Benign Paroxsysmal Positional Vertigo (BPPV): An algorithm for clinicians
Dalton Gilligan, PT, DPT
Bow and Lean Test (also known as Head Pitch Test, Head Yaw Test, and Pagnini-Mc-Clure technique)
Image adopted from Choung, Shin, Kahng, Park, & Choi, 2006).
Steps to Perform (Choung, Shin, Kahng, Park, & Choi, 2006)

1. Down-pitch: Patient begins in the sitting position. Flex their head forward, and observe for nystagmus (Choung, Shin, Kahng, Park, & Choi, 2006 describe bowing head over 90 degrees, however it is my opinion that this amount may be excessive).
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-Observe for nystagmus.

2. Up pitch: Extend patient's head at least 45 degrees.
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-Observe for nystagmus.

Geotrophic Variant

Up-pitch: Horizontal nystagmus away from the side of involvement
Down-pitch: Horizontal nystagmus towards the side of involvement
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Apogeotrophic Variant

Up-pitch: Horizontal nystagmus towards the side of involvement
Down-pitch: Towards the side of involvement

Evidence:
Low sensitivity value and high false-negative rate (Riga, 2013).