Life after benign paroxysmal positional vertigo: one-year analysis of recurrence, headaches, neck pain, falls, and functional vestibular symptoms

Abstract

Purpose: Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder causing recurrent episodes of vertigo. Despite symptom resolution at discharge, events such as relapses, migraines, neck pain, falls, and persistent postural-perceptual dizziness (PPPD) may occur. This study aims to estimate the incidence, timing, and risk factors for these symptoms.

Methods: This multicenter, prospective, observational study recruited patients with a first episode of BPPV. Patients were treated with canalith repositioning maneuvers and discharged when no nystagmus was observed. Follow-up included in-person and telephone assessments over one year. The incidence and timing of symptoms were calculated, and risk factors were identified through regression models.

Results: 201 patients were recruited, and 124 met the inclusion criteria. 70.97% experienced events after discharge, though symptoms were not always severe enough to seek medical care. No useful risk factors were found for predicting BPPV recurrence. Low vitamin D levels increased recurrence risk but did not effectively discriminate patients. Women were more likely to develop headaches. Prior headaches, migraines, or neck pain were the strongest predictors of future occurrences of these conditions. Headaches or neck pain themselves triggered vestibular symptoms, often indistinguishable from BPPV. BPPV was associated with new-onset neck pain. The risk of falls increased with age. Anxiety triggered by BPPV predicted PPPD. Developing symptoms after discharge increased the likelihood of other events.

Conclusion: Although BPPV is considered resolved when no nystagmus is observed during provocation tests, it should be understood as a condition accompanied by other symptoms that often persist after discharge in most patients.

Keywords: Accidental falls; Benign paroxysmal positional vertigo; Migraine disorders; Neck pain; Patient discharge; Persistent postural-perceptual dizziness.