The Hallpike test looks for torsional nystagmus (the eyeball twisting). Where seen, , this confirms BPPV. Often, no nystagmus is seen, and the patient may simply report being dizzy in the Hallpike position: if this dizziness lasts an appropriate amount of time (30-40 seconds) it can be considered a subjectively positive Hallpike. In more frail patients, or if both sides of the examination couch are not accessible, the Sidelying test is an alternative.
A Hallpike is designed to provoke vertigo – so the patient should be pre-warned and reassured. If the Hallpike test is positive a treatment (Epley manoeuvre) can be performed immediately to resolve the problem in the majority.
Please see the NHS Lothian videos on Hallpike testing.
C.M. & R.R. 01-07-25
