Persistent Postural-Perceptual Dizziness: Long-Lasting Dizziness After a Trigger

Table of Contents

1. A Chronic Functional Vestibular Disorder
2. The 2017 Bárány Society Diagnostic Criteria
3. Common Triggering Events
4. Who Keeps the Dizziness After an Inner-Ear Illness
5. How Common It Is in Dizziness Clinics
6. What Research Shows About the Mechanism
7. Overlap With Anxiety, Depression and Migraine
8. Vestibular Rehabilitation Trials
9. Antidepressant Medicine Studies
10. Cognitive Behavioral Therapy Trials
11. Newer Approaches: Brain Stimulation and Virtual Reality
12. What the Pooled Reviews Conclude
13. Long-Term Course
14. What Is Not Known
15. Connections
16. Key Research Papers
17. Featured Videos

A Chronic Functional Vestibular Disorder

The 2017 consensus document of the Bárány Society, the international society of balance specialists, states that the name is new but the disorder is not. Its criteria were built by expert consensus from 30 years of research on four older labels: phobic postural vertigo, space-motion discomfort, visual vertigo and chronic subjective dizziness. The document classifies persistent postural-perceptual dizziness as a chronic functional vestibular disorder and states that it is not a structural or psychiatric condition. “Functional” here means that the balance system is working in an altered way, not that a part of it is damaged and not that the symptoms are imagined.¹

A 2026 review from Japan reports that the criteria were then included in the World Health Organization’s International Classification of Diseases, 11th revision (ICD-11), and describes persistent postural-perceptual dizziness as the most frequent cause of chronic dizziness.² A 2018 review in a neurology teaching journal places it within the wider group of functional neurological disorders and describes it as a long-term maladaptation to the neuro-otological, medical or psychological event that first triggered the vestibular symptoms. The same review notes that standard balance tests and conventional brain scans usually come back normal, and that many people go on to develop a secondary functional gait problem, anxiety, avoidance of situations that bring on the symptoms, and severe disability.³

The 2017 Bárány Society Diagnostic Criteria

The consensus document describes the condition through these features, as its abstract states them:¹

• The symptoms: one or more of dizziness, unsteadiness, or non-spinning vertigo.
• How long: present on most days for three months or more.
• What makes it worse: upright posture; active or passive movement (moving oneself, or being moved, as in a car); and exposure to moving or complex visual stimuli.
• What can start it: conditions that disrupt balance or cause vertigo, unsteadiness or dizziness, including peripheral or central vestibular disorders, other medical illnesses, or psychological distress.
• Other conditions: it may be present alone or exist alongside other conditions.
• Subtypes: possible subtypes are still waiting to be identified and validated.

In a Brazilian series of 81 patients, the reported provoking factors were visual stimuli (74%), body movements (52%) and sleep deprivation (38%).⁴ A 2024 South Korean study across 18 medical centers compared 76 people who met all of the criteria with 109 who had a “clinical variant” that did not meet all three worsening factors. People in the variant group without visual worsening had lower rates of panic disorder, less space-motion discomfort, a smaller impact from dizziness and less depression than the definite group, which the authors read as a possible distinct subtype shaped by visual dependence.⁵

Common Triggering Events

Research groups divide cases into “secondary” persistent postural-perceptual dizziness, which follows an identifiable bodily (organic) trigger, and “primary” persistent postural-perceptual dizziness, where no bodily trigger is found. The share of each and the triggers named differ by clinic:

