Dix-Hallpike test: how to diagnose BPPV

The Dix-Hallpike is the gold-standard test for posterior-canal BPPV. Knowing how it works — and which side it lights up — tells you which ear to treat.

How the test works

The Dix-Hallpike puts the posterior semicircular canal of one ear in a gravity-dependent position. If loose otoconia are sitting in that canal, they shift, the canal fires, and you feel an intense burst of vertigo — usually with a visible upbeating, torsional eye movement (nystagmus).

Step-by-step

  1. 1. Sit upright on a bed

    Sit so that when you lie back, your head will extend slightly past the edge of the bed or pillow.

  2. 2. Turn your head 45° to the test side

    Start with the side you suspect. Keep your eyes open.

  3. 3. Lie back quickly, head hanging

    With your head still rotated, lie back rapidly so your head hangs about 20° below horizontal. Hold for at least 30 seconds and notice when spinning starts and stops.

  4. 4. Sit up and rest, then test the other side

    Sit up, wait one minute, then repeat with the head turned 45° to the opposite side.

Interpreting the result

  • Positive on one side — that ear is affected. Treat with the Epley or Semont maneuver.
  • Positive on both sides — bilateral BPPV. Treat the worse side first, wait 24 hours, then the other.
  • Negative on both — likely not posterior-canal BPPV. See BPPV symptoms for other possibilities.

Related BPPV guides

Frequently asked questions

What is the Dix-Hallpike test?
The Dix-Hallpike is the standard diagnostic test for posterior-canal BPPV. By lowering you quickly into a head-hanging position with your head rotated 45°, it provokes the characteristic vertigo and nystagmus from displaced inner-ear crystals.
What does a positive Dix-Hallpike look like?
Within 5–20 seconds of reaching the head-hanging position, you feel intense spinning, and an observer sees an upbeating, torsional nystagmus (eyes beating up and twisting toward the affected ear). Both fade within about 60 seconds.
Can you do the Dix-Hallpike on yourself?
You can attempt a self-test, but you'll miss the eye-movement part — a clinician usually watches for nystagmus. At home, focus on whether the head-hanging position reliably triggers brief spinning and which side is worse; that side is usually the affected ear.
What if the Dix-Hallpike is negative?
A negative result on both sides means it's probably not posterior-canal BPPV. The horizontal canal (tested with a supine roll test) or another condition entirely — vestibular migraine, Meniere's, vestibular neuritis — may be responsible.