Persistent Postural Perceptual Dizziness


PPPD is a type of chronic dizziness. It usually is described as constant sensation of floating or rocking without nausea. It is worse when standing, when tired/towards the end of the day and when in complex visual environments like grocery stores or crowds. It usually comes on after an alarming event such as first panic attack, vestibular migraine, BPPV episode or fainting spell.


PPPD is a sudden change in the brain’s ability to interpret space/motion. Following an alarming event, the fight or flight system is activated, changing how space/motion is perceived. Once the alarming event stops, instead of resetting, the brain maintains that abnormal perception, causing constant rocking sensation for at least three months. People with migraine or anxiety/depression are at higher risk for developing PPPD, but it can occur in anyone.


Treatment is aimed at helping the brain re-establish a better sense of perception and balance. This attempted by using physical therapy, medications that work on serotonin levels in the brain and sometimes psychological therapy to help reduce the anxiety associated with this disturbing condition. Most patients get some relief with the treatments, but some can have symptoms permanently.