Benign paroxysmal positional vertigo Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.


This guidance refers to:

  • Benign paroxysmal positional vertigo: recurrent severe rotational vertigo provoked by positional changes, not associated with hearing loss, tinnitus or headache. Each episode of vertigo lasts less than 30 seconds.
  • Adults 18+

This guidance does not cover:

  • Other pathologies causing vertigo e.g. labyrinthitis (vestibular neuronitis).
  • Under 18+


Signs and Symptoms

Symptoms include:

  • Each episode of vertigo lasts less than 30 seconds.

History and Examination

  • Hallpike's positional test is diagnostic
  • Otherwise normal examination of ears and cranial nerves

Differential Diagnoses

  • If Hallpike Test is negative or atypical response consider other pathologies

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • Immediate, single plane or non-fatiguing nystagmus in response to Hallpike indicates possible central pathology


Note- Patients may not be fit to drive themselves home after an Epley manoeuvre


Referral Criteria

  • Red Flags
  • Hallpike's negative or atypical (even if history suggests BPPV)
  • Epley manoeuvre unsuccessful or not possible e.g. severe cervical spondylosis

Referral Instructions

  • e-consultation is not currently available for this specialty
  • Referrals should be made via ICG to TRISH (if training has been undertaken) - See user guides (EMIS & S1) for further information.
  • For those Practices who have not received ICG training referrals should be made via eRS
  • Please identify speciality and clinic type

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/Additional Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This Care Pathway was ratified by: The OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: ENT2 - 05.2017
Any feedback or suggestions to improve this guidance should be sent to:
Only the electronic version is maintained, once printed this is no longer a controlled document


Home > Care Pathways > Ear, Nose & Throat (ENT)* > Benign paroxysmal positional vertigo Care Pathway