The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult vestibular-trained physical therapist, neuro-optometrist, or concussion specialist for individualized guidance. Persistent postural-perceptual dizziness (PPPD) is chronic non-vertiginous dizziness lasting 3+ months, triggered by upright posture, active or passive motion, and complex visual environments (Silverberg et al., 2020). PPPD develops in 20-40% of chronic post-concussion patients after an initial vestibular insult. PPPD is functional vestibular disorder rather than structural damage. Diagnosis requires three or more months of dizziness triggered by upright posture, motion, or visual stimuli. Treatment includes vestibular rehabilitation with habituation exercises, SSRI or SNRI medication (sertraline, venlafaxine), and cognitive behavioral therapy. Recovery over 6-18 months with treatment. PPPD is chronic non-vertiginous dizziness. Non-vertiginous dizziness. Triggered by posture, motion, and visual stimuli. Triggered by posture motion visual. Functional disorder not structural damage. Functional disorder. PPPD Diagnostic Criteria (Barany Society) Symptoms lasting 3+ months. 3+ months duration. Dizziness on most days. Dizziness on most days. Triggered by upright posture. Triggered by upright posture. Triggered by active or passive motion. Triggered by motion. Triggered by complex visual environments. Triggered by visual stimuli. Preceded by acute vestibular event. Preceded by acute vestibular event. Not better explained by another diagnosis. Not better explained by another diagnosis. How Concussion Triggers PPPD Acute vestibular insult from concussion. Acute vestibular insult. Maladaptive postural strategies persist. Maladaptive postural strategies. Visual dependence develops. Visual dependence develops. High-risk strategy for movement predictions. High-risk motion predictions. Cortical processing of vestibular signals altered. Cortical processing altered. Anxiety often perpetuates PPPD. Anxiety perpetuates PPPD. Attention hypervigilance to symptoms. Attention hypervigilance. Common Triggers Standing. Standing. Walking. Walking. Grocery store aisles. Grocery store aisles. Busy visual environments. Busy visual environments. Scrolling. Scrolling. Riding as passenger. Riding as passenger. Escalators. Escalators. Highway driving. Highway driving. Watching motion on screen. Watching motion on screen. Crowded spaces. Crowded spaces. Symptoms Rocking sensation. Rocking sensation. Swaying sensation. Swaying sensation. Floating sensation. Floating sensation. Unsteadiness without spinning. Unsteadiness without spinning. Non-vertiginous dizziness. Non-vertiginous dizziness. Visual motion sensitivity. Visual motion sensitivity. Difficulty in crowds. Difficulty in crowds. Worsening throughout day. Worsening throughout day. Improvement lying down. Improvement lying down. Treatment Approach Vestibular rehabilitation with habituation. Vestibular rehab habituation. Gaze stabilization exercises. Gaze stabilization exercises. Visual motion desensitization. Visual motion desensitization. Sertraline 25-100 mg daily. Sertraline 25-100 mg daily. Venlafaxine 37.5-150 mg daily. Venlafaxine 37.5-150 mg daily. Cognitive behavioral therapy. Cognitive behavioral therapy. Combined treatment most effective. Combined treatment most effective. Prognosis Recovery over 6-18 months with treatment. Recovery 6-18 months. 50-70% substantial improvement rate. 50-70% substantial improvement. Untreated PPPD often chronic. Untreated PPPD often chronic. Early intervention improves outcomes. Early intervention improves outcomes. Supporting Mobility Routine These exercises support PPPD recovery through cervical mobility and nervous system regulation. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. How is PPPD different from BPPV? BPPV causes brief spinning vertigo triggered by specific head positions and treated by Epley maneuver. PPPD causes chronic non-vertiginous dizziness triggered by upright posture, motion, and visual stimuli lasting 3+ months. BPPV is peripheral vestibular structural problem. PPPD is functional vestibular disorder involving cortical processing. Can PPPD be cured after concussion? PPPD can substantially improve with treatment. Recovery over 6-18 months with vestibular rehabilitation, SSRI or SNRI medication, and cognitive behavioral therapy. 50-70% of patients achieve substantial improvement. Early intervention improves outcomes. Combined treatment approach more effective than any single treatment. Which SSRI is best for PPPD? Sertraline (25-100 mg daily) and venlafaxine (37.5-150 mg daily) most studied for PPPD. Both effective in 60-70% of patients. Sertraline SSRI. Venlafaxine SNRI. Escitalopram alternative. Response often within 8-12 weeks. Combined with vestibular rehabilitation more effective than medication alone. Why does PPPD develop after concussion? PPPD develops when acute concussion causes vestibular insult and the brain adopts maladaptive postural strategies, visual dependence, and high-risk motion predictions that persist after acute injury resolves. Anxiety and hypervigilance to symptoms perpetuate the disorder. Functional vestibular processing alteration rather than structural damage. Should I see a specialist for PPPD after concussion? Yes. Vestibular-trained physical therapist and vestibular neurologist support diagnosis and treatment. Otolaryngologist rules out other vestibular disorders. Neuro-otologist specializes in central vestibular disorders. Psychiatric consultation for medication selection. Concussion clinic coordinates multidisciplinary care. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed