Dix-Hallpike maneuver

Indications

• used in the assessment of vertigo
  • most useful in evaluation of suspected benign-positional vertigo

* side-lying test may be appropriate for patients unable to tolerate full neck extension

Contraindications

• not useful for evaluation of Meniere's disease

Procedure

• the sitting patient's head is placed in extension, then rotated 45 degrees to one side, then lowered to 30 degrees below the horizontal plane
• the patient is observed for nystagmus (rotational or vertical) & symptoms of vertigo

Interpretation

• benign positional vertigo*
  • rotational nystagmus & vertigo occur, generally only on one side; vertigo severe prior to fatigue (see below)
  • dizziness (vertigo) & nystagmus begin in 2-20 seconds
  • vertigo generally severe
  • duration of nystagmus < 1 minute
  • vertigo stops in < 30-60 seconds
  • the response fatigues; nystagmus & vertigo decrease with repetition, that is, it is not observed after a few repetitions
  • nystagmus unidirectional, mixed upbeat & torsional with small horizontal component
• central vertigo generally
  • vertigo generally mild
  • dizziness (vertigo) & nystagmus begin immediately
  • vertigo does not stop rapidly
  • duration of nystagmus > 1 minute
  • elicits vertical nystagmus or horizontal nystagmus without torsional component
  • vertigo is not fatigable; vertigo does not decrease with repetition

* see Epley maneuver for treatment of benign positional vertigo

More general terms

• maneuver
• physical examination technique

Additional terms

• Epley procedure/maneuver (canalith repositioning)
• side-lying test
• vertigo