What Is PPPD? Understanding Persistent Postural-Perceptual Dizziness

What Is PPPD?

PPPD stands for persistent postural-perceptual dizziness, a condition that causes ongoing feelings of dizziness, unsteadiness, or imbalance rather than the spinning sensation many people associate with vertigo. Instead of feeling like the room is moving, people with PPPD often describe a constant sense of swaying, rocking, or being off balance, which is why it is sometimes called non-spinning vertigo or chronic subjective dizziness. These symptoms can make everyday activities like walking, standing, or being in busy environments feel uncomfortable and exhausting. 

Although PPPD can be frustrating and disruptive, it is a recognized and fairly common condition, and with the right approach, it is also treatable.

What Does PPPD Feel Like?

PPPD symptoms usually feel more like an ongoing imbalance than true spinning vertigo. People with PPPD often describe:

• A constant or frequent feeling of swaying, rocking, or unsteadiness
• A swaying feeling in the head, especially when standing or walking
• Feeling worse in busy visual environments, such as stores, crowds, or scrolling screens
• Increased symptoms with movement or when staying upright for long periods
• A sense of dizziness that does not involve the room spinning, sometimes described as non-spinning vertigo
  

Although some people refer to this as PPPD vertigo, these symptoms are different from the sudden, spinning sensation seen in other balance disorders.

What Causes PPPD?

PPPD often begins after another balance or neurological issue, even if that original problem has already improved. Common triggers include vestibular disorders, inner ear problems, or other forms of vestibular dysfunction, concussions, migraines, or repeated episodes of vertigo or anxiety-related dizziness. 

In persistent postural-perceptual dizziness, the brain can remain stuck in a heightened “threat” or imbalance response, continuing to send signals that something is wrong even when the initial cause is no longer active. Over time, this pattern can reinforce dizziness and unsteadiness, which helps explain why PPPD symptoms can linger and become chronic.

How PPPD Is Different From Other Types of Dizziness

PPPD is different from conditions like BPPV and classic vertigo because it does not usually cause sudden, spinning sensations. In the PPPD vs BPPV comparison, BPPV tends to trigger brief episodes of spinning dizziness with specific head movements, while PPPD causes more constant, non-spinning dizziness and ongoing imbalance. Some people may still refer to this as PPPD vertigo, but the symptoms are typically steadier and more pattern-based rather than sudden and short-lived.

How Is PPPD Diagnosed?

There is no single test that confirms PPPD, so diagnosis is based on a careful review of symptoms, how long they have been present, and the pattern of dizziness over time. A specialist will typically look at your symptom history and perform neurological and balance exams to understand better what is happening. Imaging studies or vestibular testing may also be used to rule out other conditions that can cause similar symptoms. 

Making the correct PPPD diagnosis is important because treatment approaches differ from those for other balance disorders, and understanding what PPPD is helps avoid unnecessary testing or ineffective treatments.

Treatment Options for PPPD

PPPD treatment usually takes a combined approach that focuses on retraining the brain and balance system rather than relying on a single fix. Care plans may include:

• Vestibular physical therapy to improve balance and reduce sensitivity to movement
• Medications, in some cases, to help manage symptoms or related anxiety
• Cognitive-behavioral strategies or other forms of anxiety management

Many patients worry about whether there is a true PPPD cure, and while there may not be a quick or instant solution, symptoms can often be significantly reduced and well-controlled over time. With consistency in treatment and realistic expectations, many people experience strong PPPD treatment success and can return to normal or near-normal daily activities, even when vestibular dysfunction was part of the original trigger.

When to See a Specialist

Persistent postural-perceptual dizziness is often misunderstood, and many people spend months trying to push through symptoms before realizing something more is going on. Dizziness should be evaluated when symptoms last for weeks or months, when there is ongoing imbalance or swaying, or when dizziness begins to interfere with daily activities or confidence. Getting the right evaluation matters because an accurate PPPD diagnosis helps guide the most effective treatment plan. 

Chronic dizziness is not something you have to “just live with,” and understanding what PPPD is can be the first step toward improvement. Brain & Spine works closely with referring providers to evaluate complex dizziness and balance conditions and support patients on a path toward better stability, comfort, and quality of life.