A practitioner should be aware that if a person whose symptoms are consistent with BPPV, but does not show improvement or resolution after undergoing different particle repositioning maneuvers — detailed in the Treatment section below — need to have a detailed neurological assessment and imaging performed to help identify the pathological condition. Differential diagnosis
Vertigo, a distinct process sometimes confused with the broader term, dizziness, accounts for about six million clinic visits in the United States every year; between 17 and 42% of these people are eventually diagnosed with BPPV. Other causes of vertigo include:

Motion sickness/motion intolerance: a disjunction between visual stimulation, vestibular stimulation, and/or proprioception
Visual exposure to nearby moving objects (examples of optokinetic stimuli include passing cars and falling snow)
Other diseases: (labyrinthitis, Ménières disease, and migraine, etc.) Treatment
Repositioning maneuvers
A number of maneuvers have been found to be effective including the Epley maneuver, the Semont maneuver, and to a lesser degree Brandt–Daroff exercises. Both the Epley and the Semont maneuvers are equally effective. None of these maneuvers addresses the presence of the particles (otoconia); rather it changes their location. The maneuvers aim to move these particles from some locations in the inner ear that cause symptoms such as vertigo and reposition them to where they do not cause these problems. These maneuvers are easily performed at home and online resources are available to patients. The Epley maneuver is the most popular of the maneuvers because it is designed to address particles in the posterior semicircular canal, the most common cause of BPPV.
The most significant symptom is nystagmus as it is essential to determine the kind of nystagmus ( horizontal, vertical, or diagonal ) to select the correct cure maneuver. Cause
Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia or otoliths. In people with BPPV, the otoconia are dislodged from their usual position within the utricle, and over time, migrate into one of the three semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially "ear rocks") within the affected semicircular canal causes abnormal (pathological) endolymph fluid displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis. There is a direct link between the kind of nystagmus and which of the three semicircular canals is affected. With horizontal nystagmus ( left-right eye movement ) the horizontal ( also called lateral ) canal is affected, with vertical nystagmus ( up-down eye movement ) the superior ( also called anterior ) canal is affected, and with diagonal nystagmus ( diagonal or rotational eye movement ) the posterior canal is affected. Diagonal eye movement is easily confused with horizontal movement. This is important since it might result in selecting a wrong and thus ineffective cure maneuver. In rare cases, the crystals themselves can adhere to a semicircular canal cupula, rendering it heavier than the surrounding endolymph.