To explore the clinical characteristics and significance of head-shaking nystagmus (HSN) in patients with unilateral peripheral vestibular dysfunction (UPVD). Methods: Eighty-eight UPVD patients were included in this study, and their HSN type and caloric testing results were retrospectively collected. The clinical features, HSN type and related parameters, and correlation between HSN and semicircular canal paresis (CP) values were analyzed. Results: Eighty-eight patients with UPVD were included. The male/female ratio was 1/1.32, and the average age was (53.06±14.83) years. There were 53 HSN+ patients (60.23%). Patients were divided into 3 groups based on the presence of HSN and spontaneous nystagmus (SN): HSN+/SN+ group (16 patients), HSN +/SN- group (37 patients), and HSN-/SN- group (35 patients). Compared with the other 2 groups, the HSN+/SN+ group included a higher proportion of patients in the acute stage (within 2 weeks of onset), greater average CP value, and higher proportion of patients with a profound lesion (all P<0.05). Qualitative analysis of HSN revealed 39 patients with monophasic HSN, 13 cases with biphasic HSN, and 1 case of perverted HSN. Of the monophasic cases, 30 showed fast phase beating toward the normal side (76.92%), and 14 were in the acute stage (46.67%). Of the biphasic cases, 9 showed fast phases beating first toward the normal then toward the impaired side (69.23%), and 3 were in the acute stage (33.33%). The duration of the first phase of biphasic HSN was shorter than that of the second phase (P<0.05), but the slow-phase velocity (SPV) of the first phase was greater than that of the second phase (P<0.05). Conclusion: In patients with UPVD, those with HSN and SN are more commonly in the acute stage and frequently suffer profound lesions. Monophasic HSN is most common, with the fast phase directed toward the normal side, and is most often observed in the acute stage. Biphasic HSN more commonly shows fast phases beating first toward the normal side then toward the affected side and is less frequently seen in acute stage patients. In biphasic HSN, the first-phase SPV is high but duration short, and the second-phase SPV is low but duration long.