PPPD is a common cause of chronic dizziness. The dizziness is not explained by damage or dysfunction of the vestibular system. That system is the balance centre in the inner ear. People continue to experience persistent dizziness despite their vestibular system functioning well. Sometimes we see these symptoms reduce when the person is distracted.
Often PPPD is triggered by an acute vestibular episode. Triggers include BPPV, vestibular neuritis, vestibular migraines, head trauma, anxiety, and other events.
Reasons PPPD may develop
During an acute vertigo event, the brain normally depends more on our visual and somatosensory system. This causes the body to be hyper-aware of our balance sensations. The body also adopts more protective strategies.
After the event, the brain may not revert to normal balance processing. Instead, a maladaptive cycle can develop, and that cycle causes PPPD symptoms. Simply, a person with PPPD does not switch out of ‘crisis’ mode. They remain on ‘red alert’.
The brain becomes hyper-vigilant and sensitive to differences between anticipated and actual motion.
Diagnosis
- dizziness, unsteadiness, or non-spinning vertigo present on most days for more than 3 months
- persistent symptoms occur without specific provocations, worsened by upright posture, head or body motion, and moving or complex visual stimuli
- usually precipitated by conditions that cause acute vestibular symptoms
- symptoms cause distress and functional impairment
- symptoms are not accounted for by anything else
Treatment
The aim is to readapt the brain and vestibular system back to normal function. Treatment also aims to promote automatic movement control.
- vestibular and balance rehabilitation therapy
- psychological therapy
- medical management
Take this with you
This page is drawn from our PPPD handout, which you can download and take to your GP or specialist.
Download the PPPD handout (PDF)