PPPD is dizziness that persists even after you’ve recovered from an event that disrupted your balance, such as an injury or illness. It could last several years, but treatments such as medications and therapy may help it resolve sooner.
Persistent postural-perceptual dizziness (PPPD) is a recently defined syndrome characterized by ongoing dizziness, vertigo, and instability of coordination. Although research links it to several other health conditions, it doesn’t have a clear cause.
If you have PPPD or related symptoms, you might have questions about the risk factors, diagnosis, and treatment. This article provides an overview of PPPD.
It’s not clear what causes PPPD. However, many experts note that PPPD tends to occur after an illness, injury, or distressing event.
Conditions that may trigger PPPD include:
- vestibular disorders, such as:
- mental health conditions, such as:
- head injuries and whiplash
- autonomic nervous system disorders, such as orthostatic or postprandial hypotension
- heart dysrhythmia
- adverse reactions to medication
One hypothesis suggests that after an instance of one of the conditions listed above, your brain’s postural control system becomes extra sensitive to visual information, leading to PPPD symptoms.
Of course, many people experience one or more of the conditions listed above without ever experiencing PPPD. It’s still unclear why some people develop PPPD and others do not.
PPPD typically occurs in middle age, especially in people who are perimenopausal. This might be due to hormonal changes associated with menopause.
In a 2021 review of 198 people with PPPD, researchers reported that about 69% were female and the average age was 48 years.
People who experience mental health issues such as depression and anxiety may have an increased risk of PPPD. For example, the authors of the above review found that about 42% of people with PPPD also experienced PTSD or anxiety.
Still, it’s not yet clear how these conditions are related. People with mental health conditions might have an increased risk of developing PPPD, but PPPD may also worsen existing mental health conditions.
PPPD has three main symptoms:
PPPD symptoms may come and go throughout the day, with episodes lasting up to several hours. Also, they will occur most days for a period of at least 3 months.
Many people with PPPD report that their symptoms worsen when they are:
- in an upright position
- standing, walking, or riding in a car
- in visually charged environments such as movie theaters or grocery stores
When to see a doctor
Dizziness is a common sensation that most people experience from time to time. Occasional dizziness isn’t usually a symptom of a health problem.
However, it’s best to consult a doctor if you experience ongoing or recurrent dizziness with no obvious cause. Also consider seeing a doctor if dizziness or related symptoms are causing you distress or interfering with your everyday activities.
Your doctor will ask you to describe your symptoms and medical history. They will perform a physical examination and check your eyes, ears, posture, and gait.
They might also order neurological exams or brain scans such as MRI or CT scans to rule out other conditions that cause similar symptoms. Such conditions include:
To diagnose PPPD, your doctor will look for the following:
- dizziness, vertigo, or swaying that:
- lasts for more than 3 months
- is present most days
- interferes with your activities or mental health
- cannot be explained by another condition
- symptoms that worsen when you are:
- engaging in active or passive movement
- exposed to intense visual environments
- a precipitating event or condition, such as a vestibular syndrome or traumatic event
Several treatments are available for PPPD. Most people use one or more of the following treatments:
- Medication: Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may help reduce dizziness and treat co-occurring mental health conditions.
- Vestibular rehabilitation therapy (VRT): VRT consists of exercises designed to reduce wobbliness, dizziness, and vertigo.
- Cognitive behavioral therapy (CBT): CBT techniques can help reduce both dizziness and anxiety associated with dizziness.
PPPD symptoms usually go away after a few years. A 2020 study of 33 individuals with PPPD found that the median duration of the condition was 60 months.
However, in the 2021 study of 198 individuals with PPPD cited above, people experienced symptoms for a median duration of 1.5 years and an average duration of 3.5 years.
Although symptoms might go away on their own with time, treatment is likely to help shorten the duration of PPPD.
PPPD is a syndrome that causes dizziness, vertigo, and unsteadiness. Experts defined it in 2017 to address cases of the above symptoms that last longer than 3 months and cannot be explained by another disorder.
Although anyone can experience PPPD, it’s more common in people who are middle-aged and female. It often occurs after an event such as an illness or injury.
Consult a doctor if you experience chronic dizziness that interferes with your mental health or daily activities. A doctor can help you learn more about managing PPPD symptoms.