Background and objectives: paroxysmal positional vertigo is the most common disorder causing dizziness. Most of the studies confirm the effectiveness of particle reposition maneuver in the management of benign paroxys- mal positional vertigo but still many otologists recommending medical therapy for this disorder; therefore this study has been conducted to evaluate the effect of particle reposition maneuver versus medical therapy by Betahistine-HCl for treatment of benign paroxysmal positional vertigo. Methods: This prospective comparative study was conducted in Otolaryngology department at Rizgary hospital from January 2014 till December 2015. One hundred & fifty patients were selected randomly for either PRM or treatment by Betahistine-HCl as modalities for treatment of posterior canal benign paroxysmal positional vertigo. Results: The mean age of the patients was (54.56 ±11.160) years. The male to female ratio was 1:2. 60% of patients presented with previous history of vertigo, 30.5% of patients had an associated age related hearing loss. The number of patients, who responded to particle reposition maneuver, was 60 patients out of 72 patients with success rate of 83.3%. While the number of patients who responded to treatment by Betahis- tine-HCl and had negative Dix-Hallpike maneuver were 27 patients out of 70 patients with a success rate of 38.3%. Conclusions: The study confirms effectiveness of the particle reposition maneuver in the management of benign par- oxysmal positional vertigo, compared to medical therapy by Betahistine, which has inferior outcome in the treatment of BPPV. Betahistine-HCl may have a role when particle reposition maneuver fails or contraindicated.