Benign paroxysmal positional vertigo (BPPV) is the most commonly encountered peripheral vestibulopathy in clinical practice. BPPV may be due to two main pathophysiological mechanisms: that of canalolithiasis, with debris free to float within the affected semicircular canal (SC), and that of cupulolithiasis, with debris attached to the cupula of the affected canal. The main symptom of BPPV is recurrent vertigo, typically triggered by changing head position with respect to gravity. Being a mechanical disorder, therapy of BPPV is mainly physical, and takes advantage of several maneuvers, proposed over time for the treatment of each canal. However, despite the existence of a wide number of techniques, the primary aim of its therapy is to minimize patients’ discomfort, choosing the most well-tolerated and readily effective maneuvers, every time step by step adjusted to each subject. The response to this intent is the “Minimum Stimulus Strategy” (MSS), which is a minimal invasive and nystagmus-based approach aimed to reduce the number of maneuvers needed to diagnose and to treat BPPV. Epley was the first to apply this new approach, using it in the management of posterior SC BPPV, and subsequently, this strategy was extended to the other BPPV variants. Specifically, it was proposed to begin the patient’s examination in a sitting position, observing the nystagmus induced and/or modified by the upright head pitch test (uHPT), bending the patient’s head forward and backward around the Y-axis in the pitch plane. More recently, other tests have been added to this type of approach, rotating the patient’s head in sitting position along other axis: the X-axis in the roll plane by the upright head roll test (uHRT), and two additional planes aligned with each couple of vertical SCs, the left anterior/right posterior (LARP) plane by the upright LARP test (uLARP), and the right anterior/left posterior (RALP) plane by the upright RALP test (uRALP). All these tests define the “Upright BPPV Protocol” (UBP), which consists of slowly rotating the patient’s head along all the SCs’ planes while sitting, simultaneously monitoring the induced nystagmus by video-Frenzel goggles. The aim of this chapter is to shed light on this new approach to BPPV, examining its pathophysiological aspects.