Dix Hallpike Maneuver for Diagnosing BPPV

Dix Hallpike maneuver:

The Dix Hallpike maneuver is the gold standard for diagnosing benign positional paroxysmal vertigo caused by a posterior canal otolith. The patient is positioned recumbent with the head back and toward the affected ear, causing the otolith to progress superiorly along the natural course of the canal. Typically, after a five to 20-second delay, this will cause vertigo and rotary or up-beating nystagmus, which will resolve within 60 seconds.

The Dix Hallpike maneuver is indicated for patients with paroxysmal vertigo in whom benign positional paroxysmal vertigo is considered in the differential. These patients experience vertigo in brief episodes lasting less than one minute with changes of head position and return to total normalcy between episodes. Light-headedness or a sensation of nausea might last longer than one minute, but if the sensation of movement persists for more than one-minute alternative diagnoses must be considered. Dizziness is a common complaint, and serious causes must be considered and excluded first. Non-paroxysmal vertigo is more likely to be caused by a vestibular syndrome or central etiology, such as brain stem stroke. Distinguishing these causes requires thorough neurological examination (possibly including the HINTS exam), a detailed history, and possibly, imaging with CT scan and MRI as indicated. Any neurological deficit, especially truncal ataxia, should generate concern for a central cause and trigger further workup. If the history is consistent with benign positional paroxysmal vertigo, the Dix Hallpike maneuver is the test of choice for diagnosis.

The Dix Hallpike Test is the hallmark test for bppv aka. benign paroxysmal positional vertigo.
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📚 ARTICLES: Bhattacharyya et al. (2017): https://www.ncbi.nlm.nih.gov/pubmed/28248609

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This is not medical advice! The content is intended to be educational only for health professionals and students. If you are a patient, seek care of a health care professional.