• German tertiary vertigo center, 356 patients (registry study, 2020): 55% were classed as primary and 45% as secondary. The most common bodily triggers in the secondary group were benign paroxysmal positional vertigo (27%) and vestibular migraine (24%). People in the primary group were younger on average (44 against 48 years), with a peak around age 30 as well as a shared peak at 50–55.⁶
• Italian tertiary referral center, 126 patients (retrospective review, 2023): 43% primary and 57% secondary. Benign paroxysmal positional vertigo was the bodily trigger in 51 people. Compared with people whose positional vertigo did not lead to persistent dizziness, those who developed it were older on average and had waited longer between the start of the positional vertigo and its final diagnosis. Sex, how often the positional vertigo came back, and migraine did not differ between the groups.⁷ The site’s BPPV page covers that condition.
• Australian clinic, 198 cases over 5 years (case review, 2021): anxiety disorders and vestibular migraine were among the common precipitating conditions. Just under half of the cases had a vestibular abnormality on testing, such as one-sided loss of inner-ear balance function or an isolated otolith (gravity-sensing organ) abnormality.⁸
• Head injury (United States tertiary center, retrospective cohort, 2025): 134 of 1,503 patients with persistent postural-perceptual dizziness (8.9%) had a traumatic brain injury as the triggering event, and 85.8% of those injuries were mild. The share of women was lower in this group (58.2%) than among people with the condition from all causes.⁹ The site’s Concussion page covers mild head injury.
• Children and young people (United States, chart review, 2021): among 53 patients aged 21 or younger, other diagnoses alongside persistent postural-perceptual dizziness included benign paroxysmal positional vertigo (64.2%), vestibular migraine (56.6%) and anxiety (28.3%). These figures describe conditions present together, not which one came first.¹⁰

Vestibular neuritis, an inflammation of the balance nerve, is the trigger most studied for how dizziness becomes chronic (see the next section and the site’s Vestibular Neuritis page). Panic attacks and other psychological distress are named triggers in the consensus criteria themselves.¹

An older prospective study from a United States tertiary balance center (1998–2004), run before the 2017 name existed, followed 345 people referred for chronic dizziness of three months or longer with no clear cause. Primary and secondary anxiety disorders were diagnosed in 206 (59.7%), and central nervous system conditions — migraine, mild traumatic brain injury and dysautonomia (a disorder of the automatic nervous system) — in 133 (38.6%). Four of five patients with migraine or heart-rhythm problems also had anxiety. The authors wrote that the high rate of anxiety that develops after a balance illness may give a false impression that the dizziness is psychological in origin.¹¹

Who Keeps the Dizziness After an Inner-Ear Illness

A 2023 systematic review pooled 13 studies on what predicts persistent postural-perceptual dizziness, or similar chronic dizziness, after a peripheral vestibular illness, with at least three months of follow-up. The strongest predictors were anxiety after the vestibular injury, dependent personality traits, autonomic arousal (a racing, on-alert body) and increased body vigilance after the event, and visual dependence. The severity of the original inner-ear damage, or how well it had compensated on testing, did not predict who stayed dizzy. Data on anxiety that existed before the illness were mixed, and the authors concluded that pre-existing psychiatric conditions, other than dependent personality traits, were not relevant to who developed it.¹²

Two British studies of vestibular neuritis add detail. In a 2014 cross-sectional study of 28 patients seen at least six months after the illness, the authors noted that around 50% of patients report long-term vestibular symptoms after vestibular neuritis. The third of patients with the worst outcomes were more visually dependent than healthy controls on a rod-and-disk test (6.35° error against 3.39°).¹³ In a 2017 prospective study of 40 patients tested in the first days of the illness (32 retested at a median of 10 weeks), visual dependence and autonomic arousal in the acute phase predicted the later outcome. Worse recovery went with more visual dependence, autonomic arousal, anxiety or depression and fear of bodily sensations, but not with the inner-ear test results.¹⁴

How Common It Is in Dizziness Clinics

How common persistent postural-perceptual dizziness is in the general population is not known. Two 2023 Cochrane reviews state that the condition was only recently defined and that its prevalence is currently unknown.¹⁵¹⁶ Clinic figures exist, and they vary with the kind of clinic:

• A South Korean referral dizziness clinic analyzed the diagnoses of 21,166 consecutive dizzy patients seen from 2003 to 2019. “Psychiatric or persistent postural perceptual dizziness”, counted as one group, was the second most common cause (20.8%) after benign paroxysmal positional vertigo (24.1%), and the most common cause in adults aged 19 to 64 (26.3%).¹⁷
• An Irish general neurology clinic screened 1,315 new referral letters from 2021 to 2023: 202 (15.4%) mentioned dizziness, vertigo or unsteadiness, and 22 of those met the diagnostic criteria.¹⁸
• Women outnumber men in most clinic series: 80 of 100 patients in a Canadian multidisciplinary dizziness clinic,¹⁹ a female-to-male ratio of 5.7 to 1 in the Brazilian series,⁴ 56% in the German registry,⁶ and 44 of 53 (83.0%) in the pediatric series.¹⁰

Reviews from specialist centers describe persistent postural-perceptual dizziness as the most common cause of chronic dizziness or chronic vestibular syndrome in vestibular referral settings.²²⁷ These are specialist-clinic statements; they do not show how common it is among people who never reach such a clinic.

