BPPV is diagnosed by history and by a positioning test. The characteristic story is brief spinning triggered by head movement, lasting seconds rather than hours. The Dix-Hallpike manoeuvre reproduces it and lets the clinician observe the characteristic eye movement.
BPPV is diagnosed by history and by a positioning test. The characteristic story is brief spinning triggered by head movement, lasting seconds rather than hours. The Dix-Hallpike manoeuvre reproduces it and lets the clinician observe the characteristic eye movement.
Three features point strongly towards BPPV: the spinning is brief, typically lasting under a minute; it is triggered by a change in head position, classically rolling over in bed, looking up or bending down; and between episodes you feel normal, though sometimes vaguely unsteady. Vertigo lasting hours, or constant dizziness, points elsewhere. Hearing loss or ringing alongside it also points away from BPPV and warrants a different assessment.
The Dix-Hallpike manoeuvre involves sitting you up, turning your head to one side and lying you back quickly with your head extended slightly over the end of the couch. If BPPV is present in that ear, it reproduces the vertigo after a short delay and produces a characteristic eye movement called nystagmus, which the clinician observes. It is deliberately provocative and briefly unpleasant, which is worth knowing before rather than during.
A typical history with a positive positioning test usually needs nothing further. Testing is considered when the picture is atypical, when there are additional neurological symptoms, when hearing is affected, or when treatment has not worked. VNG balance testing is performed at both CNS offices and can help where the localisation is genuinely unclear. New neurological symptoms alongside vertigo are a different matter and need urgent assessment.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: dizziness and vertigo; MedlinePlus, National Library of Medicine; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.