Role of migraine in recurrent benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) frequently recurs, affecting quality of life. Although migraine and environmental factors such as atmospheric pressure and temperature have been proposed as predictors, their precise influence remains unclear. We aimed to evaluate whether migraine, thyroid disease, and environmental factors (atmospheric pressure and temperature) predict recurrence of BPPV. We retrospectively analyzed data from 374 patients diagnosed with BPPV between 2018 and 2024 at a university otolaryngology clinic. Clinical history, migraine and thyroid status, and meteorological data were evaluated. Multivariate logistic regression assessed independent predictors of recurrence. Recurrence occurred in 20.1% of patients. Migraine was significantly associated with increased recurrence risk (OR 2.07; 95% CI: 1.01–4.22; p = 0.046), independent of age and sex, independent of thyroid disease, and environmental conditions. No significant associations were found between recurrence and atmospheric pressure ( p = 0.586), temperature ( p = 0.224), or thyroid disease ( p = 0.089). Migraine significantly predicts BPPV recurrence, independent of environmental factors. These findings strongly support routine migraine screening in clinical practice for patients with BPPV, to facilitate early identification and tailored management strategies aimed at reducing recurrence. • Migraine roughly doubles the risk of recurrent BPPV. • BPPV recurred in about 20% of patients during multi-year follow-up. • Thyroid disease showed no association with BPPV recurrence. • Weather factors did not influence the risk or timing of BPPV recurrence. • Migraine occurred across all BPPV canal and cupula subtypes.