What Research Shows About the Mechanism

The consensus document states that the processes underlying persistent postural-perceptual dizziness are not fully known, and that emerging research suggests it may arise from functional changes in postural control, multi-sensory information processing, or the brain’s integration of spatial orientation and threat assessment.¹ The research behind those ideas falls into three groups.

Postural control (balance-platform studies)

• Cross-sectional platform study, 2016: 20 women with persistent postural-perceptual dizziness scored lower than 15 healthy women on conditions 2 to 6 of the sensory organization test (a computerized balance platform that removes or confuses vision and foot-sole feedback), and lower than 15 women who had recovered from an acute vestibular illness on conditions 2 and 3.²⁰
• German registry, 2020: posturography was the most sensitive test in the 356 patients, showing a “phobic sway pattern” in 50% of cases.⁶
• A 2015 imaging paper summarizes the older working model: chronic subjective dizziness is thought to arise from continued use of “high-threat” postural control strategies (a stiff, over-cautious way of standing and walking) and greater reliance on visual cues long after the triggering event has resolved.²¹

Visual dependence (clinical and laboratory tests)

• Belgian cross-sectional study, 2022: 38 people with persistent postural-perceptual dizziness, 21 dizzy people without it and 69 healthy people. The persistent postural-perceptual dizziness group had higher scores on the Visual Vertigo Analog Scale (a questionnaire on dizziness in visually busy situations) than the other dizzy group, and that score was the feature most associated with the diagnosis. Their balance on clinical tests was no worse than in the other dizzy patients, and rod-and-disc scores did not differ among the three groups. The authors concluded that patients were more visually dependent but did not have worse balance than other dizzy patients.²²
• The vestibular neuritis studies above link visual dependence early in the illness with poorer recovery.¹³¹⁴

Brain imaging (small functional magnetic resonance imaging studies)

• Resting-state functional magnetic resonance imaging, 38 patients and 38 controls (2018): patients showed reduced connectivity among brain areas that handle multisensory balance information and spatial thinking, and increased connectivity in networks linking visual and emotional processing. Some differences remained after accounting for anxiety and depression. A computer classifier using 11 connectivity measures sorted patients from controls with a sensitivity of 78.4% and a specificity of 76.9%.²³
• Sound-evoked vestibular stimulation, 18 patients with chronic subjective dizziness and 18 controls (2015): patients showed weaker activation of the parieto-insular vestibular cortex, the insula, hippocampus and anterior cingulate cortex.²¹
• Virtual-reality rollercoaster, 15 patients and 15 controls (2017): an insula response to simulated vertical motion seen in controls was absent in patients, and activity in the patients’ visual cortex rose with the severity of their dizziness handicap.²⁴
• Review of the imaging studies (2021): local activity and connectivity in vestibular cortical areas appear decreased, possibly related to structural differences such as reduced cortical folding and grey-matter volume, while connectivity between the prefrontal cortex and visual and motor regions appears increased. The authors read this as support for a shift that weights vision over vestibular input and lets anxiety-related mechanisms act more strongly on walking and spatial orientation.²⁵

All of the imaging work compares groups of a few dozen people at one point in time. It shows differences that go with the condition, not what caused them, and none of it is a diagnostic test in clinical use.

Overlap With Anxiety, Depression and Migraine

Anxiety and depression. In the Canadian series of 100 patients, 53.5% scored as moderately to severely depressed on a standard questionnaire, while 64% were minimally or mildly anxious on an anxiety scale; the average Dizziness Handicap Inventory score was 60.3.¹⁹ In the German registry, anxiety disorders (20% against 10%) and depressive disorders (25% against 9%) were more frequent in primary than in secondary cases.⁶ The consensus criteria still treat the condition as a vestibular disorder rather than a psychiatric one,¹ and the predictor review found that anxiety arising after the vestibular event mattered more than anxiety present before it.¹² The site’s Anxiety and Panic Disorder pages cover those conditions.

