Persistent Postural-Perceptual Dizziness (PPPD)

PPPD is a type of chronic dizziness. The dizziness is often described as a feeling of floating or rocking. It becomes worse when standing, with changes to head/body movement, and with busy visual environments such as grocery stores. It typically starts after an acute event of vertigo, unsteadiness, or dizziness. It is more common in people who have a history of anxiety/depression or vestibular migraines.

What causes PPPD?

PPPD occurs after an alarming event, such as a vestibular migraine, BPPV, Neuritis/Labyrinthitis, or panic attack with dizziness. The brain’s fight or flight system is activated, changing how space/motion is perceived even after the alarming event stops, causing a constant rocking sensation for at least three months.

What are the symptoms of PPPD?

PPPD rarely occurs without a triggering event. The primary symptom is a sensation of rocking or swaying, or unsteadiness without vertigo for more than three months. Symptoms are present at least 15 out of 30 days and become worse when standing, moving the head or body, and with exposure to complex visual or physical motion. It normally starts after an episode of acute vertigo. Anxiety or depression may co-exist with PPPD.

How is PPPD Diagnosed?

PPPD may coexist with other vestibular disorders. A triggering event may also not be easy to identify. It is important to medically rule out any other potential causes for the dizziness. An audio-vestibular assessment is recommended to rule out other potential vestibular disorders.

What is the treatment for PPPD?

Patients with PPPD often avoid situations which may exacerbate symptoms and may become fearful of situations that may exacerbate symptoms. It therefore may have psychological consequences. Often a combination of medication, counseling, and vestibular rehabilitation therapy are recommended.