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Horizontal head-shaking test: pathophysiological mechanisms and clinical interpretation.

Vincenzo Marcelli1, Beatrice Giannoni2, Giampiero Volpe3

  • 1Department of Neuroscience, Reproductive Science and Dentistry, Section of Audiology, University of Naples "Federico II", Naples, Italy.

Frontiers in Neurology
|January 23, 2026
PubMed
Summary
This summary is machine-generated.

The horizontal head-shaking test (HST) is a valuable bedside tool for assessing vestibular function. It helps differentiate peripheral from central vestibular disorders by analyzing post-head-shaking nystagmus patterns.

Keywords:
head shaking induced nystagmushead shaking testunsteadinessvelocity storage mechanism (VSM)vertigo

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Area of Science:

  • Neuroscience
  • Otolaryngology
  • Vestibular System Physiology

Background:

  • The horizontal head-shaking test (HST) is a long-established bedside maneuver.
  • It primarily stimulates lateral semicircular canals (LSCs) at high frequencies.
  • HST reveals dynamic asymmetries in the angular vestibulo-ocular reflex (aVOR).

Purpose of the Study:

  • To explore the neurophysiological underpinnings of post-head-shaking nystagmus (post-HSN).
  • To elucidate the role of the velocity storage mechanism (VSM) in modulating post-HSN.
  • To highlight the clinical utility of HST in differentiating peripheral and central vestibular pathologies.

Main Methods:

  • Stimulation of the lateral semicircular canals via rapid head oscillations.
  • Observation and analysis of resultant nystagmus (post-HSN).
  • Interpretation based on Ewald's second law and the velocity storage mechanism.

Main Results:

  • Post-HSN reflects excitatory-inhibitory imbalances between labyrinths, modulated by the VSM.
  • VSM integrates canal signals and influences post-HSN characteristics (direction, duration, morphology).
  • Peripheral lesions typically cause horizontal post-HSN, while central disorders yield vertical, torsional, or exaggerated responses.

Conclusions:

  • HST is a neurophysiologically grounded tool for assessing vestibular-cerebellar networks.
  • It aids in discriminating between peripheral and central vestibular disorders.
  • HST offers diagnostic, prognostic, and educational value in clinical vestibular assessment.