Benign paroxysmal positional vertigo (BPPV) is caused by displacement of otoconia fragments from utricle into the semicircular canals. It follows that the principal management of BPPV is canalith repositioning. However, there are a number situations in which canalith repositioning is not utilized, practical, effective, or leaves residual symptoms. In such scenarios, vestibular suppressants such as antihistamines, anticholinergics, and benzodiazepines can be effective in symptom relief. Better understanding of comorbid conditions associated with BPPV provides an opportunity to proactively treat BPPV and prevent recurrences. These conditions include osteoporosis and vitamin D deficiency, which typically prompt treatment with bisphosphonates and vitamin D supplements, respectively. Treatment of BPPV include canalith repositioning, pharmacotherapy and combination therapy which are described in detail in this chapter.