Dix-Hallpike Maneuver

The Dix-Hallpike maneuver is the most commonly used test for positional nystagmus and it is most often used to assess for benign paroxysmal positional vertigo (BPPV), which can occur when calcium particles (otoconia) inappropriately fall into one of the semicircular canals. 1. To perform this maneuver, the patient is seated upright. 2. Laterally rotate the patient’s head 45 degrees and then briskly bring the patient backwards so the patient’s head hangs over the exam table. Hold the patient’s head in this position for at least 30 seconds and observe for the development of nystagmus — the nystagmus in BPPV can be delayed for up to 30 seconds. 3. If BPPV is present, nystagmus will rapidly build and then slowly abate over 15 to 45 seconds. When assessing for BPPV, it is most ideal to have the patient wear Frenzel lenses and to darken the room. In BPPV, the patient experiences vertigo in conjunction with the nystagmus and the nystagmus is fatigable, meaning it diminishes in intensity with repeated provocation of the nystagmus. 4. After the Dix-Hallpike maneuver is completed in one direction, the patient sits upright and the test is performed in the other direction. 5. If posterior semicircular canal BPPV is diagnosed, a canalith-repositioning technique, such as the modified Epley maneuver, can be performed very easily at the time of diagnosis.