Persistent Postural Perceptual Dizziness (PPPD)


What is PPPD?

PPPD is a problem that causes dizziness and/ or unsteadiness for 3 months or more. Symptoms are present most days and can increase and decrease throughout the day.

PPPD often develops shortly after an event, such as an episode of dizziness (including Benign Paroxysmal Positional Vertigo (BBPV), migraine or vestibular neuritis). It can also develop after any other illness, stressful event or rarely, occur spontaneously. During the initial event, your body reacts and as symptoms setting down, that initial reaction should go away.

However, with PPPD the initial reaction doesn’t settle down, and instead of fully recovering, the brain stays on high alert and over-reacts. This is your nervous system not recovering entirely. The reaction, which helped you in the beginning, but is persisting now, is:

In PPPD, these reactions continue, and the result is a feeling of swaying/ rocking in the head and being very reliant on your vision for information about what is going on. The brain software is not working well; the hardware is ok. This conditioned behaviour has led to symptoms most of the time. This cycle can be broken with treatment.

Common Symptoms of PPPD

Symptoms of dizziness, unsteadiness, lightheadedness, or feeling not quite right are common symptoms. You may be sensitive to different sensory experiences such as busy environments, bright lights and noise. You may feel worse when:

Investigative tests may be ordered to rule out other balance disorders. These may include scans of your brain and inner ear.


Diagnosis of PPPD

There is no test that is specific for PPPD. Certain signs and symptoms allow a diagnosis. PPPD may coexist with other disorders including vestibular, neurologist, psychiatric, general medical.

Management of PPPD

Management of PPPD may include: