Benign Paroxysmal Positional Vertigo (BPPV) has a recurrence rate estimated between 15% and 40% within one to two years after an initial episode. While many patients respond well to canalith repositioning procedures (CRPs), a smaller subset experiences more frequent recurrences. Understandably, these individuals often ask what they can do to prevent future episodes.
This post explores several actions patients can take to reduce the likelihood and impact of recurrent BPPV:
1. Vitamin D Supplementation
Multiple studies suggest that vitamin D supplementation may reduce recurrence rates in patients with low vitamin D levels. However, there is no evidence that supplementation helps if your vitamin D levels are already within a normal range.
It’s a good idea to have your levels checked if you experience frequent recurrences.
2. Sleep Position
Older research has shown that BPPV tends to occur more frequently on the same side people sleep on. Logically, avoiding sleeping on the affected side may help reduce recurrences. However, it’s important to note that post-treatment positioning restrictions have not been shown to impact the overall success rate of canalith repositioning procedures.
3. Daily Epley Exercises
Performing Epley or similar exercises daily does not reduce recurrence rates. These maneuvers are designed to move displaced particles out of the semicircular canals and into the vestibule, where they dissolve more quickly. In fact, daily repetition may increase the risk of recurrence in less common forms of BPPV, such as horizontal or anterior canal types, by repeatedly placing the head in positions that promote particle displacement.
4. Reinitiating Epley Exercises During Recurrence
Most BPPV recurrences occur in the same ear and same canal as the initial episode. Patients who have been previously instructed in the use of repositioning exercises can typically resume them if symptoms return.
5. Remote Support from a Practitioner
We encourage patients to email us and share videos of their eye movements if they experience recurring symptoms. This allows us to provide timely feedback—whether it’s reassurance to resume exercises, a recommendation to modify the technique, or a prompt to schedule an in-person evaluation.
6. Skip the Meclizine (Antivert)
Though commonly prescribed, meclizine does not treat BPPV, prevent its recurrence, or speed recovery. However, it can be used as an anti-nausea aid during repositioning treatments if dizziness or motion sickness prevents you from completing exercises effectively.
Final Thoughts
While we cannot fully prevent BPPV recurrences, we can manage them effectively. Treatments are generally safe, fast, and successful once a correct diagnosis is made.
Educating patients is key—by recognizing symptoms early and knowing what steps to take, individuals can regain control and seek help or begin treatment without delay.
About the author
Alan Desmond, AuD, is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. He has written several books and book chapters on balance disorders and vestibular function. He is the co-author of the Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo (BPPV). In 2015, he was the recipient of the President’s Award from the American Academy of Audiology.
