Betahistine for residual dizziness after canalith repositioning in benign paroxysmal positional vertigo: a systematic review of randomized controlled trials

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. Although canalith repositioning maneuvers (CRMs) are highly effective, a substantial proportion of patients experience residual dizziness (RD) after successful repositioning. Betahistine has been proposed as an adjunctive therapy to facilitate recovery; however, its effectiveness in RD remains uncertain....

Audiologists and vestibular specialists managing post-CRM residual dizziness in BPPV patients should review this systematic review's pooled findings; if betahistine shows significant benefit, it may warrant a protocol update in collaboration with referring physicians.

Residual dizziness after canalith repositioning maneuvers (CRM) is common and currently lacks a standardized treatment; robust evidence for or against betahistine would directly impact vestibular rehabilitation practice.

1. 01Systematic review of RCTs in Frontiers in Pharmacology evaluates betahistine for post-CRM residual dizziness in BPPV.
2. 02Canalith repositioning maneuvers (CRM) are the first-line treatment for BPPV but often leave patients with lingering dizziness.
3. 03Betahistine is a vestibular suppressant drug already used for some balance disorders.
4. 04Systematic review methodology provides higher-level evidence than individual trials.
5. 05Findings could guide whether betahistine should be routinely recommended after CRM in BPPV.

PMID

42311406

DOI

10.3389/fphar.2026.1855843.

Journal

Frontiers in Pharmacology

Publication type

systematic_review

Evidence level

1a

Population

Patients with benign paroxysmal positional vertigo (BPPV) who underwent canalith repositioning maneuvers and experienced residual dizziness

Intervention

Betahistine

Comparator

Placebo or no treatment (as reported in included RCTs)