Persistent Postural-Perceptual Dizziness (PPPD) is a condition where people experience constant non-spinning dizziness that can be triggered by motion, visually busy environments, or simply standing. Typically linked to a vestibular event such as an infection, injury, or psychological stress, PPPD can last three months or longer.
Causes and Symptoms
PPPD often occurs after an acute vestibular disorder such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or vestibular migraines. Experiencing PPPD symptoms well after the initial issue can cause significant disruption to daily life. Psychological stress, anxiety, and depression also exacerbate these symptoms. People with PPPD may find that busy visual environments, like grocery stores, driving or navigating movement-heavy spaces, heighten their dizziness and sense of imbalance.
Diagnosis Criterion
If you think you might have PPPD, your doctor will evaluate you using the following recommended criterion:
- The patient must experience symptoms of unsteadiness, non-spinning vertigo, imbalance, and/or dizziness for over 45 days within a 90 day period. Likewise, symptoms must last hours, but can fluctuate in severity.
- Symptoms aren’t directly triggered by specific events like BPPV or blood pressure drops (orthostatic hypotension). However, the dizziness and imbalance can get worse when the patient is standing upright, looking at moving objects (like cars or crowds), or when the patient moves without paying attention to their body’s position. This means certain activities or environments that involve motion or visual stimuli can intensify their symptoms, making daily tasks more difficult.
- PPPD must occur after a condition the causes balance issues such as BPPV, vestibular neuritis, or traumatic brain injury.
- The patient’s life is negatively impacted. Doing simple tasks like walking or driving are difficult when they feel like they are swaying from side to side despite being still.
- There is no other medical condition that better explains the patient’s symptoms.
Management and Hope for Recovery
Although PPPD can significantly impact a patient’s quality of life, there are several treatment options that have been proven effective:
-Vestibular rehabilitation therapy is one common treatment approach that helps patients regain their stability and confidence in movement. When participating in VRT, it is important that sessions are appropriately challenging. Over aggressive exercises will make symptoms worse and patients less likely proceed.
-Medications, particularly selective serotonin reuptake inhibitors (SSRIs), have shown promise in relieving symptoms
-Cognitive-behavioral therapy (CBT) interventions, which focus on reducing anxiety and managing stress.
– Health Coaching can also play a valuable role in this recovery process by guiding individuals through stress reduction strategies, building resilience, and supporting lifestyle changes that promote overall well-being.
An approach combining physical therapy, medical treatment, and mental health support can also greatly improve the lives of those with PPPD.
While recovery from PPPD can be slow, many patients see positive results over time, especially when they integrate a variety of therapeutic approaches. Coaching, along with medical care, can help individuals stay on track toward managing their symptoms and regaining their quality of life. Think health coaching may be a right fit for you? Schedule a complimentary discovery call today!
References
Knight B, Bermudez F, Shermetaro C. Persistent Postural-Perceptual Dizziness. [Updated 2023 Apr 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578198/
