Epley begins after the last step of the Dix Hallpike
Patient remains in the position with exacerbated nystagmus for approximately 1–2 minutes.
Patient's head is then turned 90 degrees to the opposite direction so that the unaffected ear faces the ground
Maintain the 20 degree neck extension
Keep the head and neck in a fixed position while the patient rolls onto their opposite shoulder. The patient is now looking downwards at a 45 degree angle.
Keep the patient in the new position for 1 minute.
Finally bring the patient up to sitting while holding the head in 45 degree rotation.
May require multiple attempts, but you can discharge patient home with daily exercises
Improvement after x1 in 47% of patients, after x2 an additional 16%, and after x3 an additional 21%
Maintain the 20 degree neck extension
Improvement after x1 in 47% of patients, after x2 an additional 16%, and after x3 an additional 21%
Antihistamines
Diphenhydramine (Benadryl) 25-50mg IM/IV/PO q4hr
Meclizine(Antivert, Antrizine, Dramamine) 25mg PO QID
Promethazine(Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr
Anticholinergic
Scopolamine transdermal patch 0.5mg (behind ear) QID
Benzodiazepines
Lorazepam (Ativan), diazepam (Valium) or Klonopin (clonazepam)
Diphenhydramine (Benadryl) 25-50mg IM/IV/PO q4hr
Meclizine(Antivert, Antrizine, Dramamine) 25mg PO QID
Promethazine(Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr
Scopolamine transdermal patch 0.5mg (behind ear) QID
Lorazepam (Ativan), diazepam (Valium) or Klonopin (clonazepam)
Benign paroxysmal positional vertigo
Vestibular/otologic
Vestibular neuritis
Benign paroxysmal positional vertigo 
Labyrinthitis
Traumatic 
Cluster headache
Infection