Still Dizzy - could be PPPD
Are you always Dizzy- It could be PPPD?
Persistent postural-perceptual dizziness (PPPD), is a common cause of chronic (long-lasting) dizziness.
What is PPPD
PPPD is categorized by non-spinning dizziness, or unsteadiness, that lasts for longer than 3 months.
Usually, PPPD is triggered by an episode of vertigo or dizziness. After that first episode, the person continues to have feelings of movement, dizziness, unsteadiness or light-headedness that can last for hours or days at a time. These symptoms are present nearly all the time, but they can be better or worse at times. Things like sitting or standing upright and seeing busy patterns or movement often make the symptoms worse.
As a result, people with PPPD often become anxious about losing their balance or falling. They may avoid situations that make their symptoms worse, to the point where it can start to interfere with their lives. Shopping centres and computer screens may cause an issue.
In addition to the anxiety you can start to feel neck pain and headaches. This occurs when the head movements that provoke your symptoms are avoided, resulting in stiff neck joints and muscles. Thus you start avoiding activities for fear of provoking those awful symptoms.
But there is something you can do: See one of our Physios, for an exercise programme (vestibular rehabilitation), and some treatment for your neck, as well as an explanation about the condition.
The five following criteria must be met to be diagnosed PPPD:
- One of more symptoms of dizziness, unsteadiness, or non-spinning vertigo are present on most days for 3 months or more. Symptoms last for hours, but may vary in severity. Symptoms are not required to be present continuously throughout the entire day.
- Symptoms occur without specific provocation but are exacerbated by upright posture, head movement and exposure to moving stimulus.
- The disorder is precipitated by conditions that cause vertigo including acute, episodic or chronic vestibular syndromes, neurological or medical illnesses or psychological distress.
- Symptoms cause significant distress or functional impairment
- Symptoms are not better accounted for by another disease or condition.
PPPD is a central processing disorder. That means that there is nothing structurally wrong with either the brain, the vestibular system or connecting nerves. The problem lies with the system being too sensitive – that is, the vestibular system and processing of information is working too well, as if constantly on ‘high alert’.
What can be done about it
People with this condition can show significant improvement in symptoms with vestibular rehabilitation. Exercises that repeatedly allow exposure to an unpleasant stimulus, called habituation exercises, have been shown to gradually reduce the symptoms of dizziness and unsteadiness over time. To have success with this rehabilitation, you need to challenge the system, therefore these exercises will usually make you feel slightly worse for a couple of minutes, however, contribute to long term improvements.