PPPD (Persistent Postural-Perceptual Dizziness) is a condition that causes ongoing dizziness and unsteadiness, often described as rocking, swaying, floating, or “walking on a trampoline.” Symptoms are commonly worse when standing or walking, and in visually busy environments such as supermarkets, crowds, screens, or scrolling. PPPD often begins after an earlier vestibular event (such as BPPV, vestibular neuritis, vestibular migraine, or concussion). Vestibular physiotherapy can help reduce sensitivity and restore confidence.
In Short:
PPPD symptoms are often present most days, and many people describe feeling “not quite right” rather than true spinning vertigo.
Common PPPD symptoms:
• Rocking or swaying sensation (even when sitting still)
• Feeling unsteady on your feet
• Lightheadedness or “floating”
• Brain fog or difficulty concentrating
• Feeling worse when upright (standing/walking)
• A sense of imbalance or motion that is hard to describe
• Increased sensitivity to movement or busy environments
• Fear of symptoms returning (very common)
Common Triggers
• Supermarkets / shopping centres
• Crowded streets, busy cafés or queues
• Scrolling on your phone
• Computer work / screens
• Fluorescent lighting
• Head turns while walking
• Car travel, trains, or busy junctions
• Wide open spaces or visually patterned floors
If this sounds familiar: A vestibular assessment can confirm whether PPPD is the main driver, or whether there is a combination of causes (such as BPPV or migraine patterns).
PPPD stands for Persistent Postural-Perceptual Dizziness.
It is a condition where the balance system becomes over-sensitive and “on high alert,” often after an initial dizzy event. Even when the original trigger has improved, the nervous system can remain stuck in a pattern of heightened sensitivity — making normal environments feel unstable, overwhelming, or unsafe.
PPPD is real, common, and treatable.
PPPD frequently develops after one of the following:
• BPPV (positional vertigo)
• Vestibular neuritis / labyrinthitis
• Vestibular migraine
• Concussion / post-concussion dizziness
• A period of stress, illness, or anxiety around symptoms
• A single frightening dizzy episode (even if brief)
Sometimes PPPD becomes the “main issue” even when the original vestibular problem has settled.
This is one of the most classic PPPD experiences.
Supermarkets and busy environments can trigger symptoms because they place a heavy load on the visual system while you’re moving and scanning your surroundings.
Common reasons include:
• Lots of moving visual information (people, trolleys, lights)
• Repetitive patterns (long aisles, shelves, tiled floors)
• Turning your head while walking and scanning items
• The brain relying too strongly on visual cues for balance (visual dependence)
This can create a “sensory mismatch” feeling — even though nothing dangerous is happening.
The good news: this sensitivity can be retrained gradually.
PPPD is diagnosed through:
• a detailed symptom history
• identifying typical trigger patterns (supermarkets, screens, crowds)
• vestibular screening and balance testing
• checking for other vestibular causes that may need different treatment (e.g. BPPV)
Many people with PPPD have normal scans or normal medical tests.
That does not mean symptoms are imagined — it simply means the issue is often functional and treatable with the right approach.
Your initial appointment includes:
1) Detailed history
We explore:
• when symptoms started
• what triggers them
• whether you had a previous vestibular event (BPPV, neuritis, migraine, concussion)
• your movement tolerance and daily impact
2) Vestibular assessment
This may include:
• positional testing (to rule in/out BPPV)
• eye movement screening
• balance assessment
• movement tolerance tests
3) Clear explanation + plan
You’ll leave knowing:
✅ what’s driving symptoms
✅ why certain environments trigger you
✅ what the plan is (step-by-step)
✅ what to expect over the coming weeks
PPPD typically responds best to a graded, structured rehab plan rather than trying to “push through” symptoms randomly. Our goal is to reduce visual motion sensitivity, rebuild balance confidence, and help you return to normal environments (shops, work, screens, travel) without fear.
PPPD symptoms can feel unpredictable and worrying — especially when tests or scans have come back “normal”.
