Not in the way a progressive disease does. Benign paroxysmal positional vertigo causes brief spinning triggered by a change in head position, and it does not steadily deteriorate. It does recur in a substantial minority of people, and a recurrence can feel like worsening when it is the same problem returning.
Not in the way a progressive disease does. Benign paroxysmal positional vertigo causes brief spinning triggered by a change in head position, and it does not steadily deteriorate. It does recur in a substantial minority of people, and a recurrence can feel like worsening when it is the same problem returning.
The mechanism is mechanical rather than degenerative. Calcium carbonate crystals that normally sit in the utricle become displaced into one of the semicircular canals, where they move with gravity and stimulate the canal when it should be quiet. The brain receives a signal of rotation that the eyes and body do not confirm, and the result is vertigo lasting seconds. Nothing about that process is inherently self-worsening. Once the crystals are relocated the canal behaves normally again, which is why treatment can work so quickly.
Recurrence is common and is not a sign that the first treatment failed. The same displacement can happen again, and it is more likely after head injury, after vestibular neuritis, and with increasing age as the supporting structures change. Some people have a single episode and nothing further for many years; others have episodes periodically. Because each episode is the same mechanical problem rather than an accumulating one, the treatment for a recurrence is the same as for the first episode.
Canalith repositioning, of which the Epley manoeuvre is the familiar example, uses a sequence of head positions to move the crystals out of the canal. Most posterior canal cases settle within one or two treatment visits. Diagnosing which canal is involved comes first, because the manoeuvre differs by canal and performing the wrong one is ineffective. Positional testing and repositioning are performed in the office, and VNG balance testing is available at both locations when the picture is less clear.
Certain features argue against BPPV and matter more than the severity of the spinning. Dizziness that is constant rather than triggered by position. Hearing loss or tinnitus, which point towards the inner ear in a different way. New headache, double vision, slurred speech, facial weakness or unsteadiness on walking, which raise the question of a central cause. Vertigo that has genuinely become steadily worse over weeks is not behaving like BPPV and should be reassessed rather than treated again.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: dizziness and vertigo; National Institute of Neurological Disorders and Stroke; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.