Unraveling the mystery behind chronic dizziness

Most people experiencing dizziness also feel vertigo… like the room is spinning.

But Persistent Postural-Perceptual Dizziness (PPPD) is a chronic condition marked by non-spinning dizziness, unsteadiness, or perceptual imbalance that worsens when standing, walking, or exposed to complex visual stimuli.

Symptoms persist for months, and physical tests often reveal little despite real suffering.

A new review by Qin and colleagues (2025) digs into what might be going wrong in PPPD.

Traditionally, PPPD has been thought to arise from altered postural control, but the paper expands the picture.

It brings in how visual processing, emotional threat or anxiety, sensory integration, and brain network changes may all contribute.

Here are some key findings:

• People with PPPD tend to favor visual and body-sense information over inner-ear (vestibular) cues for balance, even when those other cues are less accurate.
• Postural control becomes “stiff” and less adaptive; people stay in protective or hypervigilant body postures long after any triggering event has passed.
• Brain imaging suggests abnormal activity or connectivity in regions involved in threat/emotion, spatial orientation, and multisensory integration.
• The balance between sensory inputs seems disturbed: the brain may over-rely on vision, under-tune vestibular signals, or mis-weigh signals overall. Visual motion, moving scenes, and upright posture are big triggers.

The review highlights how anxiety, threat perception, and past vestibular insults may prime the brain to anticipate danger or pay heightened attention to visual and spatial cues.

This feedback loop makes symptoms worse.

Fortunately, our vertigo and dizziness exercises work wonders for all types of vertigo and dizziness, including PPPD. I highly recommend checking them out here…