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Vertigo is a common symptom that can be challenging to evaluate and treat. Vertigo can arise from various pathophysiologies, ranging from benign to potentially life-threatening. Clinicians must perform a thorough history and physical examination to distinguish between benign and urgent causes of vertigo. Clinicians should be able to differentiate vertigo associated with central vestibular etiologies from peripheral vestibular disease processes. Benign positional paroxysmal vertigo (BPPV) is one of the most common causes of vertigo. The Dix-Hallpike maneuver is the gold standard test used to diagnose BPPV, which is crucial in confirming posterior canal BPPV. This activity reviews the Dix-Hallpike maneuver and highlights the role of an interprofessional healthcare team's role in evaluating and treating patients with vertigo. Objectives: Identify patients presenting with vertigo symptoms suitable for Dix-Hallpike maneuver assessment. Differentiate posterior canal benign positional paroxysmal vertigo (BPPV) from central vestibular etiologies using the Dix-Hallpike maneuver's results. Determine when or when not to use the Dix-Hallpike maneuver to treat vertigo. Collaborate with specialists for further evaluation and management of complex vertigo cases. Access free multiple choice questions on this topic.

Vertigo is a symptom characterized by a perceived sensation of motion, either of the self or the surroundings, in the absence of true motion.[1] While it is a common complaint, evaluating a patient with vertigo can be challenging. The differential diagnosis for vertigo is broad, encompassing central and peripheral vestibular causes, cardiovascular disease, metabolic dysfunction, and medication reactions. Most cases are mild and self-limited; however, studies have shown that up to 15% of patients with vertigo presenting in the emergency department may have life-threatening underlying causes.[2] Therefore, clinicians must perform a thorough history and physical examination to distinguish between benign and serious causes, ensuring prompt evaluation and treatment for those requiring urgent attention. Benign positional paroxysmal vertigo (BPPV) is the most common vestibular disorder globally, affecting approximately 2.4% of the general adult population over their lifetime.[3][4] Typically, patients with BPPV experience spontaneous remission within days to weeks of symptom onset. Although BPPV is self-limited and can be treated with simple procedures, recurrence rates are high, with rates ranging from 36% to 50% reported in the literature. These frequent recurrences can have a significant negative impact on an individual's quality of life.[5][6] The Dix-Hallpike maneuver is a valuable tool clinicians utilize to differentiate one of the most prevalent and harmless causes of vertigo from potentially severe alternative diagnoses. It serves as the gold standard test for diagnosing BPPV. When properly employed, the Dix-Hallpike maneuver can confirm the diagnosis of posterior canal BPPV, enabling them to administer bedside maneuvers that often offer immediate relief to patients.[7]

During the Dix-Hallpike maneuver, it is common for patients to experience nausea and vomiting. To mitigate these symptoms, administering an antiemetic before the procedure can be helpful.[5] This preventive measure can help alleviate the potential discomfort associated with the maneuver and improve the overall patient experience.

Vertigo is a prevalent and distressing symptom that can significantly impact a patient's quality of life. Due to the diverse range of conditions associated with vertigo and its frequent co-occurrence with nonspecific symptoms like nausea, dizziness, and imbalance, determining the underlying cause can be challenging. When the etiology of vertigo is uncertain, seeking a specialty consultation is appropriate. Patients presenting with nonparoxysmal vertigo or vertigo accompanied by neurological deficits, such as truncal ataxia, should not undergo the Dix-Hallpike maneuver. These associated findings are concerning for central etiologies and warrant further neurologic evaluation. Improving healthcare professionals' understanding of promptly evaluating and treating vertigo will lead to better patient outcomes. For patients with an appropriate history and a positive Dix-Hallpike test, a diagnosis of BPPV can be established without further testing.[5][9] Routine vestibular testing and radiographic imaging should not be ordered for patients who meet the diagnostic criteria for BPPV.[9] In the absence of additional vestibular signs or symptoms inconsistent with BPPV, vestibular testing and imaging are associated with low yield and may result in false-positive diagnoses. Moreover, they can accrue additional costs, prolong the diagnostic process, and delay appropriate treatment. Once a diagnosis of BPPV is made, treatment options such as the Epley maneuver and vestibular rehabilitation can be considered. Strong evidence exists for using the Epley maneuver to treat posterior canal BPPV. A meta-analysis conducted by the Cochrane Collaboration concluded that the Epley maneuver was an effective treatment for BPPV, although there was a high likelihood of symptom recurrence.[6] Nurse practitioners, physician assistants, and physicians should be familiar with the Dix-Hallpike maneuver and the Epley maneuver. Additionally, an interprofessional team approach involving collaboration among healthcare professionals can enhance the evaluation and care of patients with vertigo, leading to optimal patient outcomes.