Persistent Postural-Perceptual Dizziness ( PPPD) is a condition the symptoms of which usually consist of dizziness and unsteadiness provoked by non physical factors. For some individuals, PPPD can cause chronic dizziness following a bout of acute dizziness or vertigo. Dizziness is a condition that affects 4% of the population and 15-20% of these patients are diagnosed with PPPD.
Persistent Postural-Perceptual Dizziness, previously known as Chronic Subjective Dizziness, was given as a diagnosis when a patient experienced dizziness symptoms without any positive objective tests for a condition. We have often found people to be unsatisfied by this diagnosis and feeling as if their very real sensations of dizziness have been put down to psychosocial factors.
PPPD is now seen as the most common vestibular condition affecting people in the 30-50 age group and the second most common diagnosis for all vestibular patients.
PPPD usually comes about following a more acute vestibular problem such as BBPV, vestibular neuritis, concussion, whiplash or vestibular migraine. PPPD is often left as a residual effect once the objective changes of the original problem have been resolved.
The cause of PPPD is not yet understood but it is thought to be linked with central postural control centres of the vestibular system failing to properly adapt once the acute issue has resolved.
What is the Medical Treatment for PPPD?
Medical treatment for this condition, which is linked to anxiety, is mainly focused around vestibular rehabilitation, CBT and medications.
Anxiety is a risk factor for getting PPPD, as well as depression and those with introverted personalities. Those with higher levels of anxiety also have higher risks of longer recovery times, usually due to poorer brain compensation and reliance on avoidance strategies to manage symptoms.
PPPD and Chiropractic
The area of the nervous system that controls posture is located in the brainstem. The brainstem is protected by the upper cervical spine. Making sure that the upper cervical spine is functioning correctly can give the body enough adaptive capacity to resolve the feeling of dizziness and unsteadiness.
We have seen a number of people in the office with this condition that have responded well to Upper Cervical Chiropractic care. If you are struggling with this problem or something similar please feel free to reach out and contact us by booking a complimentary discovery call.
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- The most common form of dizziness in middle age: phobic postural vertigo]. Strupp M, Glaser M, Karch C, Rettinger N, Dieterich M, Brandt TNervenarzt. 2003 Oct; 74(10):911-4.
- Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizzinessPractical Neurology 2018;18:5-13.
- Staab, Jeffrey P. et al. ‘Diagnostic Criteria for Persistent Postural-perceptual Dizziness (PPPD): Consensus Document of the Committee for the Classification of Vestibular Disorders of the Bárány Society’. 1 Jan. 2017 : 191 – 208.