What is Persistent Postural-Perceptual Dizziness (PPPD)?

This information explains persistent postural-perceptual dizziness, or PPPD, and possible treatments. It also answers some questions that people with PPPD often ask.

After reading this information, you should understand what PPPD is and that:

  • PPPD has a specific set of symptoms.
  • PPPD may or may not be related to another condition.
  • PPPD can be treated.
  • PPPD is not all in your head.

Ask your healthcare provider any questions you have about this information or about your dizziness.

“Dizziness” is a word that can describe many different sensations. Here “dizzy” refers to the feelings that people sometimes describe as:

  • Light-headed
  • Foggy-headed
  • Heavy-headed
  • Cloudy-headed
  • Cotton-headed

“Dizziness” may be a feeling that your balance is just not as good as it used to be. “Unsteadiness” refers to a sensation of swaying or rocking that you get when you sit or stand. Unsteadiness might also be a sensation of veering off to the side when walking.

“Vertigo” is a feeling of spinning or tilting suddenly. Vertigo is not part of PPPD although some people have PPPD along with other conditions that cause vertigo.

Persistent-postural-perceptual dizziness or PPPD is defined as:

  • A feeling of dizziness or unsteadiness that you have most of the time.
  • You have this sensation almost every day.
  • This sensation has lasted at least three months.

Some things may make your PPPD worse:

  • Your own movement.
  • Movement of things around you.
  • Busy stores.
  • Social gatherings.
  • Traffic.

“Visually demanding” things may also make your PPPD worse. For example:

  • Reading.
  • Working on the computer.
  • Watching TV.
  • Playing video games.
  • Walking on carpets with complex patterns.

You may have PPPD for a while without knowing what was wrong. After having a lot of tests without feeling better, you may feel frustrated.

PPPD can be related to other problems, or you can have it without having any related health problems. Either way, PPPD can be treated.

Possible triggers of PPPD

The exact cause of PPPD is not yet known. However, it often starts after one of these problems:

  • A vestibular or balance disorder that affects the inner ear or brain.
  • Vestibular migraine – a type of migraine headache that causes vertigo or dizziness.
  • Anxiety that causes dizziness or lightheadedness.
  • A concussion.
  • Autonomic disorders that cause fainting spells, near faints or dizziness.
  • Other medical problems that cause dizziness such as heart rhythm problems.
  • Side effects of some medicines.


Treatments for PPPD include both physical therapy and medications. These treatments can be used alone or together.

If your PPPD is related to another condition, like migraine or anxiety, that condition should also be treated.

Physical Therapy

The kind of physical therapy used to treat PPPD is called habituation therapy or exposure therapy. This therapy exposed you gradually to things that seem to cause your dizziness or make it worse. The idea is that repeated, brief exposure to these things will help you build up a tolerance to them, so they won’t make you dizzy anymore.

You will have a treatment plan and be asked to work through it at home

It may take a few weeks to see significant improvement and at least 8 to 12 weeks to get the best results from your exercise program


Two groups of medications used to treat PPPD include:

  • Selective serotonin reuptake inhibitors, or SSRIs. These medications are often used to treat depression and anxiety but seem to work in treating PPPD. Even if you are not depressed or anxious, SSRIs may help reduce your dizziness a lot.
  • Serotonin and norepinephrine reuptake inhibitors, or SNRIs. These medications are also used to treat depression and anxiety. Even if you do not have a psychiatric illness, they can help reduce your dizziness.

You may notice some improvement in your dizziness starting about 4 to 6 weeks after starting your medication, but it takes at least 8 to 12 weeks before you see the full benefits. Usually you continue treatment for at least a year.

Take your medications as prescribed. Don’t stop taking them without talking to your health care provider.

Self care

The goal of treatment is for you to get back to your normal activities.

Things you can do:

  • Follow your treatment plan, including your home exercises.
  • Take your medications as your healthcare provider tells you to. Never stop taking medications without talking to your health care provider.
  • As you recover, pace yourself. Take breaks from activity as needed.
  • Don’t limit your activities.

Frequently Asked Questions

Is PPPD a psychiatric illness?

No, PPD is not a psychiatric disorder. But behavioral changes can sometimes help. For that reason, you may see a behavioral medicine specialist.

Why do I have PPPD?

We don’t really know why people get PPPD. If you had a related condition, such as, for example, an inner ear infection that gave you vertigo, you may have gotten more sensitive to your own movement and balance. This sensitivity may contribute to your PPPD

Will I get better?

About four out of five people get better with treatment. Even if your dizziness doesn’t go away completely, treatment may improve it quite a bit.

How long do I need treatment?

Usually the initial period is from 8 to 12 weeks, for both physical therapy and medications. Your treatment plan may last for a year or more.

Do the medications cause side effects?

SSRIs and the SNRIs may cause side effects. Ask your doctor and pharmacist about possible side effects. You may see dizziness listed as a possible side effect of these medications. However, that doesn’t refer to the type of dizziness caused by PPPD. Rarely is PPPD made worse by SSRIs or SNRIs.

How can you be sure that PPPD is what I have?

Research studies show that if you fit the criteria for PPPD describes in the first section of this material and have had a complete evaluation, it is not likely that other diagnoses have been missed.

Sources: Persistent Postural-Perceptual Dizziness (PPPD) Booklet from the Mayo Clinic

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