We take time to explain:
• why your symptoms are happening
• why supermarkets, crowds, scrolling or busy environments trigger you
• what recovery looks like (gradual, steady progress)
• how your rehab plan will be progressed safely
This alone helps reduce the “threat response” that keeps PPPD going.
PPPD improves when the balance system learns that normal movement and environments are safe again.
We do this through a structured progression such as:
• controlled head and body movement tasks
• walking and turning drills
• balance retraining
• visual motion exposure (introduced gradually)
The aim is to reduce sensitivity without over-flaring symptoms.
For many people with PPPD, the hardest part is returning to real-world environments like:
• supermarkets and shopping centres
• busy streets or crowds
• visually patterned floors
• scrolling, screens, and fast visual input
Virtual Reality rehab allows us to recreate these triggers in a safe and controlled way, so we can train your system gradually — without needing to “just cope” in the real world.
VR can help improve:
• visual motion sensitivity
• balance confidence during movement
• tolerance to complex environments
• “supermarket dizziness” symptoms
• fear and avoidance patterns linked to dizziness
We tailor the VR exposure to your current tolerance and build it up step-by-step as symptoms settle and confidence returns.
Your programme may also include targeted vestibular rehab and balance work such as:
• gaze stability exercises (when appropriate)
• walking pattern and turning confidence
• postural control and balance progression
• graded return to normal daily activities and exercise
If migraine features, concussion symptoms, or neck-related factors are also present, we factor this into your plan so you’re not chasing the wrong target
PPPD recovery is helped by consistent routines and pacing.
We’ll guide you through practical strategies including:
• symptom pacing (so you build tolerance without crashes)
• breathing and nervous system regulation tools
• sleep and recovery support
• confidence-building steps back to normal life
✅ Most people improve fastest when rehab is consistent, progressive, and matched to their tolerance.
PPPD usually improves gradually rather than instantly.
Most people notice progress as:
• fewer “bad days”
• less intensity in supermarkets / crowds
• less brain fog
• improved confidence with walking and movement
• less symptom checking and avoidance
Many people benefit from 4–10+ sessions, depending on:
• how long symptoms have been present
• how sensitive the system has become
• whether there’s overlap with migraine, concussion, or anxiety cycles
• your goals (return to work, sport, driving, travel, busy environments)
Seek urgent medical assessment if dizziness comes with:
• facial droop or weakness
• speech problems or confusion
• sudden numbness
• severe sudden headache
• chest pain, collapse or fainting
• sudden hearing loss
• new double vision
If you’ve had dizziness for weeks or months — especially symptoms worse in supermarkets, crowds, scrolling, or visually busy environments — PPPD may be part of the picture.
A vestibular assessment can help you understand what’s driving symptoms and give you a clear step-by-step plan to get back to normal life.
✅ In-person assessment in Dublin
✅ Clear explanation and diagnosis pathway
✅ Structured graded rehab plan
✅ Confidence returning with movement and daily life
PPPD often feels like rocking, swaying, floating, or ongoing unsteadiness rather than true spinning vertigo.
Yes. Many people describe symptoms even when seated, especially after a visually demanding day.
Busy visual environments increase visual demand and can overload a sensitised balance system, making symptoms feel stronger.
PPPD is not “just anxiety,” but anxiety can amplify symptoms. PPPD often involves a nervous system stuck in high alert after a vestibular event.
Yes — PPPD can develop after BPPV, especially if symptoms persisted for a while or the experience felt frightening.
Sometimes, but many people improve faster with a structured rehab plan rather than waiting for symptoms to settle.
Treatment typically includes education, graded exposure, virtual reality, balance/vestibular rehab and practical symptom regulation strategies.
Recovery is individual. Many people improve over weeks to months with consistent rehab and the right progression.
They can overlap, but they are not the same. Vestibular migraine often has migraine features or patterns, while PPPD is strongly linked with persistent motion/visual sensitivity.
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