Why Do Some People Keep Getting Vertigo Back? Understanding Recurrent BPPV and What the Research Really Shows
- Julian Simpson
- 2 days ago
- 5 min read
Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.
Why Do Some People Keep Getting Vertigo Back? Understanding Recurrent BPPV and What the Research Really Shows
If you’ve ever been hit with sudden spinning dizziness while rolling over in bed, looking up, or bending down to pick something up, you’ll know how unsettling it can be. For many people across Sunbury and Melton, this doesn’t just happen once—it can come back again and again, disrupting work, driving, and even simple things like getting out of bed.
This condition is called Benign Paroxysmal Positional Vertigo (BPPV), and despite its intimidating name, it is actually the most common cause of vertigo worldwide. The good news? It’s highly treatable. The frustrating part? For some people, it keeps returning.
So what does the latest clinical research actually say about why BPPV recurs—and what can be done about it?
Why Vertigo Disrupts Everyday Life
For many locals juggling long commutes along the Calder Freeway or Western Highway, BPPV can be more than an inconvenience—it can affect safety, confidence, and quality of life.
Typical experiences include:
Sudden “room spinning” when turning in bed
Dizziness when looking up or down
Nausea or imbalance while walking
A lingering “off balance” feeling after an episode
Even though most episodes are brief, the fear of recurrence often becomes the biggest burden.
What’s Actually Happening in BPPV? (In Plain English)
Inside your inner ear are tiny calcium carbonate crystals called otoconia. Their job is to help detect gravity and movement.
In BPPV:
These crystals become dislodged from their normal position
They move into one of the balance canals in the inner ear
When your head moves, the crystals shift fluid incorrectly
This sends a false signal to your brain: “You’re spinning”
This mismatch between inner ear signals and vision is what creates the intense vertigo sensation.
What the PubMed Research Shows About Recurrence
A major systematic review and meta-analysis of 36,646 patients across 60 studies found that while most BPPV cases resolve, recurrence is common and influenced by several measurable risk factors.
Key clinical findings include:
Females had higher recurrence risk
Age over 65 increased risk
Diabetes significantly increased the recurrence risk
Hypertension and hyperlipidaemia were strongly associated
Head trauma history increased recurrence risk
Osteopenia/osteoporosis also contributed
Importantly:
Around 95% of BPPV cases respond well to canalith repositioning therapy (CRT)
However, recurrence rates range from 10–18% within 12 months, and up to 50% over 10 years
Why Does BPPV Keep Coming Back?
The research suggests recurrence is rarely random. Instead, it appears linked to:
Metabolic health factors (blood sugar, cholesterol, vascular health)
Inner ear sensitivity or degeneration
Neurological triggers like migraine
Postural and lifestyle loads (including prolonged screen use)
In simple terms: BPPV is often a systems issue, not just a one-off mechanical fault.
Evidence-Based Management: What Actually Works
The gold-standard treatment remains canalith repositioning techniques (such as the Epley manoeuvre), which physically guide displaced crystals back to where they belong.
However, modern care is increasingly multimodal, meaning it works best when several approaches are combined:
A structured, evidence-informed approach may include:
Targeted repositioning manoeuvres (CRT)
First-line treatment with very high success rates
Vestibular and balance rehabilitation
Helps retrain the brain’s balance system
Reduces sensitivity to movement triggers
Lifestyle and posture education
Sleep positioning strategies
Safe movement patterns during flare-ups
Cervical spine assessment
Neck dysfunction can sometimes influence balance input
Gentle manual therapy may support mobility and proprioception
Metabolic health support (in collaboration with GP)
Blood sugar, blood pressure, and cholesterol management
Why a multimodal approach matters Research consistently shows that combining manual therapy, exercise-based rehabilitation, and education leads to better long-term outcomes than any single approach alone. This is because BPPV is influenced by both mechanical inner ear changes and broader neurological, metabolic, and postural factors—not just one isolated system.
Where Chiropractic Care Fits In
Modern clinical guidelines show strong support for spinal manipulative therapy (SMT) in musculoskeletal conditions:
Around 90% of global clinical practice guidelines support SMT for lower back pain
100% recommend SMT for neck pain (Trager et al., 2024)
While BPPV itself is an inner ear condition (not a spinal one), chiropractic care can play a supporting role in selected cases by focusing on:
Cervical spine mobility and joint function
Reducing neck-related proprioceptive strain
Supporting posture and balance integration
Coordinating referral pathways for vestibular rehabilitation when needed
Importantly, conservative manual therapy has a strong safety profile, with serious adverse events reported as extremely rare in clinical literature (Breen et al., 1999), especially when care is appropriately screened and delivered.
What Treatment Looks Like in Practice
At Health Wise Chiropractic, a typical supportive care plan for someone with vertigo symptoms may include:
A detailed case history (including triggers and medical screening)
Movement and balance assessment
Cervical spine and postural evaluation
Gentle manual therapy where appropriate
Vestibular exercise recommendations (home-based)
Education on flare-up management and recurrence prevention
Referral to GP or ENT if red flags are present
The goal is not just symptom relief—but reducing recurrence risk and improving confidence in movement.
The Takeaway
BPPV is highly treatable, but recurrence is common—especially in people with metabolic, neurological, or musculoskeletal risk factors.
The strongest message from the research is this:
Most people recover fully with repositioning techniques
Recurrence is influenced by whole-body health factors
Long-term management works best when care is multidisciplinary and active
How Chiropractic Care May Help
At Health Wise Chiropractic, we take a comprehensive approach to posture-related care.
Treatment may include:
We focus on addressing both the symptoms and the underlying biomechanical stress contributing to neck dysfunction.
About the Author
Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.
He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.
His treatment focus includes:
Chiropractic adjustments
Sports chiropractic
Massage therapy
Shockwave therapy
Laser therapy
Non-surgical spinal decompression
Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.
reference
Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y, Han L, Ma X, Xia R, Yu L. Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. Ear Nose Throat J. 2022 Mar;101(3):NP112-NP134. doi: 10.1177/0145561320943362. Epub 2020 Aug 10. PMID: 32776833.
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