The head impulse test (HIT) is used to evaluate the vestibulo-ocular reflex (VOR) during high-velocity head rotation. Corrective catch-up saccades triggered during or after a HIT usually indicate peripheral vestibular hypofunction; whereas normal clinical (bedside) HIT findings in acute vestibular syndromes suggest a central cause. Recent quantitative studies evaluating HITs using magnetic search coils or video-based techniques have demonstrated specific abnormal HIT patterns associated with central vestibular disorders. Improved identification of abnormal HIT patterns may help practitioners localize lesions responsible for central and peripheral vestibulopathies.