These positions are classically associated with potential compromise of vertebrobasilar circulation, so they should be avoided in a patient who develops dizziness during vertebral artery testing.

Current practice: dizziness during cervical positional testing is a warning symptom. Do not continue provocative testing or cervical manipulation. Stop, reassess for vascular or neurologic red flags, and arrange urgent medical evaluation if symptoms are new, severe, persistent, or accompanied by neurologic signs. The diagnostic validity of the extension-rotation test itself is limited, as summarized in this validity study.