Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness. Most patients are easily resolved by one or several sessions of appropriate repositioning maneuver, although a small percentage of patients suffer from persisting symptom over several months. When BPPV is not controlled by appropriate repositioning maneuver, that condition is no more ‘benign’. In this session, other management options reported in the literature for ‘intractable’ positional vertigo are reviewed and also other conditions simulating intractable positional vertigo are discussed.