Benign paroxysmal positional vertigo is the commonest cause of recurrent positional dizziness, and most of it can be diagnosed and cured in a single visit without imaging. The pearl is to do the manoeuvre rather than reach for a scan or a vestibular sedative.
For the posterior canal, the Dix-Hallpike test provokes the characteristic brief, fatigable, upbeating-torsional nystagmus with latency. When it is positive, treat immediately with the Epley canalith-repositioning manoeuvre on the same side, which resolves symptoms in most patients, repeating it if needed.
Reserve imaging for red flags — a central pattern of nystagmus, focal neurology, or vertigo that does not fit a canal. Avoid prolonged vestibular suppressants, which slow central compensation. A manoeuvre at the bedside beats a prescription for most positional vertigo.
- Use the Dix-Hallpike test to diagnose posterior-canal benign paroxysmal positional vertigo.
- Treat a positive test immediately with the Epley repositioning manoeuvre on the affected side, repeating if needed.
- Reserve imaging for red flags: central nystagmus, focal neurology, or vertigo that fits no canal.
- Avoid prolonged vestibular suppressants, which delay central compensation.
Why it matters
Most positional vertigo is benign and curable in one visit, so reaching for a scan or a sedative instead delays relief and wastes resources.
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