Vertigo Resource Hub

Here you will find tools and resources to help with differential diagnosis of vertigo and dizziness. 

Red Flags

Vertigo Decision Guides

The HINTS Exam

BPPV Video Guide

Vestibular Physiotherapy Referral Form

Red Flags

(Urgent Medical Assessment Needed)

• New severe headaches + dizziness

• Neurological deficits (ataxia, dysarthria, diplopia, weakness)

• Vertical nystagmus or direction-changing gaze-evoked nystagmus

• Acute hearing loss

• Inability to stand or walk

• High vascular risk + acute continuous vertigo (HINTS exam normal)

Vertigo Decision Guides

Diagnostic Flowchart for Physicians

Wu V, Beyea MM, Simpson MT, Beyea JA. Standardizing your approach to dizziness and vertigo. J Fam Pract. 2018 Aug;67(8):490;492;495;498. PMID: 30110495.Download the full article here.

The HINTS Exam

Video curtesory of Dr. Peter Johns, emergency room physician from Ottawa, Canada.

BPPV Video Guide

Benign Paroxysmal Positional Vertigo (BPPV) is caused by displaced otoconia in the semicircular canals, causing positional vertigo, dizziness and nystagmus. Assessment involves finding the affected ear using the Dix-Hallpike test. Maneuvers, such as the Epley maneuver, help to move the otoconia out of the semicircular canal, resolving the patient's symptoms. Expect to need to repeat the manevuer 2-4 times. 

Please note that not all BPPV is resolved with the Epley maneuver. If this doesn't work for your patient, please consider referring for further testing and treatment. 

Step 1: Test using the Dix-Hallpike

Begin with the Dix-Hallpike Test.

Complete both the Right and Left Dix-Hallpike Tests. Take note of which causes the strongest reproduction of symptoms and observe for corresponding nystagmus. 

Step 2: Treat using the Epley Maneuver

If the Dix-Hallpikes tests reproduced the patients symptoms and nystagmus was observed, treat using the Epley Maneuver.

If the Right Dix-Hallpike caused nystagmus: Complete the Right Epley Maneuver

If the Left Dix-Hallpike caused nystagmus: Complete the Left Epley Maneuver

If the Dix-Hallpike test did not reproduce symptoms, or the nystagmus presented atypical (horizontal with no torsion component or wasn't present in room light), please refer to Vestibular Physiotherapy for Infrared Video Goggle testing.

Step 3: Rest and Education

After completing the Epley Maneuver, allow the patient to rest in a seated position for 5-10 minutes until symptoms subside.

Provide the patient with reassurance and education around BPPV. Feel free to download and use our BPPV Patient Education Handout with your patients. 

For additional BPPV instructional videos, click here.