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Patient guide · Vestibular assessment

Dix-Hallpike manoeuvre, the bedside test that diagnoses posterior-canal BPPV in one minute.

The Dix-Hallpike manoeuvre is a bedside positional test used to diagnose benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal. Positive response is upbeat / torsional nystagmus with vertigo - instantly treated with the Epley manoeuvre.

A consultant performing the Dix-Hallpike manoeuvre in a private London ENT clinic

Key facts

The Dix-Hallpike, in six lines.

The essentials of the test, its accuracy and how it fits alongside other vestibular investigations.

  • 01

    What it is

    A bedside positional test used to diagnose posterior-canal benign paroxysmal positional vertigo (BPPV).

  • 02

    How it’s done

    Head turned 45° to the affected side, then rapidly lowered into a 30° head-below-body position.

  • 03

    A positive result

    Upbeat, torsional nystagmus with vertigo - typically after a 2–15 second latency.

  • 04

    Sensitivity

    Approximately 80% for posterior-canal BPPV - the commonest form of positional vertigo.

  • 05

    Treated immediately

    A positive test is treated the same visit with the Epley manoeuvre - often fully resolving symptoms.

  • 06

    Complementary tests

    Complements videonystagmography (VNG) and full vestibular assessment where the diagnosis is unclear.

Indicative pricing

What a private Dix-Hallpike costs in London.

Indicative ranges across UK private providers.

In short

£220–£380, usually under 30 minutes.

Test / bundle Indicative range
Dix-Hallpike manoeuvre (bedside test) £180–£280
Dix-Hallpike + Epley treatment £220–£380
ENT / vestibular consultation + Dix-Hallpike £350–£550
Vestibular assessment (Dix-Hallpike + VNG) £550–£900
Full vertigo work-up (ENT + VNG + audiometry) £750–£1,200
MRI IAM (asymmetric hearing loss follow-on) £450–£850

Prices vary by clinic, whether a full consultation is included, and whether videonystagmography or audiometry is added.

The problem

Positional vertigo is under-treated because the test is under-used.

The Dix-Hallpike takes a minute - and the treatment that follows takes another. Yet many people cycle through antiemetics and imaging before someone lies them down and looks at their eyes. We route you to a clinician who does this every day.

  • Room-spinning on rolling over?

    Classic posterior-canal BPPV - the exact question the Dix-Hallpike answers.

  • Vertigo when looking up?

    Another classic trigger. We test both sides and treat what we find.

  • Recurring, treated, back again?

    BPPV can recur. Same-visit Epley plus home exercises are the standard plan.

What it shows

What the Dix-Hallpike can - and can’t - tell you.

The manoeuvre answers a specific question: is this posterior-canal BPPV, and which side. These are the patterns your clinician is looking for.

  • Posterior-canal BPPV

    The classic finding: upbeat, torsional nystagmus with vertigo on the affected side.

  • Anterior-canal BPPV (rare)

    Downbeat nystagmus on positioning - rare and needs careful differentiation from central causes.

  • Latency of nystagmus onset

    Typical peripheral BPPV shows a 2–15 second delay before nystagmus and vertigo appear.

  • Short duration (< 60 s)

    Peripheral nystagmus is brief and self-limiting - usually under a minute.

  • Fatigable response

    Repeated testing produces a smaller response - a hallmark of peripheral BPPV.

  • Reversal on sitting up

    Nystagmus commonly reverses direction when you return to sitting - expected and reassuring.

  • Central nystagmus pattern (differential)

    Non-fatigable, immediate, purely vertical or direction-changing nystagmus points to a central cause.

  • Red flag: sustained down-beating or vertical nystagmus - central cause, urgent neurology

    Do not wait - these patterns need urgent neurology and cross-sectional imaging.

Treatment and next steps

What happens after a positive test.

Same-visit repositioning, home exercises and - where needed - a wider vestibular work-up.

  • Epley manoeuvre

    The first-line treatment for confirmed posterior-canal BPPV - often resolving symptoms in the same visit.

  • Semont manoeuvre

    An alternative repositioning manoeuvre when the Epley is not tolerated or ineffective.

  • Brandt-Daroff home exercises

    Home-based habituation exercises for residual symptoms or recurrence between clinic visits.

  • Vestibular rehabilitation therapy

    Structured therapy programme for persistent imbalance, compensation and confidence rebuilding.

  • Antiemetics for acute symptoms

    Short-course medication for severe nausea during an acute attack - not for long-term BPPV control.

  • MRI internal auditory meatus

    Reserved for asymmetric hearing loss, red flags or diagnostic uncertainty - rules out vestibular schwannoma.

  • ENT referral for refractory disease

    Ongoing consultant care when standard manoeuvres fail or symptoms recur despite treatment.

  • Structured follow-up

    Post-Epley review to confirm resolution, repeat manoeuvres if needed and pre-empt recurrence.

