Can GPs diagnose benign paroxysmal positional vertigo and does the Epley manoeuvre work in primary care?

British Journal of General Practice, September 2010 moved quickly ‘from a sitting position to lying with the head tipped 45 ̊ below the horizontal, 45 ̊ to the side, and with the side of the affected ear (and semicircular canal) downwards.’ The Dix-Hallpike test is positive when torsional (rotatory) nystagmus occurs when the head is turned to the affected ear. In a prospective study of diagnosis of vertigo in general practice, a positive Dix-Hallpike test had a positive predictive value of 83.3% and a negative predictive value of 52% in diagnosing BPPV. Having done so, GPs can then usually resolve the condition through a manipulation called the Epley manoeuvre. Benign paroxysmal positional vertigo (BPPV) in adults is a common cause of dizziness seen in general practice with a 1year prevalence of 1.6%. It is characterised by brief episodes of dizziness or vertigo typically triggered by rapid changes in the position of the head and can be associated with nausea which may persist. BPPV can resolve spontaneously within weeks or months. It can present in clusters and can recur after remission. This short paper is based on a critical literature review.