Blog For Therapists & Other Providers Who Treat Dizziness & Vertigo

Atypical BPPV: Understanding Posterior Canal BPPV Variants

May 13, 2026

Most clinicians are comfortable treating classic posterior canal BPPV.

A patient rolls over in bed, looks up, bends forward, or gets out of bed and experiences brief vertigo. You perform the Dix-Hallpike test, see the expected upbeat torsional nystagmus toward the affected ear, complete a Modified Epley or Semont maneuver, and symptoms improve quickly.

Simple.

Except when it is not.

- What happens when the history sounds exactly like BPPV, but the Dix-Hallpike is negative?

- What if symptoms are stronger when the patient sits up than when they lie back?

- What if the nystagmus is downbeat instead of upbeat?

- What if the nystagmus is sustained or the standard maneuvers

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Atypical BPPV: Understanding Posterior Canal BPPV Variants

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Two Step