Red flags and differentials

When positional vertigo is not the whole story.

The Dix-Hallpike is safe and well-tolerated. The clinical judgement is knowing when it is not the right first move - and what to do instead.

  • Central positional nystagmus

    Non-fatigable, immediate, purely vertical or direction-changing nystagmus - points to a central cause.

  • Post-cerebellar stroke vertigo

    New vertigo with headache, ataxia or focal neurology needs urgent stroke assessment, not a bedside manoeuvre.

  • Vestibular schwannoma

    Progressive unilateral hearing loss, tinnitus or facial numbness warrants MRI internal auditory meatus.

  • Bilateral BPPV

    Positive Dix-Hallpike on both sides is uncommon - usually post-traumatic and needs specialist management.

  • Persistent postural-perceptual dizziness

    Chronic non-spinning dizziness driven by upright posture and visual motion - needs vestibular rehab, not repeat Epleys.

  • Vestibular migraine

    Episodic vertigo with migraine features - often mislabelled as BPPV. Needs a migraine-focused work-up.

  • Ototoxic drug injury

    Aminoglycoside or platinum-chemotherapy exposure can cause bilateral vestibulopathy - needs formal vestibular testing.

  • Post-traumatic BPPV with skull-base fracture

    BPPV after head trauma with suspected skull-base fracture needs imaging before positional testing.

  • Superior canal dehiscence

    Sound- or pressure-induced vertigo with autophony - needs high-resolution CT of the temporal bones, not repositioning.

Reading your report

A Dix-Hallpike report can look intimidating. It isn’t.

Whatever the finding, the report keeps to the same four parts.

A consultant ENT surgeon reviewing vestibular test findings on a clinical workstation at a UK private clinic

A quiet reminder

The report is written for your doctor, not for you - and that’s normal.

If you would like us to talk you through it before your follow-up, just ask.

  1. 01 Header

    Presentation and history

    Your details, the character and triggers of the vertigo, and any red-flag features that shape interpretation.

  2. 02 Technique

    Manoeuvre performed and side tested

    Which side was tested first, head position, speed of descent and any modifications for neck or back limitations.

  3. 03 Findings

    Latency, direction and duration

    Nystagmus latency, direction (upbeat, torsional, downbeat), duration, fatigability and reversal on sitting up.

  4. 04 Impression

    The conclusion: read this first

    Posterior-canal BPPV, alternative diagnosis or negative test - with the concrete next step. Read this first.

Recognised by major UK insurers

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Frequently asked

Everything we get asked about the Dix-Hallpike.

Quick answers on what the test feels like, what a positive result means, and what treatment follows.

  • What is the Dix-Hallpike manoeuvre?

    A bedside positional test used to diagnose posterior-canal benign paroxysmal positional vertigo (BPPV). Your head is turned 45° toward the ear being tested and you are rapidly lowered so your head hangs about 30° below the horizontal. Your clinician watches for a specific pattern of nystagmus and vertigo.

  • What does a positive Dix-Hallpike look like?

    A positive test produces upbeat, torsional nystagmus with vertigo after a 2–15 second latency, lasting under a minute, that fatigues on repeat testing and reverses on sitting up. That pattern is characteristic of posterior-canal BPPV.

  • Is the test painful?

    No - but it will briefly reproduce your vertigo, which is unpleasant. The whole positional part usually lasts under a minute, and if the test is positive we treat it the same visit with the Epley manoeuvre.

  • Will I be treated in the same visit?

    Yes. If the Dix-Hallpike is positive, we perform the Epley manoeuvre in the same appointment. Many patients notice a marked improvement before they leave the clinic.

  • When is the Dix-Hallpike not the right test?

    If your vertigo is constant, has neurological features (weakness, slurred speech, double vision, ataxia), follows head trauma with suspected skull-base fracture, or is accompanied by progressive unilateral hearing loss - different investigations are needed first.

  • How quickly can I be seen?

    Often within 24–48 hours across our London ENT and vestibular network, including evenings and Saturdays where availability allows.

Sources

What we relied on.

Last reviewed 2026-07-30. Next review 2027-07-30. Reviewer: Pulse Atlas Editorial Board, .

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Looking for a different test?

In practice, in London

What dix hallpike maneuver looks like on the ground in London

With dix hallpike maneuver, the London question is usually about report turnaround and the radiologist reading it - not whether the scan is available. On the NHS, dix hallpike maneuver typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to - and it’s the single most common reason people call us in the first place.

A private dix hallpike maneuver pathway in London usually looks like this: an initial consultation, any diagnostics booked at a nearby facility (most within Zone 1 or 2), and a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists, which keeps the standards consistent across both settings. For dix hallpike maneuver specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.

There are dozens of consultants in London who see dix hallpike maneuver - but not all of them are the right fit for every case. The right first appointment saves you from repeating yourself later.