Persistent postural-perceptual dizziness
Persistent postural-perceptual dizziness (PPPD)1 typically presents as persistent dizziness and/or unsteadiness on most days, usually without spinning vertigo, lasting for 3 months or more. It often complicates other vestibular conditions (eg vestibular neuritis, vestibular migraine). Persistent postural-perceptual dizziness can occur after panic attacks with dizziness, and after other medical conditions (eg autonomic dysfunction, postconcussion syndrome, adverse drug reactions). The symptoms are usually worse with upright posture, head motion and exposure to strong visual motion stimuli (eg walking in a crowded shopping centre). Persistent postural-perceptual dizziness is considered a behavioural syndrome, manifest by hypervigilance and trigger avoidance—it is often associated with mild anxiety and depression.
Treatment includes education and reassurance2, antidepressant therapy and cognitive behavioural techniques. Vestibular rehabilitation is sometimes helpful as an adjunct.