Dix-Hallpike test for BPPV

What is the Dix-Hallpike test for BPPV?

The Dix-Hallpike test is a quick way to check for a common cause of dizziness called benign paroxysmal positional vertigo, or BPPV. In BPPV, tiny crystals that normally sit in one part of the inner ear become loose and drift into a balance canal. When you move your head a certain way, they make you feel a brief but intense spinning sensation.

During the test, the clinician turns your head to one side and then lies you back quickly with your head tipped slightly over the edge of the couch. If you have BPPV in that ear, this position briefly brings on the spinning, along with a particular flicking of the eyes (nystagmus) that the clinician watches for. The dizziness usually settles within under a minute.

The test deliberately provokes the symptom, so you will feel dizzy for a short time if BPPV is present. It is the standard way to diagnose the most common form of BPPV, and it tells the clinician which ear and which canal is affected, which guides treatment.

Importantly, it is not suitable for everyone in its standard form. Because it involves moving and tipping the neck, your clinician will check whether you have neck or back problems or certain blood-vessel (vascular) problems first, and may use a gentler version or avoid it.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your test

• Tell the clinician about any neck or back problems, recent neck or back surgery, or a very stiff neck, as the standard test may not be suitable.
• Mention any blood-vessel problems, such as a narrowed neck artery, previous stroke or mini-stroke, or fainting linked to neck movement.
• Mention a recent retinal detachment or recent eye surgery.
• Do not wear eye make-up if the clinic plans to record your eye movements.
• Have a light meal beforehand if you are prone to nausea, and tell the clinician if you feel very anxious about being made dizzy.
• Consider arranging a lift home if you know movement makes you very dizzy or sick.

What happens

The clinician explains the test and checks whether it is safe for you, asking about neck, back and blood-vessel problems. You sit on a couch positioned so that, when you lie back, your head can tip slightly over the top edge.

The clinician turns your head about 45° to one side, supports it, and then helps you lie back quickly so your head hangs a little below the level of the couch. They watch your eyes closely for around 30 seconds to a minute. If BPPV is present in that ear, you feel a burst of spinning and the clinician sees the typical eye movements. You are then brought back up to sitting, and the other side is usually tested.

The whole thing takes only a few minutes. If the test is positive, the clinician can often go straight on to a treatment manoeuvre (such as the Epley) at the same visit.

Is this test right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

The biggest safety point is that the standard test should not be done if you have significant neck or back problems, or certain blood-vessel problems such as a narrowed neck artery or fainting on neck movement. Tell the clinician about these so they can use a gentler version or avoid the test. The dizziness it provokes is expected and short-lived. A normal test does not rule out all causes of dizziness, and BPPV in other canals may need different positioning tests.

Published figures to discuss

The Dix-Hallpike is a low-risk bedside test, so complication rates are not the main issue. The key points are safety screening (neck, back and blood-vessel problems) and test accuracy. Reported sensitivity for posterior-canal BPPV varies between studies and is not perfect, so a single negative test does not exclude BPPV. Because reported figures vary widely with technique and the population tested, no single percentage is given here.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery. If BPPV is present, the spinning it provokes usually settles within under a minute, though some people feel a little unsteady or queasy for a short while afterwards.

• A short burst of spinning during the test if BPPV is present
• Brief nausea or unsteadiness afterwards
• Quick return to feeling steady for most people
• No lasting effect from the test itself

Aftercare

• Sit for a moment after the test until any dizziness settles.
• If you feel queasy, rest and sip some water before leaving.
• If a treatment manoeuvre was done, follow the specific after-care advice you are given.
• Avoid sudden head movements for a short while if you still feel unsteady.
• Ask what the result means and whether you need treatment or further tests.
• Report any new or worsening symptoms to your clinician.

• Told the clinician about any neck, back or blood-vessel problems
• Mentioned recent eye surgery or retinal detachment
• Came without eye make-up if recording was planned
• Had a light meal if prone to nausea
• Considered a lift home if movement makes you very dizzy
• Noted questions about the result and next steps

⚠ Get urgent help if…

• A sudden, severe or 'worst ever' headache, especially with dizziness
• Slurred speech, drooping face, or weakness or numbness in an arm or leg
• Double vision or loss of vision
• Fainting, chest pain or a very irregular pulse
• New or sudden deafness in one ear with the dizziness
• Dizziness that is constant and severe rather than brief and triggered by position

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

If the test brings on the typical short spinning and eye movements, BPPV is confirmed in that ear and canal, and treatment with a repositioning manoeuvre is usually offered. If nothing happens, the test is negative for that canal.

A negative test does not rule out BPPV completely, because it might affect a canal this test does not check, or the crystals may not be in the triggering position on the day. It also does not rule out other causes of dizziness. Your clinician may repeat the test, try a different positioning test, or look for other explanations depending on your symptoms.

The test reflects what is happening at that moment. BPPV can come back after successful treatment, and a previously negative test can become positive if symptoms return. If your positional dizziness comes back, the test can simply be repeated.

Related tests, treatments or support

The Dix-Hallpike is often followed immediately by a treatment manoeuvre (such as the Epley) if it is positive. It may be combined with the supine roll test for the horizontal canal, and with other balance tests or a hearing test if the picture is unclear.

Follow-up & long-term care

If BPPV is confirmed and treated, you may be advised to return if symptoms persist or come back, sometimes for a repeat test and treatment. If the test is negative but symptoms continue, your clinician will arrange further assessment. Ask what to do if your symptoms return.

Repeat, follow-on and what comes next

• A negative test may be repeated, or a different positioning test used, if BPPV is still suspected.
• Crystals may not be in the triggering position on the day, so the test can be falsely negative.
• BPPV commonly recurs, so the test may be repeated on future occasions if symptoms come back.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Clear explanation of the result and, if positive, prompt offer of a repositioning manoeuvre.
• Advice on what to do if symptoms persist or come back, including repeat testing.
• A named contact route and clear red-flag advice for seeking urgent help.
• Onward assessment arranged if the test is negative but symptoms continue.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether the test is part of a wider balance assessment or a standalone appointment
• Whether treatment (a repositioning manoeuvre) is done at the same visit
• The seniority of the clinician performing it (GP, audiologist, ENT specialist or physiotherapist)
• Whether infrared recording goggles and a written report are used
• The clinic facility fees
• Whether further balance tests or follow-up are recommended

• Whether the appointment includes treatment if BPPV is found
• Whether a follow-up visit for repeat testing or treatment is included
• Whether a written report to your GP is included
• What happens, and what it costs, if the result is unclear and needs repeating
• Whether any recommended further balance tests are quoted
• The clinic's cancellation and rescheduling policy

On the NHS? The Dix-Hallpike test is routinely available on the NHS as part of assessing dizziness; private assessment may be chosen for faster access or a second opinion.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

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Take this to your consultation. A good specialist will welcome every one of these.

• Is the standard test safe for me given my neck, back or circulation?
• If I have BPPV, can you treat it at the same appointment?
• What happens if the test is normal but I still feel dizzy?
• Could my dizziness be coming from a canal this test does not check?
• What should I do if the dizziness comes back later?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my test, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this test not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE CKS — Benign paroxysmal positional vertigo (BPPV) NICE CKS — Vertigo NHS — Dizziness Benign paroxysmal positional vertigo — Patient.info (professional reference) Dix-Hallpike Maneuver — StatPearls (NCBI)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.