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Positional vertigo, nystagmus patterns and canalith repositioning
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo — brief spinning triggered by head position changes. Diagnosis uses the Dix-Hallpike maneuver; treatment uses canalith repositioning maneuvers (Epley).
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Jitendra Prasad Yadav (MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM, NMC 8029). Evidence-based, no fabricated outcomes.
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo — brief spinning triggered by head position changes. Diagnosis uses the Dix-Hallpike maneuver; treatment uses canalith repositioning maneuvers (Epley).
Reviewed by Dr. Jitendra Prasad Yadav, MBBS, MD, FICN, FCNV, FIHM — Consultant Neurologist & Headache Specialist (NMC 8029), Kathmandu Neurology Clinic. For evaluation, book an appointment.
BPPV is diagnosed by history (brief positional vertigo lasting seconds to a minute) and confirmed by the Dix-Hallpike maneuver — a bedside test that provokes characteristic nystagmus (involuntary eye movements) and vertigo. The direction and duration of nystagmus identify which semicircular canal is affected (posterior, horizontal or anterior).
The Epley maneuver is the most effective treatment for posterior canal BPPV — a series of head position changes that move otoconia (calcium crystals) out of the semicircular canal back to the utricle where they don't cause symptoms. Success rate is ~80–90% after one or two treatments.
BPPV that doesn't respond to repositioning maneuvers, atypical nystagmus patterns, or associated neurological symptoms (weakness, speech problems, persistent imbalance) requires further evaluation — MRI to exclude central causes and vestibular testing.
Bhattacharyya N et al. Clinical Practice Guideline: BPPV. Neurology 2017Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.