hallpike, epley and head impulse test

Have you ever needed to do the Hallpike maneuver or the Head-Impulse test? Read on . . .  from 7/13/2012 bedside teaching rounds.This was done on a patient who had intermittent episodes of vertigo. The vertigo was sometimes positional but not in any specific, characteristic fashion. Both tests in this patient were negative. The main focus was to assure that the physician can correctly do a Hallpike maneuver and understands the head-impulse test and what it tells us.

Teaching points

– The Hallpike maneuver must be performed correctly in order to gain any information from it that is reliable.

– When the head is in the lateral position, while the patient is supine, you should see torsional nystagmus that is delayed in onset by 2-20 seconds.   This should occur only with the affected side down. It should  resolve quickly.

– The more the maneuver is performed, the more the response of nystagmus will fatigue.

– The Head-impulse test helps to diagnose the presence of a peripheral vertigo.


Head-Impulse Test