Migraine and vestibular migraine. In a United States neurotology clinic, 19 of 36 patients (53%) met headache-society criteria for migraine and 6 (17%) met the criteria for definite vestibular migraine; the authors suggest persistent postural-perceptual dizziness may lie on a spectrum with migraine.²⁶ In the Canadian clinic, 49% had migraine symptoms on a screening questionnaire,¹⁹ and in the Brazilian series migraine headache was present in 26%.⁴ A 2026 narrative review notes that some researchers propose persistent postural-perceptual dizziness is a chronic form of vestibular migraine, while its history as a functional disorder suggests otherwise. The review states that vestibular migraine is treated with migraine prevention, while vestibular rehabilitation is a cornerstone treatment for persistent postural-perceptual dizziness, and that studies of treating migraine in people who have both are still needed.²⁸ See the site’s Vestibular Migraine page.

Other vestibular conditions. The criteria allow persistent postural-perceptual dizziness to exist alongside other conditions,¹ so a person can have it together with ongoing benign paroxysmal positional vertigo, Ménière’s disease or vestibular migraine. The difference lies in the pattern: positional vertigo comes in spells of seconds with head movement, Ménière’s attacks last minutes to hours with hearing symptoms (see Vertigo and Ménière’s Disease), while persistent postural-perceptual dizziness is present on most days for months.

Vestibular Rehabilitation Trials

Vestibular rehabilitation is a program of balance, gaze and graded motion exercises, usually guided by a physical therapist, and for this condition often includes gradual exposure to visual motion.

• Meta-analysis of 8 studies (2025): rehabilitation improved total Dizziness Handicap Inventory scores compared with control groups (weighted mean difference 21.84 points, 95% confidence interval 10.97 to 32.71). Customized rehabilitation did better than virtual-reality-based rehabilitation. The authors wrote that more randomized trials are needed.²⁹
• Meta-analysis of 6 studies (2025): before-and-after scores fell by a pooled Hedges’ g of 1.60 (95% confidence interval 0.75 to 2.45), but heterogeneity between studies was very high (I² = 92%), and the authors called the evidence limited.³⁰
• Head-injury cohort (2025): vestibular therapy was the most common treatment (82.2%); 53.3% of patients were rated much or very much improved after 6 months, a poorer average response than earlier reports for other causes.⁹
• Web-based self-help program (2021): in a 10-patient feasibility study in Norway, 9 completed a six-week online program, and symptom scores improved by 6.9 points on average on the Vertigo Symptom Scale. There was no control group.³¹

The Cochrane review of non-drug treatments (2023) found no rehabilitation trial that met its rules: a placebo or no-treatment comparison, the Bárány diagnostic criteria, and at least three months of follow-up.¹⁶

Antidepressant Medicine Studies

The medicines studied are selective serotonin reuptake inhibitors (SSRIs), such as sertraline, and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine.

• Cochrane review (2023): no placebo-controlled randomized trial of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors met its inclusion rules. The authors concluded there is no evidence from placebo-controlled randomized trials for these medicines in this condition and great uncertainty over their use.¹⁵
• Systematic review (2026): 13 studies with 807 participants — 2 randomized controlled trials, 7 open-label trials and 4 observational or retrospective studies. Only 4 studies enrolled people diagnosed under the 2017 criteria; the rest used earlier labels or similar symptoms. Antidepressants were generally associated with less dizziness and fewer psychiatric symptoms, with reported response rates of 55% to 84%. Up to 25% of participants could not tolerate treatment; reported side effects were stomach and gut symptoms, sedation or fatigue, sexual side effects and headache. The authors called the evidence limited and low in quality and stated that randomized placebo-controlled trials are urgently needed.³²
• Prospective cohort, 88 patients (2005): people with chronic subjective dizziness and anxiety were given a selective serotonin reuptake inhibitor for at least 8 weeks. Those whose anxiety began after an inner-ear illness, or whose anxiety alone caused the dizziness, responded more fully than those whose inner-ear illness worsened anxiety that was already present. Intolerance rates were similar across the three groups. There was no placebo group.³³
• Uncontrolled clinic series: 68% of the 81 Brazilian patients improved on serotonin reuptake inhibitors;⁴ in the Irish clinic, venlafaxine was offered to 10 patients and 8 reported at least 50% benefit.¹⁸

