# Association between diabetes mellitus, hypertension, migraine, and recurrence risk in benign paroxysmal positional vertigo: a retrospective cohort study

## TL;DR

This study finds that diabetes, hypertension, and migraine are linked to a higher risk of recurring vertigo episodes in patients with benign paroxysmal positional vertigo.

## Contribution

The study identifies diabetes mellitus, hypertension, and migraine as independent risk factors for BPPV recurrence.

## Key findings

- Diabetes mellitus increases the odds of BPPV recurrence by 60%.
- Hypertension is associated with a 49% higher risk of BPPV recurrence.
- Migraine is linked to a 75% increased risk of BPPV recurrence.

## Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo and can be effectively treated in most patients with canalith repositioning maneuvers. Nevertheless, recurrence remains a significant challenge in clinical practice. Although the pathophysiology of BPPV is primarily explained by mechanical mechanisms, the impact of systemic comorbidities on recurrence is not clearly defined. The aim of this study was to evaluate the association between diabetes mellitus (DM), hypertension (HT), migraine, and BPPV recurrence.

In this retrospective cohort study, 300 patients aged 18 years and older who were diagnosed with BPPV were included. The diagnosis was established based on a compatible clinical history and the demonstration of characteristic positional nystagmus on Dix–Hallpike and/or supine roll tests. Clinical and demographic characteristics and canal involvement were recorded. Comorbidities were identified based on physician-documented diagnoses in electronic medical records and/or the regular use of disease-specific pharmacological treatment. Recurrence was defined as the reappearance of positional vertigo symptoms within a six-month follow-up period, accompanied by confirmatory positional nystagmus on clinical testing. Independent factors associated with recurrence were assessed using multivariable logistic regression analysis adjusted for age, sex, and canal involvement.

Of the included patients, 168 (56.0%) were female, and the median age was 57 years [interquartile range (IQR): 48–66]. Posterior semicircular canal involvement was the most common finding (74.3%). During the six-month follow-up period, BPPV recurrence was observed in 74 patients (24.7%). In the overall cohort, the prevalence of DM, HT, and migraine was 20.7, 28.7, and 15.3%, respectively. The prevalence of DM, HT, and migraine was significantly higher in patients with recurrence compared to those without recurrence (all p < 0.05). In multivariable analysis, DM [odds ratio (OR): 1.60; 95% confidence interval (CI): 1.01–2.54], HT (OR: 1.49; 95% CI: 1.01–2.32), and migraine (OR: 1.75; 95% CI: 1.05–2.92) were independently associated with BPPV recurrence.

DM, HT, and migraine are moderately but significantly associated with BPPV recurrence. These findings suggest that BPPV should be evaluated within a broader clinical framework that considers systemic comorbidities in addition to its mechanical pathophysiology.