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Benign positional vertigo (BPV) is the most frequent cause of vertigo seen in office practice, with a lifetime incidence of at least 8%.1 While most patients give a diagnostic history—brief spinning attacks on looking up, lying down or on turning over in bed—some do not; nevertheless, when the Dix–Hallpike positional test is actually carried out, they do indeed have positional vertigo, with positional nystagmus, usually from the posterior canal. BPV is so frequent that if the story is even half-reasonable it is more useful to repeat the positional test on another day than to order an MRI.2
Büki et al expand the BPV spectrum to a chronic BPV, one without benign positional nystagmus (BPN), which they claim might be two or three times as common as …
Competing interests None.
Provenance and peer review Commissioned; not externally peer reviewed.