The trial-level dosing reported in this field comes from a randomized trial in which every patient received sertraline at 50–200 mg a day (see the next section).³⁴

Cognitive Behavioral Therapy Trials

Cognitive behavioral therapy (CBT) is a structured talking therapy that works on the thoughts, fears and avoidance habits that keep symptoms going.

• Randomized trial, 91 patients, China (2018): all patients received sertraline 50–200 mg a day for eight weeks; 46 were also given cognitive behavioral therapy twice a week and 45 were not. Both groups improved on dizziness, anxiety and depression scores. The group given cognitive behavioral therapy had lower scores on all three at weeks 4 and 8, needed a lower sertraline dose, and had fewer side effects (26.1% against 48.9%). There was no placebo or therapy-only arm.³⁴
• INVEST randomized feasibility trial, 40 adults, London (2022): six sessions of rehabilitation built on cognitive behavioral principles (20 people) were compared with six sessions of standard vestibular rehabilitation (20 people). Effects at four months were small to moderate in favor of the combined program, across dizziness handicap, illness beliefs, symptom focusing, fear-avoidance and distress. No treatment-related serious adverse events were reported. The trial was designed to test whether a full trial was possible, not to prove benefit.³⁵
• Australian case series (2021): cognitive behavioral therapy was followed by large reductions in anxiety and dizziness measures over up to 6 months in the clinic’s patients; there was no comparison group.⁸
• One-year follow-up of phobic postural vertigo, 20 patients, Sweden (2007): scores one year after a course of cognitive behavioral therapy were similar to those before treatment, and no significant treatment effect remained. The authors concluded that this therapy alone had a limited long-term effect.³⁶

Newer Approaches: Brain Stimulation and Virtual Reality

• Transcranial direct current stimulation (a weak electric current through scalp electrodes), randomized double-blind sham-controlled trial, 24 patients, South Korea (2022): 15 sessions over 3 weeks, added to medicine. Active stimulation was not more effective than sham on the Dizziness Handicap Inventory, the main measure, or on balance confidence and anxiety.³⁷ This was the only study that met the Cochrane review’s rules for non-drug treatments.¹⁶
• Repetitive transcranial magnetic stimulation (magnetic pulses to the left front of the brain), single-blind placebo-controlled trial, 66 patients, China (2025): 33 received active stimulation and 33 sham over ten sessions in two weeks; 52 completed three months. The active group had lower dizziness and anxiety scores than the sham group at 2 weeks, 1 month and 3 months. The authors called for larger studies.³⁸
• Virtual reality added to rehabilitation, randomized trial, 42 patients, Jordan (2025): 21 received virtual reality plus optokinetic (moving-pattern) stimulation and rehabilitation; 21 received optokinetic stimulation and rehabilitation. Both groups improved, with no significant difference between them; the primary score fell from 41.55 to 23.40 with virtual reality and from 43.60 to 26.10 without. The authors note that without an untreated group the improvement cannot be firmly credited to treatment.³⁹

What the Pooled Reviews Conclude

2025 meta-analysis of conservative therapy (22 randomized trials, 1,764 patients). The review searched three Chinese databases plus PubMed and EMBASE up to March 2025. For a selective serotonin reuptake inhibitor combined with vestibular rehabilitation, the pooled results consistently favored the combination over either treatment alone on the Dizziness Handicap Inventory and the Hamilton Anxiety Scale. The certainty of the effect of cognitive behavioral therapy and of transcranial direct current stimulation was unclear because there were few, small studies. The main risk-of-bias concerns were selective reporting of results and the randomization process, and the certainty of all outcomes was judged moderate to very low. The authors wrote that, on current evidence, they recommend prioritizing a selective serotonin reuptake inhibitor plus structured vestibular rehabilitation, and described the treatments as having favorable safety profiles.⁴⁰

