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Persistent Postural-Perceptual Dizziness (PPPD)

About Persisitent Postural-Perceptual Dizziness (PPPD)


What Is PPPD?

Persistent Postural-Perceptual Dizziness (PPPD), formerly known as Chronic Subjective Dizziness, is a condition characterized by persistent feelings of dizziness and unsteadiness that last for an extended period, typically three months or more. It is believed to result from a combination of factors, including abnormal processing of sensory information related to body position and movement, heightened sensitivity to motion stimuli, and emotional factors such as anxiety or stress.

PPPD can be triggered by specific events, such as an acute vestibular disorder, head injury, or a traumatic life event, but it may also develop without a clear precipitating cause.

Persistent Postural-Perceptual Dizziness Diagnosis

How Do We Diagnose PPPD?

Diagnosing PPPD can be challenging due to its subjective nature and the absence of specific diagnostic tests. Headache practitioners rely on a comprehensive evaluation of the patient’s medical history and a thorough clinical examination. The diagnosis is often made based on specific criteria defined by international consensus guidelines, which include the presence of persistent dizziness or unsteadiness, exacerbated by upright posture, accompanied by various perceptual symptoms (such as visual motion sensitivity or a feeling of being “rocking” or “swaying”) and functional impairments in daily life.

PPPD Symptoms


Persistent sense of dizziness or unsteadiness that may fluctuate in intensity throughout the day but persists for a prolonged period.

Feeling of rocking, swaying, floating, or being off-balance, even when standing still.

Difficulty concentrating



Visual Disturbances

Visual disturbances, such as sensitivity to motion or busy environments, can also be present

Activity intolerance

Reduced tolerance for activities that involve motion, such as walking in crowded places or driving.

Treating PPPD 

Persistent Postural-Perceptual Dizziness Treatment

The management of PPPD typically involves a multidisciplinary approach that combines medical interventions and various forms of rehabilitation and psychological support. Treatment aims to address the underlying factors contributing to the condition and help individuals gradually regain confidence and functional abilities.

Treatment strategies for PPPD may include:

Vestibular rehabilitation therapy (VRT): A specialized form of physical therapy that focuses on exercises and techniques to improve balance, reduce dizziness symptoms, and promote central nervous system adaptation to sensory stimuli.

Cognitive-behavioral therapy (CBT): A type of therapy that helps individuals identify and modify negative thought patterns and behaviors associated with dizziness and anxiety. CBT can assist in building coping mechanisms and reducing the impact of psychological factors on symptoms.

Medications: Certain medications, such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines, may be prescribed to manage anxiety, depression, or other associated symptoms. Medication options are determined on an individual basis.

Lifestyle modifications: Implementing self-care strategies, such as regular exercise, stress reduction techniques, and maintaining a consistent sleep schedule, can help manage symptoms and improve overall well-being.

 It’s important to note that PPPD is a chronic condition that may require long-term management. The treatment approach is tailored to each individual’s specific needs and may involve a trial-and-error process to find the most effective combination of interventions. Collaborating with healthcare professionals experienced in the management of PPPD can help individuals better understand and manage their symptoms, ultimately improving their quality of life.

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