BPPV has a high recurrence rate and is mostly idiopathic (no known cause). There is no current general consensus among researchers or clinicians about recurrent BPPV risk factors. Therefore, risk factors for recurrent BPPV is a very important topic!

I’ve recently written a blog article to review three research publications about bppv recurrence. After discussing the content of that blog article with my vestibular PT colleagues, I have decided to review a few more research articles on this very important topic.

In this blog, I will review the results of three more research publications about recurrent BPPV risk factors. You may notice that the findings vary slightly from the first three research articles I reviewed.

Risk Factors

Article #1

For the first article, I have selected a 2022 systematic review and meta-analysis evaluating research on recurrent BPPV risk factors by Dr. Li, Dr. Wang, and Dr. Yu plus seven more authors.

This research team closely examined sixty published research studies from around the world that met the inclusion criteria for their meta-analysis. As such, they included a grand total of 36,646 total research participants in this systematic review.

After systematically reviewing and analyzing the selected group of sixty research studies, these authors concluded the following are recurrent BPPV risk factors:

They also reached some interesting conclusions about recurrent BPPV risk factors that surprisingly did not show up after their lengthy analysis, such as Menieres’s disease and low vitamin D.

To review the details of their analysis and findings of their systematic review in more detail, click here.

Side note: I would like to add a note that one of my vestibular PT colleagues made when reviewing this systematic review and meta-analysis. Consensus does not necessarily or always mean correctness. My colleague was specifically referencing the findings published in this article that Meniere’s disease and low vitamin D did not impact BPPV recurrence, which is contrary to other published research and surprised many of us experienced clinicians.

To check out another blog article I wrote to review a different study that found Vitamin D supplementation did have an association with BPPV, click here.

Article #2

For the second article, I selected a 2019 research study published by Dr. Zhu, et al. This research study was not included in the 2022 systematic review conducted that I just described above.

This was a retrospective observational study conducted by the Department of Neurology at a hospital in China over a six-year period. A total of 1,012 patients were included in the study, ranging in age from 18-93 years old.

The research data showed that women with BPPV had more risks of recurrent BPPV than men. The research data divided into three age groups showed that the rate of recurrent BPPV increased somewhat with age. However, the authors concluded this increase was not statistically significant, so they did not include advanced age as a recurrent BPPV risk factor.

This research study concluded recurrent BPPV risk factors are:

  • Ménière’s disease
  • High blood pressure
  • Migraine
  • High cholesterol

To read this research article in detail and learn more about the other potential risk factors they analyzed in their study along with the limitations of this data set, click here.

Article #3

The third article I selected is a 2021 Clinical Review published by Dr. Sfakianaki and four more authors at an Academic ENT Department within a hospital in Greece.

The purpose of their clinical review was to evaluate the BPPV recurrence rate and identify recurrent BPPV risk factors. They extensively searched the existing published research worldwide on this topic using specific search terms, then applied inclusion and exclusion criteria.

After this process was completed, these authors included thirty research articles in their clinical review. As such, they included a grand total of 12,585 total research participants in this clinical review.

Note: The second research article I discussed above published by Dr. Zhu et al. was included in this clinical review.

Recurrent BPPV risk factors they identified in this clinical review include:

  • High cholesterol
  • High blood pressure
  • Diabetes

Risk factors that should be considered when treating post-menopausal women with recurrent BPPV include:

  • Osteoporosis
  • Vitamin D deficiency

Other conditions that must be distinguished from recurrent BPPV by healthcare providers and have a complex relationship with BPPV include:

  • Meniere’s disease
  • Migraine

The authors suggested that conditions that needed more investigation to determine their impact on recurrent BPPV include:

  • Osteoarthritis in the neck (cervical spondylosis)
  • Sleep disorders, like insomnia
  • Bilateral or multicanal BPPV

They also reached some interesting conclusions about recurrent BPPV risk factors that surprisingly did not show up after their clinical review, such as trauma, advanced age, and female gender. I found their discussion of each risk factor that they analyzed and their discussion of other published literature to be very interesting.

To read this article in detail, click here.

Is Research the Only Way to Learn?

I think it’s always important to strike a balance between learning from published research, clinical training courses taught by mentors, and hands-on clinical experience.

To check out another article I published about BPPV recurrence based on my clinical experience, click below.

BPPV Recurrence

I have also written this article to answer some FAQs about recurrent BPPV.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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