Conditions
Persistent postural-perceptual dizziness (PPPD) is a long-lasting dizziness condition. It is usually felt as unsteadiness or a non-spinning dizziness that is present on most days, and that is worse when you stand, move, or are in busy visual settings. It is a common and often confusing diagnosis. This page explains the medical definition, what may contribute, and where our care fits.
New dizziness needs a medical evaluation. If dizziness comes with a sudden, severe headache, double vision, numbness or weakness, trouble speaking, or confusion, or if you think it could be an emergency, call 911 or go to the nearest emergency department.
The criteria come from a consensus document by the Bárány Society, published in 2017 (Staab et al., Journal of Vestibular Research, 2017, as summarized by ENT & Audiology News).
Dizziness, unsteadiness, or non-spinning vertigo on most days for at least three months
Symptoms last for hours at a time and vary in severity, though they are not constant all day
Symptoms are worse with upright posture, with movement of any kind, and with moving or complex visual surroundings
It follows an event that caused vertigo, dizziness, or balance trouble, which can be an inner ear condition, another medical or neurological illness, or psychological distress
It causes significant distress or interference with daily life
It is not better explained by another disease
The consensus document classifies PPPD as a functional disorder, not a structural or psychiatric one.
One way to think about it: after a vestibular event, the brain normally recalibrates and stops paying conscious attention to balance. In PPPD that recalibration seems to stall. The brain stays on high alert and may over-rely on vision, so upright posture, movement, and visually busy settings feel unsteady. The dizziness is real. The consensus criteria classify PPPD as a functional disorder, meaning a problem with how the system works rather than a structural problem.
Possible contributors include unresolved vestibular or neck problems, anxiety, stress, poor sleep, and avoiding movement.
Ongoing non-spinning dizziness, or a rocking or swaying feeling
Unsteadiness that is worse when standing or moving
Discomfort in busy, patterned, or moving visual settings, such as supermarkets, crowds, or scrolling
Dizziness that lasts for months after a vertigo event or concussion
Fatigue and brain fog from the effort of staying balanced How we look at PPPD at Strong Tower
Dr. Wright is a Doctor of Chiropractic with advanced training in functional neurology. PPPD is diagnosed by a medical provider after other causes are considered. We can help look at how your eyes, inner ears, neck, and balance are working together, as described on our Neurological Exam & Evaluation page.
Gradual, guided exposure to movement and visual motion is one approach people use, along with work on the vestibular and neck inputs. Exercise-based balance care is described on our Vestibular Rehabilitation page.
Our care is meant to be complementary to your medical care. If anxiety, low mood, or stress are part of the picture, see our Anxiety & Stress page.
Vertigo is a spinning sensation, often in episodes. PPPD is usually a non-spinning dizziness or unsteadiness that is present on most days for months.
The consensus criteria say it follows a condition that caused vertigo, dizziness, or balance trouble. That can be an inner ear problem, another illness, or psychological distress. Why it continues in some people is still being studied.
The consensus document classifies it as a functional disorder, not a structural or psychiatric one. Stress and anxiety can make symptoms worse.
Yes, a concussion can be the preceding event. See our Post-Concussion Syndrome page.
Mal de Debarquement is a rocking or swaying feeling that follows travel on a boat, flight, or long drive. See our Mal de Debarquement page.
A medical provider, often after tests to rule out other causes.
See our Vertigo Treatment in Smyrna, GA, Marietta, and Atlanta pages.
Next steps
Dizziness that has lasted for months is exhausting.