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Decoding PPPD: Navigating Chronic Dizziness

A patient of mine was recently presented with symptom of dizziness. My diagnosis was Persistent Postural-Perceptual Dizziness (PPPD).

PPPD is relatively “recent” diagnosis. PPHD will be listed in the upcoming International Classification of Disease (ICD-11) .

ICD11  is a system of medical coding.  This coding is created by the World Health Organization  (WHO).

The coding has been created for documenting:

  • diagnoses
  • diseases
  • signs and symptoms
  • and social  circumstances

Just in Your Head!

These are exciting times for patients who suffer this condition. Prior to the PPPD listing patients were told their problem was in their mind… a psychiatric or psychological problem underlying their dizziness.

These times are just as exciting for health practitioners… we can achieve better outcomes for our patients.

I feel relief for the patients who suffer the disease… often they  feel guilty for their problem due to it’s “psychogenic” label.

The treatment options for a psychogenic diagnosis are limited… except for psychogenic drug therapy, which most are unwilling to take.

There has been no objective tests for anatomical or physiological “abnormalities”.

PPPD patients have normal values in clinical balance tests.

Simply put, if we can’t find anything wrong with you, it must be in your head.

A Mismatch Between Perception and Expectation

We  now know PPPD is one of the most common causes of chronic dizziness in middle-aged patients… this chronic dizziness impacts activities of daily living and functionality.

PPPD is based on the clinical condition of Phobic Postural Vertigo (PPV)…. which in concept is a derangement in the sensorimotor function or a neural mismatch.

There’s a mismatch between perception and expectation… the sensory inputs perceiving our environment and our pattern of expectation- our balance.

Thus, our perception of head motion or body sway is inaccurate… causing the sensation of feeling off balance.

Symptoms of PPPD

Common symptoms of PPPD are:

  • Dizziness, unsteadiness , non-spinning.
  • Vertigo that is present on most days for a period of 3 months or more.
  • Experience of benign dizziness brought on by movement in their environment… typically worse in an upright position

The symptoms tend to start shortly after an event that causes acute vertigo ie:

  • peripheral or central vestibular disorder
  • vestibular migraine
  • panic attack with dizziness
  • mild traumatic brain injury (concussion/ whiplash)

If you are suffering any of the above symptoms please contact Dr Tio on 1300 432 639. As a Chiropractor with a special interest in the area of neurology she would be happy to put your mind at ease… and steer you down the path of recovery.

Written by

Dr Woon Jee Tio
Dr Woon Jee has achieved a Double degree Bachelor of Science (chiropractic) and Bachelor of Chiropractic….she treats a diverse group of people that include elite athletes and musicians. Dr Tio’s treatment helped them to quickly recover from injuries or strains and maintain the intense training and practice regime required of them.

9 thoughts on “Decoding PPPD: Navigating Chronic Dizziness”

  1. After a house fire was relocated to a hotel whereby my service dog suffered complications from the fire then a car ran into the house when almost completed. Fire Sept 2020 February 2021 admitted into the hospital for tachycardia. Following discharge primary physician decided to put me on bus bar antianxiety. Took it but noticed no difference. May 2021 began falling for no reason. Felt like I’d been out celebrating 24/7. They have done all sorts of things as far as testing. Shows balance impaired but why? Been to PT OT for 36 weeks without any improvement. No other meds. I am a post Lyme disease pt. Been treated for PTSD in the past. Really don’t want to take a medication (Zoloft) for this condition when this isn’t a mental illness it’s vestibular problem & what I’ve read the medication may or may not work on every patient. Please advise and thank you

    1. Hi Kitty, thanks for reaching out and sharing a bit about your health struggles. Chinese Medicine & Acupuncture can be beneficial for vestibular disorders and dizziness such as in your case. We recommend an initial consultation with one of our practitioners in order to better assess your condition and how treatment can help improve your symptoms. Please feel free to give us a call on 1300 432 639 or email us at 🙂

  2. Hello,

    I have been suffering from debilitating dizziness for almost 10 months since my son was born. My neurologist has diagnosed me with VM and PPPD. I’ve gone and tried many antidepressants with no success and only bad side effects. My condition is ruining my well-being completely and I feel so lost and helpless. Please let me know if you can help me in any way. Thank you

    Kind Regards,

    Natalia Vidovic

    1. Hi Natalia! I’m so sorry to hear of your health challenges. Our amazing practitioners here at the clinic can definitely help with your condition, providing a clear care plan detailing the treatment tailored towards you! If you are interested in discussing further or would like help arranging an initial consultation, please do give us a call on 1300 432 639 or email us at

  3. Hello Dr – I would like to discuss my PPPD issue with you to find a solution to it ????

    1. Hi Manik, absolutely! Our talented practitioners are fully prepared to help find a solution to your condition. You can contact us via phone on 1300 432 639 or email us at Alternatively, if you would like to provide your mobile number, one of our friendly Front Desk Assistants will get in contact with you 🙂

    1. Hi Bishal! Our amazing practitioners here at our clinic are able to treat PPPD. As each patient is different, the number of treatments and your improvement will depend on how you respond to the treatment and your treatment plan prescribed by your practitioner. This treatment plan is something that your practitioner will go through with you in further detail in an initial consultation. For PPPD, I recommend Dr Woon Jee Tio, our Senior Chiropractor here at the clinic. If you are interested in learning more, or if you would like to book for an initial consultation, please feel free to give us a call on 1300 432 639 or email us at Alternatively, one of our friendly Front Desk Assistants can get in touch with you if you would like to provide your mobile number ????

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