PPPD Intro: What is Persistent Postural-Perceptual Dizziness?

  • By Dizzy & Vertigo Institute
  • November 30, 2021

Persistence can be a great quality to have. It is the key to achieving goals, both personally and professionally.  But the last thing you want persistence to describe in your life is dizziness. Persistent dizziness is not a fun experience. And Persistent Postural-Perceptual Dizziness (PPPD) is a complete nuisance and disruptor to living life.

What is Persistent Postural-Perceptual Dizziness?

PPPD is a type of chronic dizziness that is most frequently described as a sense of rocking or floating. PPPD is not true rotational vertigo, where it feels as if the world around you is abnormally spinning. Rather, PPPD works in the background, giving dizzy patients a slight feeling of always “being off center”.

Because PPPD is somewhat of a silent nuisance, many people go through their life with PPPD. It’s like the annoying mosquito that won’t stop flying by your ear, but you cannot seem to get rid of it.


Stanford Medicine’s Otolaryngology division aptly describes the cause of PPPD:

PPPD is a sudden change in the brain’s ability to interpret space/motion. Following an alarming event, the fight or flight system is activated, changing how space/motion is perceived. Once the alarming event stops, instead of resetting, the brain maintains that abnormal perception, causing constant rocking sensation for at least three months. People with migraine or anxiety/depression are at higher risk for developing PPPD, but it can occur in anyone.

Think of PPPD as a reaction to stressful events that disorganizes how your body and brain calibrate your balance.


Oftentimes, Persistent Postural-Perceptual Dizziness worsens or is triggered by tiredness and fatigue, suddenly standing or changing positions, and in environments with complex visuals (concerts, movies, grocery stores, airports, etc.).

PPPD can also be triggered by anxiety and panic attacks. This is due to the effect that these have on the central nervous system, causing extra stress on the balance system.

Additionally, other balance disorders can trigger PPPD. It’s quite common for PPPD to progress after a BPPV episode, Vestibular Migraines, or following an inner ear infection (Labyrinthitis & Vestibular Neuritis). Even concussions, if the brain doesn’t heal properly, can lead to prolonged dizziness or PPPD.

PPPD Treatment

As we established in the “cause” section above, PPPD is essentially a “mis-wiring” of the brain’s balance centers. Therefore, the basis of treating PPPD is reconfiguring (or rewiring) how the brain perceives balance.

At the Dizzy & Vertigo Institute, our treatment process involves state-of-the-art equipment that can pinpoint exactly HOW the brain is misperceiving balance. We bring objective data to this subjective nightmare you’re living in.

Once we understand exactly how your vestibular system is malfunctioning, we design a personalized treatment plan to address and rehabilitate the system. 

The treatment plans for Persistent Postural-Perceptual Dizziness usually include a mixture of:

  • Sensory Reweighting – Helps the brain integrate sensory information properly
  • Immersive VR Therapy – Using simulated environments to strengthen your vestibular system in visually stressful environments.
  • Vestibular Therapy – Exercises designed to align your physical balance sensors (nerves throughout the body) and the brain’s balance GPS (vestibular system)

If you’d like to learn more about our treatment process in greater detail, from when you walk into our vestibular clinic to when you’re feeling cured of dizziness, then we suggest you check out this article: How We Treat Dizziness – What To Expect Working with the Dizzy & Vertigo Institute

Ultimately, there is a proven process for alleviating the symptoms of Persistent Postural-Perceptual Dizziness. You don’t have to go on living in a constant state of unsteadiness.

We urge you to reach out to us at (310) 954-2207 or by filling out our contact form.

We look forward to helping you!

Posted in All, Blog, PPPD

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