Can Betahistine help BPPV?

Can Betahistine help BPPV?

BPPV is defined by repeated episodes of acute, short, paroxysmal vertigo, provoked by changes in head position relative to gravity. It is the most common peripheral vestibular disorder and commonly seen in a physical therapy office. The diagnosis of BPPV is clinical and is done mainly through maneuvers that determine what canal and what type of BPPV patients present with.


Canalith repositioning maneuvers are the mainstay of BPPV treatment with level 1 evidence and clinical practice guidelines recommending them in treating BPPV. Treatment success depends on identifying and specifying the type of BPPV and canal involved. An accurate diagnosis and choice of appropriate maneuver are crucial to the success of the treatment.

Even though canalith repositioning procedures are the gold standard for treatment, betahistine could be used with success for other vestibular disorders. Betahistine serves as a co-adjuvant treatment option for various disorders related to dizziness and vertigo, mainly to aid in improving blood flow to the inner ear.

Here are two recent studies showing that adding Betahistine to Canalith Repositioning Procedures could make patients better.

In 2017, Kaur and Shamanna reported a better response in the Epley maneuver  plus betahistine group. Those receiving Epley maneuver plus betahistine experienced less recurrence and relapse.

In 2020, a randomized control trial by Sayin et al showed that betahistine add-on treatment to the appropriate canalith repositioning procedure resulted in better BPPV symptom improvement as measured by visual analog scale and dizziness handicap inventory.


Even though physical therapists cannot prescribe medication, we always want to know if something more can help reduce recurrence of symptoms and improve overall outcomes for our patients. We

With that said, the success rate of BPPV canalith repositioning procedures is very high — usually 70% to 95% — within 2-3 sessions. In those who do not improve, we do look at other factors including:

  • any correlating neck pain

  • any visual or ocular disturbances

  • Vitamin D levels

  • Overall physical activity (i.e exercise program) and

  • Dietary choices.

  • If Vestibular Rehabilitation exercises are right for you

We would normally address these factors before recommending medication but for those reading this article, this is good news to show that there are additional choices available to help you further!

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