It’s been estimated that up to 30% of people experience some form of dizziness within their lifetime. Dizziness has been listed as one of the most common reasons people visit their GP or seek a referral to see a neurologist. PPPD is the most common diagnosis of dizziness in the under 45 year old age group, making up 37.4% of diagnoses.
It is categorised by non-spinning dizziness, or unsteadiness, that lasts for longer than 3 months. It is usually made worse by movement or upright positioning. Complex patterns such as shopping centre tile patterns or computer screens have also been shown to worsen symptoms.
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’.
People with this condition 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.
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 wax and wane 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.
As there is no structural damage, there will be no findings on physical examination, laboratory testing or diagnostic imaging that can be used to diagnose PPPD. The diagnosis can be made by a physiotherapist or doctor based on symptoms.
If you think you may have PPPD or are experiencing symptoms of dizziness, don’t hesitate to get in contact! Emily Evans has a special interest in the treatment of dizziness.