Benign paroxysmal positional vertigo is common, treatable at the bedside, and often diagnosed without testing. A clear history of brief vertigo triggered by lying down or rolling over is suggestive, but the Dix-Hallpike test for the posterior canal, and the supine roll test for the horizontal canal, confirm it and tell you which manoeuvre to use.
A positive Dix-Hallpike gives torsional up-beating nystagmus after a short latency, lasting under a minute and fatiguing on repeat. Nystagmus that is purely down-beating, lasts without fatigue, or appears without latency should raise concern for a central cause.
- Do the Dix-Hallpike on both sides in any suspected positional vertigo
- Look for latency, torsional up-beating nystagmus and fatigue
- Use the supine roll test if Dix-Hallpike is negative
- Treat with the matching repositioning manoeuvre in the same visit
- Refer or image when nystagmus is atypical or there are neurological signs
Why it matters
A tested diagnosis lets you treat at once and spot the central mimics.
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