The Hallpike test looks for torsional nystagmus (the eyeball twisting). Where seen, this confirms objective nystagmus as opposed to patients who report symptoms of vertigo, who are described as having subjective nystagmus. 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 vertigo is present a treatment (Epley manoeuvre) can normally be performed immediately to resolve the problem in the majority.
NHS Lothian videos on Hallpike testing can be found here: https://vimeo.com/channels/1713248
