Hallpike manoeuvre

To perform the Hallpike manoeuvre, follow steps 1 to 4 of the Epley manoeuvre (see Epley manoeuvre for treating right-sided benign paroxysmal positional vertigo (BPPV) ). Tell the patient to keep their eyes open—a mixed torsional (upper pole of the eye beating towards the ground) and upbeating nystagmus is typical of a positive test, but may not start for a few seconds. The nystagmus fades and resolves over 30 seconds. Sometimes the nystagmus may recur when the patient sits up, but reverses direction. If the test is negative, repeat it with the head turned to the other side. The symptomatic ear is the lower ear on the side of the positive Hallpike manoeuvre.

If the patient has difficulty bending their neck back (due to stiffness or kyphosis), perform the Hallpike manoeuvre with the patient lying on their side (use steps 1 to 3 of the Semont manoeuvre in Semont manoeuvre for treating right-sided benign paroxysmal positional vertigo (BPPV) ).