2026 network meta-analysis of non-drug treatments (11 randomized trials, 518 patients). Brain stimulation (neuromodulation) ranked above control, cognitive behavioral therapy and vestibular rehabilitation for balance and anxiety outcomes. No treatment had a significant effect on depression. Most of the studies (81.8%) were at high risk of bias, and the overall evidence was rated low to moderate.⁴¹

2024 review of non-drug treatments (13 randomized trials, 618 patients). Nine trials enrolled people diagnosed with persistent postural-perceptual dizziness and four enrolled people with functional dizziness. In most trials, the effect sizes on dizziness handicap and severity were small to moderate (standardized mean differences 0.04 to 0.52). One trial of visual desensitization with personalized glasses showed large effects (1.09 and 1.05). Most trials tested single treatments rather than the combined, multi-specialty treatment the authors consider worth studying.⁴²

The Cochrane reviews (2023) set stricter rules — a placebo or no-treatment comparison and at least three months of follow-up — and found no qualifying medicine trial and only one small non-drug trial.¹⁵¹⁶ The reviews differ mainly because they set different entry rules for which studies count.

Long-Term Course

The longest follow-up comes from the older label, phobic postural vertigo. Among 106 German patients followed for a mean of 8.5 years (5 to 15.9 years), 75% reported improvement and 27% complete remission. Most improvement came in the first year after diagnosis, though some improved after two years or more. The longer the condition had lasted before diagnosis, the lower the improvement rate. Transient relapses occurred in 47% of those who improved, and the chance of a relapse stayed the same throughout follow-up. No patient’s diagnosis needed revising.⁴³

In the pediatric series, 18 of 53 young patients (34.0%) reported their symptoms resolving, between 2 and 48 months after diagnosis (median 9 months); 43.4% had initially missed school or work because of the symptoms.¹⁰ The Japanese review states that serotonergic antidepressants, vestibular rehabilitation and cognitive behavioral therapy have shown favorable effects but are not effective for every patient.²

What Is Not Known

• How common it is outside specialist clinics. No population prevalence figure exists; the Cochrane reviewers describe it as unknown.¹⁵
• What causes it. The consensus document states the underlying processes are not fully known.¹ The imaging studies are small, one-time comparisons that cannot separate cause from effect.
• Whether the medicines work better than placebo. No placebo-controlled randomized trial in people diagnosed under the 2017 criteria met Cochrane’s rules,¹⁵ and the 2026 antidepressant review calls such trials urgently needed.³²
• Long-term effects of treatment. Most trials followed patients for weeks to a few months; the one long cognitive behavioral therapy follow-up found no lasting effect at one year.³⁶
• Its relationship to vestibular migraine. Whether the two are separate conditions or parts of one spectrum is debated.²⁶²⁸
• Subtypes. The criteria leave subtypes for future research,¹ and the primary/secondary and visual/non-visual splits proposed so far have not been validated.⁵⁶
• Which combination of treatments works best. The 2025 meta-analysis favors medicine plus rehabilitation over either alone,⁴⁰ but no trial has tested all three main treatments together against each alone, and the reviews rate the evidence low to moderate at best.⁴¹⁴²

Connections

• ENT (Ear, Nose and Throat)
• Dizziness and Vertigo
• Vestibular Neuritis
• Benign Paroxysmal Positional Vertigo
• Vertigo and Ménière’s Disease
• Vestibular Migraine
• Concussion
• Anxiety
• Panic Disorder

