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Persistent postural perceptual dizziness (PPPD or 3-PD) causes you to feel dizzy and lose balance. This can be chronic or long-lasting. This can be made worse by any movement. It can be your own movement or seeing something else move.
Vertigo
Vertigo is a spinning sensation. Your inner ear or brain is not working the way it is supposed to. To cope with this, you may stiffen up and move more slowly. You may increase your visual focus on objects in the environment to help you with your balance. You may hold onto sturdy supports to help you to walk. Your brain is working hard to figure out what is going on. Normally, as the vertigo goes away, people return to having normal movement and balance. They are no longer on guard.
Symptoms
With PPD, you stay in the fight or flight mode. You continue to monitor for threats of dizziness. You use vision and touch to navigate. You become more sensitive to motion. This increases your sense of dizziness. Instead of returning to normal, the brain does not adapt. It can lead to other problems like:
Neck stiffness
Fatigue
Trouble walking
Problems with concentration
Avoiding activity
People with a history of migraine, anxiety or depression are more likely to develop PPPD.
Treatment
The aim of treatment is to help the brain have a better sense of motion and balance. This is done in three ways.
Vestibular rehabilitation therapy: This helps you learn how to improve your balance and stability. You can correctly sense motion again. It improves your vision during head movement. You will be guided through the exercise progressions that are tailored to your symptoms.
Medicine: This is used to improve your brain’s ability to adapt. Anti-depressants are used to boost serotonin levels in the brain. Your doctor will work with you to choose a medicine. You would start at a low dose. You and your doctor would slowly increase the dose until it helps. It takes about 8-12 weeks for a medicine to start working. If you have side effects, you would discuss this with your doctor.
Cognitive behavioral therapy: This helps train your thought and behavior patterns. It reduces fear and boosts your confidence You will learn to reduce dizziness. You will cope better with symptoms when they happen. This is best done early after the onset of PPPD.
What to Expect
Treatment will require time and patience. Symptoms may not completely go away, but your daily life should improve.