What is the duration of Benign Paroxysmal Positional Vertigo (BPPV)?

From the Guidelines

Benign Paroxysmal Positional Vertigo (BPPV) typically lasts for a short duration, with each vertigo episode lasting less than one minute, though the overall condition can persist for days to weeks if left untreated.

Duration of BPPV

The duration of BPPV can vary, but most cases resolve spontaneously within a few weeks or months as the displaced calcium crystals in the inner ear are naturally reabsorbed 1.

• The natural course of BPPV is to become less severe over time, with people often reporting that their very first BPPV spinning episode was the worst and the following episodes were not as bad 1.
• There is evidence that if BPPV is left untreated, it can go away within weeks, with a mean time interval from onset of symptoms to spontaneous resolution of BPPV of 39 days 1.
• However, with proper treatment such as the Epley maneuver or other repositioning techniques performed by a healthcare provider, symptoms can often be resolved in just one or two treatment sessions 1.

Recurrence of BPPV

BPPV can recur in about 15-30% of patients within one year, so knowing how to recognize symptoms and seek prompt treatment is important for long-term management 1.

• The recurrence rate of BPPV may be estimated at 15 percent per year, and patients with BPPV after trauma are likely to demonstrate an even higher recurrence rate of their BPPV 1.
• Counseling patients about the recurrence risk of BPPV can have several benefits, including earlier recognition by patients of recurrent BPPV, allowing earlier return for treatment or vestibular rehabilitation 1.

From the Research

Duration of BPPV

• The duration of Benign Paroxysmal Positional Vertigo (BPPV) can vary from person to person, with some people experiencing symptoms for a short period, while others may have symptoms that last for several months 2.
• A study published in 2013 found that the reported duration of symptoms at the time of the first examination varied from 1 day to 18 months 2.
• Another study published in 1997 found that while 93% of patients improved, many had persistent nystagmus at the first evaluation, and in only 63% was resolution clearly related to a canalith repositioning procedure (CRP) session 3.
• A review of the literature published in 2019 found that BPPV is typically self-limited, but can have a considerable impact on quality of life, and that the diagnosis can be established with a Dix-Hallpike maneuver for the posterior and anterior canals, or supine roll test for the horizontal canal 4.

Treatment and Recurrence

• The Epley maneuver, also known as the canalith repositioning procedure, is a common treatment for BPPV, and has been shown to be effective in resolving symptoms in many patients 5, 6.
• However, there is a high recurrence rate of BPPV after treatment, with one study finding that 36% of patients experienced a recurrence of symptoms 6.
• A study published in 2013 found that symptom recurrence was noted in 139 patients, and that a statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy 2.

Factors Affecting Duration

• The duration of BPPV can be affected by various factors, including age, with elderly people having a higher recurrence rate 2.
• Head trauma and a history of vestibular neuropathy can also increase the risk of recurrence 2.
• The effectiveness of treatment, such as the Epley maneuver, can also impact the duration of symptoms, with some patients experiencing complete resolution of symptoms, while others may have persistent symptoms 3, 6.