Key Research Papers

1. Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017;27(4):191-208. PubMed PMID: 29036855
2. Horii A, Yagi C, Kimura A. Persistent postural-perceptual dizziness (PPPD): the most common cause of chronic dizziness. Jpn J Radiol. 2026 (online ahead of print). PubMed PMID: 42776447
3. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2018;18(1):5-13. PubMed PMID: 29208729
4. Bittar RS, Lins EM. Clinical characteristics of patients with persistent postural-perceptual dizziness. Braz J Otorhinolaryngol. 2015;81(3):276-82. PubMed PMID: 25382427
5. Park JH, Nguyen TT, Kim SH, et al. Clinical characteristics of persistent postural-perceptual dizziness and its visual subtype in Korean patients: A multicenter cross-sectional study. Brain Behav. 2024;14(2):e3389. PubMed PMID: 38391108
6. Habs M, Strobl R, Grill E, Dieterich M, Becker-Bense S. Primary or secondary chronic functional dizziness: does it make a difference? A DizzyReg study in 356 patients. J Neurol. 2020;267(Suppl 1):212-222. PubMed PMID: 32852579
7. Casani AP, Ducci N, Lazzerini F, Vernassa N, Bruschini L. Preceding Benign Paroxysmal Positional Vertigo as a Trigger for Persistent Postural-Perceptual Dizziness: Which Clinical Predictors? Audiol Res. 2023;13(6):942-951. PubMed PMID: 38131807
8. Waterston J, Chen L, Mahony K, Gencarelli J, Stuart G. Persistent Postural-Perceptual Dizziness: Precipitating Conditions, Co-morbidities and Treatment With Cognitive Behavioral Therapy. Front Neurol. 2021;12:795516. PubMed PMID: 35027907
9. Johnson B, Johnson N, Staab J, Esterov D. Prevalence and treatment outcomes of persistent postural-perceptual dizziness after traumatic brain injury. PM R. 2025;17(6):621-627. PubMed PMID: 39950553
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12. Trinidade A, Cabreira V, Goebel JA, Staab JP, Kaski D, Stone J. Predictors of persistent postural-perceptual dizziness (PPPD) and similar forms of chronic dizziness precipitated by peripheral vestibular disorders: a systematic review. J Neurol Neurosurg Psychiatry. 2023;94(11):904-915. PubMed PMID: 36941047
13. Cousins S, Cutfield NJ, Kaski D, et al. Visual dependency and dizziness after vestibular neuritis. PLoS One. 2014;9(9):e105426. PubMed PMID: 25233234
14. Cousins S, Kaski D, Cutfield N, et al. Predictors of clinical recovery from vestibular neuritis: a prospective study. Ann Clin Transl Neurol. 2017;4(5):340-346. PubMed PMID: 28491901
15. Webster KE, Harrington-Benton NA, Judd O, et al. Pharmacological interventions for persistent postural-perceptual dizziness (PPPD). Cochrane Database Syst Rev. 2023;3(3):CD015188. PubMed PMID: 36906836
16. Webster KE, Kamo T, Smith L, et al. Non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD). Cochrane Database Syst Rev. 2023;3(3):CD015333. PubMed PMID: 36912784
17. Kim HJ, Lee JO, Choi JY, Kim JS. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol. 2020;267(8):2252-2259. PubMed PMID: 32300888
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20. Söhsten E, Bittar RS, Staab JP. Posturographic profile of patients with persistent postural-perceptual dizziness on the sensory organization test. J Vestib Res. 2016;26(3):319-26. PubMed PMID: 27392836
21. Indovina I, Riccelli R, Chiarella G, et al. Role of the Insula and Vestibular System in Patients with Chronic Subjective Dizziness: An fMRI Study Using Sound-Evoked Vestibular Stimulation. Front Behav Neurosci. 2015;9:334. PubMed PMID: 26696853
22. De Vestel C, De Hertogh W, Van Rompaey V, Vereeck L. Comparison of Clinical Balance and Visual Dependence Tests in Patients With Chronic Dizziness With and Without Persistent Postural-Perceptual Dizziness: A Cross-Sectional Study. Front Neurol. 2022;13:880714. PubMed PMID: 35685740
23. Lee JO, Lee ES, Kim JS, et al. Altered brain function in persistent postural perceptual dizziness: A study on resting state functional connectivity. Hum Brain Mapp. 2018;39(8):3340-3353. PubMed PMID: 29656497
24. Riccelli R, Passamonti L, Toschi N, et al. Altered Insular and Occipital Responses to Simulated Vertical Self-Motion in Patients with Persistent Postural-Perceptual Dizziness. Front Neurol. 2017;8:529. PubMed PMID: 29089920
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27. Li K, Si L, Cui B, Ling X, Shen B, Yang X. Altered intra- and inter-network functional connectivity in patients with persistent postural-perceptual dizziness. Neuroimage Clin. 2020;26:102216. PubMed PMID: 32097864
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