BPPV keeps coming back: what to do when the spinning returns

If your BPPV keeps coming back, you're in good company. The Vestibular Disorders Association (VeDA) says long-term return rates are as high as 50% within 5 years, and higher when BPPV started after a head injury. A return is usually treated the same way as the first time, with a repositioning maneuver. The catch is that it can come back in a different canal or the other ear, so the maneuver that worked last time may not be the right one now. Unless your clinician gave you a written plan for repeats, call them when it returns, and get checked if anything feels different from before.

How often BPPV comes back

The numbers vary from source to source, so take them as a rough guide:

• VeDA says long-term recurrence is as high as 50% within 5 years, especially when it followed trauma.
• MedlinePlus says vertigo sometimes returns after a few weeks, and that about half the time BPPV comes back later on.
• Cleveland Clinic notes that some people have vertigo once and never again, while others have repeat episodes.

So it may come back quickly, years later, or never. Each return can usually be treated. The US ear, nose and throat doctors' society (AAO-HNS) says that although research hasn't found a way to stop BPPV coming back, it can be treated with a high rate of success.

What causes BPPV to come back

Most of the time there's no clear reason. The AAO-HNS says most cases happen for no reason, and that BPPV can sometimes be linked to trauma, migraine, other inner-ear problems, diabetes, osteoporosis, or lying in bed for long periods, for example after surgery or an illness. It says your risk of repeats can shift from low to higher because of things like an injury, other inner-ear or medical conditions, or getting older.

VeDA lists similar links, including concussion and other head injuries, inner-ear infection, low vitamin D, diabetes, osteoporosis and reduced blood flow. It also mentions a possible link with the side you usually sleep on.

None of these means you did something wrong. They're worth raising with your doctor, especially if your spells keep coming close together.

What to do when BPPV keeps coming back

When the room spins again, work through this in order.

1. Sit or lie down where you are and keep your head still until it settles. MedlinePlus says to sit down right away when you feel dizzy, because you can lose your balance and fall.
2. Check the warning signs at the end of this page. If any apply, call 911.
3. Ask yourself whether it's exactly like last time. Same moves set it off? Same side? Nothing new, like hearing changes, headache or numbness?
4. If it's the same and your clinician gave you a written plan for repeats, follow that plan exactly: the same maneuver, the same side, the same number of rounds.
5. Otherwise, call your clinician. MedlinePlus says to contact your provider when vertigo symptoms return, and that you'll need to be treated again.

Cleveland Clinic says your provider may teach you to do the Epley at home in case your symptoms come back, and that learning the correct movements first matters because doing them wrong could make symptoms worse. VeDA says a therapist may teach you a self-maneuver if your BPPV always comes back in the same canal and it's safe for you. It adds that many people prefer to go back so the therapist can confirm it's the same problem, because the maneuver that worked one time isn't always the one you need the next. The guide on the Epley maneuver at home covers the steps and who shouldn't do them alone.

Call your clinician instead of repeating it yourself if

• it feels different from last time, or lasts longer
• it seems to be on the other side, or you aren't sure which side
• it started after a fall or a knock to the head
• you have something new, such as hearing changes, trouble walking, a lot of vomiting, or dizziness when you're keeping still
• you've done the maneuver as instructed and still have symptoms

That last line comes straight from Cleveland Clinic, which says to call your provider if you've tried the Epley and still have symptoms. Your provider may need to test for other causes. While you wait, MedlinePlus advises getting up slowly, holding on to something when you stand, avoiding sudden moves and not driving or climbing while you have symptoms. The guide on sleeping with BPPV covers getting through the nights.

Keep a BPPV log

A log turns "it came back again" into something your clinician can use. It also shows you whether spells are getting closer together or further apart. Keep it on paper by the bed or in a phone note, and fill in a line for each spell:

• date and time
• what set it off, such as lying down, rolling to the left, looking up or bending over
• which side you were lying on or turning toward
• roughly how long the spinning lasted, in seconds or minutes
• anything else that came with it, like nausea, a full ear, ringing or a headache
• what you did, such as which maneuver, which side and how many rounds
• how you felt an hour later and the next day
• any falls or near falls
• any new medicine, illness, injury, or days in bed before it started

What to ask your clinician

The best time to plan for the next return is while you're well. Take your log and these questions.

• "Was it the same ear and the same canal as last time?"
• "How many days should I try at home before I call you?"
• "Could anything in my health be making it come back, like my old head injury, my migraines or bone thinning?"
• "Would a vestibular therapist help, for treatment or for my balance between spells?"
• "Which signs mean I should come in, or go to the emergency room, instead of treating it at home?"

If the spinning has stopped but you still feel off between spells, the guide on still being dizzy after the Epley explains what's usual.

When to get help now

A return of BPPV shouldn't come with any of these. VeDA says BPPV doesn't affect your hearing or cause fainting, headache, numbness, trouble speaking or clumsy movements. Mayo Clinic adds that repeated, sudden, severe or long-lasting dizziness with no clear cause should be checked by a professional.

Questions people ask

Can BPPV come back after the Epley maneuver?

Yes. A successful Epley moves the crystals that were loose at the time. More can come loose later. MedlinePlus says that about half the time BPPV comes back later on.

How quickly can BPPV come back?

It varies. MedlinePlus says vertigo sometimes returns after a few weeks. For other people it's years, or never. A log shows you your own pattern.

Does BPPV always come back?

No. Cleveland Clinic says some people have vertigo once and never have it again.

Can you prevent BPPV from coming back?

Not reliably. The AAO-HNS says research hasn't found a way to stop it returning. What you can control is how fast you get the right treatment, which is why a written plan from your clinician helps.