<jats:sec> <jats:title>Objective:</jats:title> <jats:p>This study aimed to assess the long-term recurrence rate and correlations between recurrence and potential risk factors in patients with benign paroxysmal positional vertigo (BPPV).</jats:p> </jats:sec> <jats:sec> <jats:title>Design:</jats:title> <jats:p>A total of 548 consecutive patients who demonstrated typical posterior or horizontal BPPV between January 2010 and December 2012 were included in this prospective study. All patients were contacted by phone every 6 months for 5 years and were asked to revisit the clinic when they experienced positional vertigo to be reexamined for recurrence. Recurrence of BPPV was defined as having positional vertigo and nystagmus confirmed following a symptom-free period of at least 7 days after complete resolution. We assessed the 5-year recurrence rate of BPPV, and the time point of recurrence in all patients as well as the risk factors of BPPV recurrence, including the clinical characteristics, therapeutic results of BPPV, and various comorbidities.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Among the 548 patients, 121 (22.1 %) had at least one recurrence. Of these, 78 patients (54.5%) had only one recurrence within 5 years, while 43 (45.5%) patients experienced two or more recurrences. A recurrence occurred within 1 year in 82 patients (67.8%). The Cox proportional hazard ratio analysis found that head trauma (<jats:italic toggle="yes">p</jats:italic> = 0.015), Meniere’s disease (<jats:italic toggle="yes">p</jats:italic> = 0.016), the number of canalith repositioning procedures performed (<jats:italic toggle="yes">p</jats:italic> = 0.037), and the number of previous vertigo attacks (<jats:italic toggle="yes">p</jats:italic> = 0.038) were significant risk factors of BPPV recurrence as opposed to hypertension or hyperlipidemia.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>The recurrence rate of BPPV was 22.1% at 5 years after the initial treatment. About 70% of recurred patients had a recurrence within 1 year. Head trauma, ipsilateral Meniere’s disease, the number of canalith repositioning procedures performed, and the number of previous vertigo attacks were significant risk factors of BPPV recurrence.</jats:p> </jats:sec>