Background: Although head trauma is considered a common cause of benign paroxy smal positional vertigo (BPPV), clinical presentation and outcome of traumatic B PPV (t BPPV) have not been systematically evaluated. Objectives: To compare the clinical presentation, patients response to physical treatment, and outcome o f patients with t BPPV with those with the idiopathic form (i BBPV). Setting: Tertiary referral neuro otology outpatient clinic. Methods: We reviewed the cli nical records of 247 consecutive patients with posterior canal BPPV during the y ears 1997 to 2000. All patients were diagnosed using the Dix Hallpike test and treated using the particle repositioning maneuver. Patients with an onset of pos itional vertigo within 3 days of well documented head trauma were included in t he t BPPV group. The outcome was compared with the outcome of 42 patients with i BPPV who were similarly treated and followed up. Results: Twenty one (8.5%) of the 247 patients with BPPV fulfilled the diagnostic criteria for t BPPV. Th e most common cause of head trauma was motor vehicle crash, documented in 57%of the cases; half of the patients additionally suffered from a whiplash injury. W hile the other causes were diverse, common falls were predominant. Only 2 of the patients involved in motor vehicle crashes experienced brief loss of consciousn ess. Sixty seven percent of patients with t BPPV required repeated physical tr eatments for complete resolution of signs and symptoms in comparison to 14%of p atients with i BPPV (P<.0 01). During a mean ±SD follow up of 21.7±9.7 months, 57%of t BPPV patients and 19%of i BPPV controls had recurrent attacks (P<.004). Conclusions: The nat ure and severity of the traumas causing t BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousne ss. It appears that t BPPV is more difficult to treat than i BPPV, and also ha s a greater tendency to recur. Background: Although head trauma is considered a common cause of benign paroxy smal positional vertigo (BPPV), clinical presentation and outcome of traumatic B PPV (t BPPV) have not systematically evaluated. Objectives: To compare the clinical presentation, patient’s response to physical treatment, and outcome of patients with t BPPV with those with the idiopathic form (i BBPV). Setting: Tertiary referral neuro otology outpatient clinic. Methods: We reviewed the cli nical records of 247 consecutive patients with posterior canal BPPV during the y ears 1997 to 2000. All patients were diagnosed using the Dix Hallpike test and treated using the particle repositioning maneuver. Patients with an onset of pos itional vertigo within 3 days of well documented head trauma were included in t he t BPPV group. The outcome was compared with the outcome of 42 patients with i BPPV who were treated treated and followed up. Results: Twenty one (8.5%) of the 247 patients with BPPV fulfilled the diagnostic criteria for t BPPV. Th e most common cause of head trauma was motor vehicle crash, documented in 57% of the cases; half of the patients there occurred suffered from a whiplash injury. W hile the other causes were diverse, common falls were predominant Only 2 of the patients involved in motor vehicle crashes experienced brief loss of consciousn ess. Sixty seven percent of patients with t BPPV required repeated physical tr eatments for complete resolution of signs and symptoms in comparison to 14% of p atients with i BPPV ( P <.01 01. During a mean ± SD follow up of 21.7 ± 9.7 months, 57% of t BPPV patients and 19% of i BPPV controls had recurrent attacks (P <.004). Conclusions: The nat ure and severity of the traumas causing t BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousne ss. It appears that t BPPV is more difficult to treat than i BPPV, and also ha sa greater tendency to recur .