The Dix-Hallpike maneuver is a test that doctors use to diagnose a particular kind of vertigo called benign paroxysmal positional vertigo (BPPV). People with vertigo experience a feeling of room-spinning dizziness.

The Dix-Hallpike maneuver is really just a series of movements you perform while a doctor observes your response. This test has been used since at least 1952 and is considered the “gold standard” doctors use to diagnose BPPV.

While BPPV might have a complicated name, its cause is simple. This type of vertigo happens when calcium crystals in your inner ear, which help you balance, become displaced. This results in symptoms of dizziness and nausea.

BPPV is one of the most common causes of vertigo, and once it’s diagnosed, it’s usually fairly simple to treat.

The Dix-Hallpike test is typically performed in a doctor’s office.

The doctor will ask you to sit upright on an exam table with your legs stretched out in front of you and your head turned to one side.

They will then ask you to lower your head and torso back so that you end up lying with your head stretched off the edge of the exam table, turned with one ear down at a 45-degree angle. If there are misplaced calcium deposits (also called canaliths) in the posterior canal of your inner ear, this will trigger vertigo symptoms.

While you’re lying back, your doctor will check for eye movement called nystagmus, which can indicate dizziness. The doctor may then ask you questions about how you’re feeling before switching sides and testing the opposite ear.

After you perform the Dix-Hallpike test, a doctor can typically give you the results of what they observed right away. Depending on those results, they may be able to come up with a treatment plan immediately.

Dix-Hallpike maneuver positive

If the doctor notes that your vertigo is triggered by the maneuver, it’s likely that you have BPPV affecting your posterior ear canal on the right, left, or both sides.

The treatment for this condition starts with something called the Epley maneuver, which can sometimes be performed during the same appointment as the Dix-Hallpike test.

The Epley maneuver consists of a series of slow movements of your head and neck. These movements can dislodge canaliths and move them into a part of your ear where they’ll stop triggering vertigo.

Dix-Hallpike maneuver negative

If your Dix-Hallpike test is negative, it’s possible that there is another cause for your vertigo symptoms, such as:

It’s also possible to receive a false negative, in which case you may need to see a specialist and repeat the test again.

If you get a negative test, your doctor may recommend more tests to check for other causes of your BPPV.

Can results be inconclusive?

The ability of the Dix-Hallpike maneuver to correctly diagnose people with BPPV is anywhere from 48 to 88 percent. Obviously, this is a huge gap. Medical literature suggests that if a specialist or someone deeply familiar with the test performs it, you’ll more likely receive an accurate result.

Since false negatives do happen, a negative result in a clinical setting doesn’t conclusively mean that BPPV isn’t what’s causing your vertigo. In some cases, you may need to ask for a second opinion and do the maneuver again before being tested for other conditions.

People with vertigo that developed recently are candidates for the Dix-Hallpike maneuver. Symptoms of BPPV include:

  • loss of balance during everyday tasks
  • dizziness after moving your head, sitting up quickly, or lying down
  • nausea and vomiting

BPPV symptoms usually last up to a minute and tend to recur.

The purpose of the Dix-Hallpike maneuver is to trigger your vertigo so that the doctor can observe it. For this reason, the doctor may offer you an anti-vomiting medication before doing the test in case the maneuver triggers nausea.

Ear, nose, and throat specialists (ENTs) may have more experience performing the Dix-Hallpike test than general practitioners. So it might be best to see a specialist while you’re in the process of figuring out what’s causing your vertigo.

Keep in mind that false negatives do happen, and be prepared to schedule a follow-up appointment or further testing if you don’t get a positive result the first time you’re tested.

For most people, this testing method is safe. There is very little risk of any long-term side effects beyond dizziness for a few minutes after the test is performed.

The Dix-Hallpike maneuver is a simple, safe way to test your body to see if BPPV is causing your vertigo symptoms. It doesn’t require special preparation or downtime to recover.

This simple maneuver has worked for decades to diagnose the presence of canaliths that need to be repositioned in a person’s ear. If you receive a positive diagnosis for BPPV, you can move into the treatment phase of managing your vertigo.