dizzy feeling. this maneuver is intended to shake things up a little, and allow the crystal to settle back where it belongs. like shaking a snow globe and letting it settle. so why would it take 48 hours for the crystal to sit back in place in such a tiny area?

  40. Thank you! I was sleeping for a two hours and I have such a dizziness that woke me up from sleep! After that, I couldn't walk straight or if I lay on the side I was so dizzy… Then I perform this maneuver with help of my mom and now I am perfectly fine! 🙂 It works! Thank you doctor!!!

  41. I'm not sure if I have Labyrinthitis or BPPV, tried this but it never helped (but only did it once). I don't have the eye movements, and I had have spinning vision but that symptom subsided after 2 hours. Now I just feel really dizzy and had to vomit.

  42. I have been dizzy for two days straight. We just came home from an out of town trip to denver and we flew and took shuttle busses. Not sure if it was caused by travel or altitude or both, but I am super upset and just want to feel normal. Do you think it could be vertigo?

  43. the instructions i got from urgent care did not mention the 48 hours i have not done this but wanted to watch a video. i have suffered for a year and finally got the right info. im now off work a week to rest and get this taken care of.

  44. im getting an appointment with an ent dr. my diziness or vertigo happens when i bend over, roll from right side to back or to right side or sometimes just lying down. frustrating as hell. i am off balance too. my symptoms have subsided today …but i never know when they will appear

  45. Hello I've been suffering with vertigo. This is my second round of it in 6 months. The NTE wasn't listening to me on the first visit but after the MRI came back clear I had to be stern with him that it's not just dizziness. I'm glad to see this video and will certainly give it a try. It seems though when my allergies are high (now is the season) the vertigo is back not sure if it's coincidental….

  46. Thank you so much. Currently I'm having vacation in abroad (South Korea) and few days ago i had this attack. Dizziness and nausea. Vomited until I went to ER. But they said my problem was on my stomach. I tried to explained that my stomach just totally fine. So i started to find about my problem and i found that BPPV is suit with all the symptoms. I tried this maneuver today and i swear it was the most difficult thing. Sooooooo dizzy. But within hours i can feel the different!!! I don't have the thing to hold my neck but i tried to keep my head in straight position. Hopefully tomorrow the dizziness won't come back. I hope

  47. Hi guys, I am a 22 year old female that was diagnosed with BPPV in my right ear by an ENT specialist today.

    I have researched about the Epley procedure and tried it out yesterday night and got really dizzy at the first step where you lie down with your head facing the affected side, and also the third step where I turned my body to the good size with my chin tucked in my left shoulder. However, it only made me even more dizzy and nauseous, I threw up after that.

    Today, I asked the ENT specialist about Epley's maneuver and he said that he does not believe that such a simple procedure will fix it so he prescribed me Betaserc, Clarinase and a nasal spray. He also said that I can try it by myself but he had patients where their condition worsened after the procedure.

    Went I went back home I tried the Epley maneuver again. This time I did not feel the dizziness in the first step mentioned above but I still got really dizzy on the third step where I turned my body with my chin tucked in the left shoulder. I felt slightly nauseous and groggy after that but not as bad as yesterday.

    Should I continue doing the Epley Manuever? I am kind of afraid of trying it again and I am so worried that I have to live with this.

  48. Hi Bob and Brad, I got vertigo one morning turning over in bed.  I was diagnosed with BPPV.  I have had the eply done every week over 3 weeks and haven't gotten better.  Now I am getting an MRI.  I have no other symptoms other than the dizziness.  I'm so worried this may never get fixed.  It's been a month now.

  49. both the physios are so nice and seem fun to hang out with.😝😝 I love them🙋 Epley's maneuver cannot be this fun🙌

  50. I have a friend that has severe vertigo due to a stem cell stroke. Do you think this would be safe for him to try?

  51. Well I am just now going to try this at home ,did do it at the Doc's today.Been dizzy a little for a week off and on and getting some worse.I'm going to try it.It's going to work.I am going to feel better.And yea these guys are helpful and fun.Butt I don't see the need for the wardrobe change midstream?

