What is PPPD?
PPPD is a problem that causes dizziness and/ or unsteadiness for 3 months or more. Symptoms are present most days and can increase and decrease throughout the day.
PPPD often develops shortly after an event, such as an episode of dizziness (including Benign Paroxysmal Positional Vertigo (BBPV), migraine or vestibular neuritis). It can also develop after any other illness, stressful event or rarely, occur spontaneously. During the initial event, your body reacts and as symptoms setting down, that initial reaction should go away.
However, with PPPD the initial reaction doesn’t settle down, and instead of fully recovering, the brain stays on high alert and over-reacts. This is your nervous system not recovering entirely. The reaction, which helped you in the beginning, but is persisting now, is:
- Deliberately stopping you from swaying; and
- Telling your brain that you cannot trust your internal messages of what is going on around you.
In PPPD, these reactions continue, and the result is a feeling of swaying/ rocking in the head and being very reliant on your vision for information about what is going on. The brain software is not working well; the hardware is ok. This conditioned behaviour has led to symptoms most of the time. This cycle can be broken with treatment.
Common Symptoms of PPPD
Symptoms of dizziness, unsteadiness, lightheadedness, or feeling not quite right are common symptoms. You may be sensitive to different sensory experiences such as busy environments, bright lights and noise. You may feel worse when:
- You stand or sit upright
- You see movement, such as when you scroll on a phone, watch TV, look at traffic
- You see complex patterns, such as a busy carpet, wallpaper, or supermarket aisle
- You are walking, or riding in a car
Investigative tests may be ordered to rule out other balance disorders. These may include scans of your brain and inner ear.
Diagnosis of PPPD
There is no test that is specific for PPPD. Certain signs and symptoms allow a diagnosis. PPPD may coexist with other disorders including vestibular, neurologist, psychiatric, general medical.
Management of PPPD
Management of PPPD may include:
- Vestibular physiotherapy – education, exercises to retrain eye and head movement and increase your tolerance to movement and sensory stimulation, exercises for balance
- Psychology - Cognitive Behavioural Therapy (CBT)
- Medications – work to reduce your symptoms in combination with vestibular physiotherapy and CBT