Obtain a history of vertigo that occurs when turning in bed or tilting the head backward and lasts 10 to 30 seconds.
Ask about symptoms such as hearing loss, tinnitus, weakness, and numbness of the face or limbs, which suggest an alternative etiology.
Look for physical exam findings that suggest a peripheral cause of vertigo compatible with BPPV, such as spontaneous nystagmus, gaze-invoked nystagmus, a positive head thrust test, and abnormal Dix-Hallpike maneuver.
Look for physical exam findings that suggest a central cause of vertigo not compatible with BPPV, such as cranial nerve dysfunction and brainstem dysfunction.
Obtain basic vestibular laboratory testing in patients with atypical dizziness or vertigo between attacks of typical BPPV.
Obtain MRI scan of the head and internal auditory canals to exclude structural lesions in patients with cranial nerve or brainstem dysfunction; hearing loss, tinnitus or ear fullness; downbeating rather than upbeating nystagmus during Dix-Hallpike maneuvers; persistent symptoms and signs during Dix-Hallpike maneuvers; or in case of failure to respond to conservative management.