  52. This is what my ENT office did to solve my BPV issue, AFTER running LOTS of expensive tests, even though the doctor told me he was 90% sure it was BPV at my first visit but wanted to rule out anything else (MRI, some special eye test, ear test, allergy testing). A month later when it kicked up even worse, he finally had his nurse do this and I wore the collar and didn't lay flat for 48 hours, and although I can still trigger the feeling now and then, it goes away quickly and I have not had a major episode since 2011. The only difference was quicker transition between positions, and hanging my head off the table more (nurse supported). Vertigo is very debilitating – good luck and hope this works for those who try it.

  53. Thanks so much for this information. I was diagnosisfor vertigo. I try this method this morning and show immediate improvement.

  54. What about if it starts from just getting up, not right or left? I've had it so bad that the room was spinning what seemed to be a million miles and hour and all I could do was keep my eyes closed – it was horrific.

  55. Tucking the chin in position 3 facilitates return of otoconia to the utricle and decreases likelihood of failure when transitioning to position 4.

  56. I have strong vertigo and permanent headaches following a violent head trauma where my head hit the asphalt at 45 km/h. It's been three weeks. Vertigo appeared one week after the accident. I wonder if the Epley maneuver is prescribed in my situation. I read on Mayo's site that BPPV can develop after a head trauma but nowhere did I find info about it appearing one week after the trauma.

  57. I have had Meniere's Disease, for decades-and it's a "burnt out," case—symptoms don't present so catastrophically-Dad's now a retired ENT doc. But: I still get " Positional Vertigo," maybe once a year-Confusing! I do everything here to Fix–BUT the neck collar.And,"repeats" sometimes are needed of the positioning.

  58. I had been so sick of being unsteady, out of balance and dizzy that I began trying to find a supplement to try. The dizziness vertigo solution “Yοyο kamvuku” (Google it) was my best choice. My symptoms have improved enormously. The woozy, off balance feeling I had on a regular basis is just about gone.

  59. I have had this done before and had several people perform on me when vertigo kicks in. I know the 48 hours afterwards is very important with your head straight. What about sleeping? I’ve always been told to sleep in 90 degree like recliner or sitting up position for 48 hours. Do you recommend this?

  60. Got Vertigo recently and tried this Epley manuever. It worked well for me. However am suffering from RD (Residual Dizziness). Ca n someone let me know from your experience how much time it took for you guys to come out of this?

  61. I've had bouts of vertigo lasting from days to weeks before and just got hit with a pretty severe one over the weekend. Never has any doctor I've been to tried or mentioned this. In my own ignorance I didn't think to research either. Last night laying in bed my nausea was so overwhelming it was making me unable to breathe. I did this, finally fell asleep, and woke up at 95%. Words don't express how thankful I am for your video. I was crying in pain last night and now I'm ready to go to work and face the day.

  62. I managed to fix my dizziness about 20 years ago with the Epley manoeuvre. My doctor didn't have a clue so I researched and found that it worked perfectly.

  63. This is the best instruction I've seen for treating BPPV. I get the impression from this video that, when done right, this maneuver only needs to be done one time, followed by 48 hours of keeping the head vertical. Is that right?

    Others say to do this maneuver 3 times a day for several days and make no mention of needing to keep the head vertical for any period of time, in fact, other sources recommend doing the maneuver just before bed and then sleeping, as usual, in bed. Obviously then the head would not be kept vertical afterwards for any period of time.

    I wonder which is better. The first makes the most sense because, if the maneuver is really able to move the crystals then, after doing so (once) by keeping the head up for long enough the crystals would be kept in place long enough to be dissolved after they've been moved to the proper location by the maneuver.

    So which?
    1) One time maneuver followed by 48 hours of vertical head position.
    or
    2) Three times a day for a week, done before bed, followed by sleeping in a normal sleep position.

    My other question is: what if both sides are affected? Would you do one side and keep the head vertical for 48 hours and then, at a later date, do the maneuver for the other side, followed by a repeat of the 48-hour head positioning on a completely separate occasion?

    Good advice and instructions are greatly appreciated.

  64. I have vertigo and taking Betaserc pills; first month 3 times a day within meals then lower dosage to 2 and gradually to one and check your status. It just to prevent loosing balance and mitigate dizziness.

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