Persistent Postural-Perceptual Dizziness

Carlo Rinaudo Vertigo and Dizziness

Persistent postural-perceptual dizziness (PPPD) is a common cause of chronic dizziness in people who are between the ages of 30 and 50 years and it is also a common diagnosis in all people who present with vestibular symptoms. This disorder has a negative impact on daily living and life quality, but you do not need to suffer anymore. Get dizziness treatment as soon as possible so that you can return to your normal life. 1

History of Persistent Postural-Perceptual Dizziness

PPPD diagnosis is based on a condition called phobic postural vertigo (PPV) that was described in the 1980’s by Brandt and Dieterich. The concept of PPV was updated and refined in the early 2000’s by Staab et al. 2

In 2014, the condition became known as Persistent Postural-Perceptual Dizziness (PPPD) and new consensus criteria were established. The World Health Organization (WHO) have now included PPPD in its draft list so that, in 2017, it can be part of the upcoming International Classification of Diseases (ICD-11). 1

Symptoms of PPPD

The main symptoms of Persistent Postural-Perceptual Dizziness involve sensations of unsteadiness or dizziness but without vertigo that lasts for 3 months or even more. The symptoms are present on most days and commonly people will have daily symptoms.

The symptoms become worse with: 3,4

  • Standing or sitting up
  • Bodily or head motion
  • Exposure to environments with lots of motion around the person

Factors that may provoke PPPD symptoms

The symptoms of PPPD may develop spontaneously or certain factors or movements may exacerbate the symptoms of the disorder like: 3,4

  • Active or passive motion of the head
  • Sudden movement
  • Being in an upright position
  • Exposure to a complex or moving visual stimulus

How is Persistent Postural-Perceptual Dizziness diagnosed?

PPPD is not diagnosed with neuroimaging, laboratory tests or physical exams, but these techniques are used to diagnose and rule out other comorbid conditions. PPPD is diagnosed according to the following criteria: 3,5

  • Unsteadiness and dizziness that lasts for 3 months or more
  • The symptoms should be present on most days, but may come and go

Events that may trigger PPPD

Persistent Postural-Perceptual Dizziness is a long term condition that may be triggered by: 4

  • A vestibular disorder (acute or episodic) like vestibular neuritis, vestibular migraine or benign paroxysmal positional vertigo.
  • Medical or psychiatric events which cause problems with balance or acute vestibular symptoms.

How is Persistent Postural-Perceptual Dizziness treated?

Even though large scale studies are scarce, many smaller scale studies have shown some potential treatment options for PPPD. Medication and Vestibular Balance Rehabilitation Therapy have been suggested as treatment options.

  • Medication

SNRIs (serotonin norepinephrine reuptake inhibitors) and SSRIs (selective serotonin reuptake inhibitors) are suggested medications for PPPD. 5

  • Vestibular Balance Rehabilitation Therapy (VBRT)

Traditional VBRT programs consist of exercises for habituation, gaze stabilization, balance and gait. This type of therapy may help to reduce depression and anxiety in people suffering from PPPD and the best results are achieved after 3-6 months of continuous VBRT. 4,5

Get dizziness treatment today if you suspect that you may be suffering from PPPD. Call Brain Hub on 1300 770 197 now.



  1. Holle D, Schulte-Steinberg B,  Wurthmann S, Naegel S, Ayzenberg I,  Diener H et al.  Persistent Postural-Perceptual Dizziness: A matter of higher, central dysfunction? PLoS One. 2015; 10(11): e0142468.
  2. Staab JP, Ruckenstein MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg. 2007; 133: 170–176.
  3. World Health Organization, International Classification of Diseases, ICD-11 beta draft. Available from:
  4. Thompson KJ, Goetting JC, Staab JP, Shepard NT. Retrospective review and telephone follow-up to evaluate a physical therapy protocol for treating persistent postural-perceptual dizziness: A pilot study. Journal of Vestibular Research. 2015 Jun 2; 25(2): 97-104.
  5. Vestibular Disorders Association. Persistent Postural-Perceptual Dizziness. Available from: