Benign paroxysmal positioning vertigo (BPPV) is the most common disease that causes dizziness which is usually resolved spontaneously or by office-based physical therapy. However, clinicians sometimes encounter atypical or intractable BPPV cases which show poor effect with physical therapy including canalith reposition therapy and liberative maneuvers and frequent recurrence. There is no common definition, diagnosis and treatment protocols for intractable BPPV. Various types of intractable BPPV and reported treatment methods are discussed in this review.