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Persistent Postural – Perceptual Dizziness (PPPD)

What is PPPD?

PPPD is a long-lasting dizziness and balance disorder. It can make you feel dizzy, unsteady, or sensitive to motion and busy places. This may happen in crowds, grocery stores, or places with bright lights, moving objects, or busy patterns.

PPPD often starts after an earlier episode of vertigo, dizziness, or balance problems. Symptoms usually last longer than 3 months, happen on most days, and feel worse when you are sitting upright, standing, walking, moving, or looking at busy surroundings.

What is Happening in My Body?

After a vertigo or balance event, the brain can stay on high alert. Even when the original problem is better, the brain may still react like there is danger. This can make dizziness and unsteadiness easier to trigger, especially in busy places.

Because of this, you may feel:

  • Dizziness or vertigo
  • Rocking or swaying, even when still
  • Unsteadiness or balance problems
  • Trouble in stores or crowded places
  • Nausea or vomiting
  • Anxiety
  • Fatigue

It is important to know:

  • You did not cause this
  • Your symptoms are real
  • Many people improve with the right care
  • Symptoms can change over time

PPPD Is Usually Diagnosed When:

  • Dizziness or unsteadiness lasts more than 3 months
  • Symptoms happen on most days
  • Symptoms are worse with upright posture, motion, or busy visual settings
  • A past event of vertigo or dizziness triggered the symptoms
  • Symptoms affect daily life
  • No better diagnosis explains the symptoms

Your provider may also use lab tests or imaging to rule out other causes.

What Your Provider May Ask:

  • Have you had a past episode of dizziness, unsteadiness, or vertigo?
  • How long do your symptoms last?
  • What triggers your symptoms?
  • How often do you have symptoms
To prepare for your visit, it can be helpful to think about, and write down, answers to these questions before seeing your provider. 

How is PPPD Treated?

Treatment for PPPD often includes a combination of education, therapy, healthy habits, and sometimes medication.

Common treatment options

  • Education: Learning about PPPD can help you better understand:
    • Your symptoms
    • Common triggers
    • Why symptoms can continue
    • What may help with recovery
  • Vestibular Rehabilitation Therapy: May help your brain become less sensitive to motion and visual triggers. This therapy may include:
    • Balance exercises
    • Visual motion exercises
    • Movement training for motion sensitivity
    • Practice with activities or places that trigger symptoms
  • Counseling and Healthy Habits: Healthy routines can support recovery and may help reduce symptom flare-ups. This may include:
    • Getting regular sleep
    • Eating meals on time
    • Drinking enough water
    • Exercising regularly
    • Managing stress
    • Taking breaks from screens when needed
  • Cognitive Behavioral Therapy: Cognitive behavioral therapy, also called CBT, may also be helpful for some people. CBT can help you notice thoughts, fears, or habits that may make dizziness feel worse and learn safer ways to respond.
  • Medications: Some people may benefit from medications, such as SSRIs or SNRIs. Vestibular suppressants are usually not recommended for long-term treatment unless your provider gives specific instructions.

What Can I Expect Over Time?

Will I get better?

Many people do improve with the right diagnosis and treatment plan.

How long will it take?

Getting the right diagnosis can take time. Keeping a log of your symptoms and triggers may help. Once treatment starts, many people begin to feel better over time.

Can I live a normal life?

Yes. Many people return to normal activities once they understand their condition and have a plan. Some may still need to adjust activities during flare-ups.

When Should I Call My Provider?

Contact your provider if you have:

  • A new or severe headache 
  • Weakness, numbness, slurred speech, or vision loss
  • Fainting or loss of consciousness
  • Chest pain or shortness of breath
  • Dizziness after a head injury
  • Symptoms that are quickly getting worse or not improving

Always tell your clinician about any symptom that worries you. 

Questions to Ask Your Provider

In order to learn more about PPPD and prepare yourself for treatment and any future dizziness experiences, you may want to ask:

  • What triggers should I watch for?
  • Would vestibular therapy help me?
  • Do I need medication?
  • What should I do during a flare-up?
  • When should I follow up or seek urgent care?

Key Takeaways/Key Points to Remember

  • PPPD is a condition that can cause ongoing dizziness and unsteadiness.
  • Symptoms often get worse in busy places or with busy visual backgrounds. 
  • PPPD usually starts after an episode of vertigo, dizziness, or balance trouble. 
  • Anxiety and fatigue are common. 

Additional Resources