Persistent Postural Perceptual Dizziness: A Different Approach

Posted in Head Pain Disorders on Aug 29, 2022

Dizziness is a horrifically unpleasant symptom that affects approximately 20-30% of the population at some point in their lifetime. So if you may experience dizziness yourself and feel completely alone in your suffering, it is actually FAR more common than you may normally think. Dizziness is the sensation of perpetual imbalance, like trying to stand on a moving boat, which is quite different from the sensation of vertigo, which is like the world spinning around you. Although dizziness comes in many flavors including Meniere’s Disease, Cerviogenic Dizziness, Vestibular Migraines, Mal de Debarquement Syndrome, and Vestibular Neuritis (aka Labyrinthitis), there is another variety known as Persistent Postural Perceptual Dizziness.

Persistent Postural Perceptual Dizziness (PPPD) is pretty much exactly what it sounds like: chronic dizziness without any apparent cause. Because PPPD is commonly triggered by stress, in the past it was also described as being “psychogenic dizziness,” or a physical manifestation of mental stress.

From a medical perspective, PPPD is a conundrum because the way that the standard diagnosis-treatment model works is that in order to give a treatment, you have to first need to diagnose the condition. And the problem with PPPD is that it frequently slips between the cracks. As a consequence, people experiencing dizziness often go from specialist to specialist trying to give their condition a name but never reaching a consensus.

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Here is where we may advocate a different approach. In brief, whatever name you want to give it, whether persistent postural perceptual dizziness or something else, what is the underlying cause? Because if you can correct the underlying CAUSE, you don’t need to worry about TREATING THE EFFECTS because they should simply be able to dissolve on their own.

Persistent Postural Perceptual Dizziness is an Effect, NOT the CAUSE

Persistent postural perceptual dizziness is what is known as a “diagnosis of exclusion.” That is, your brain MRIs and inner ears all check out normal; and though you experience persistent dizziness you do not really fit into any particular box like Meniere’s disease, vestibular neuritis, or any other common syndrome. Some of the common medical treatments that have been shown to help include vestibular rehabilitation therapy, cognitive behavioral therapy, and medication such as serotonin reuptake inhibitors (SSRI). 

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Unfortunately for many people, these different therapies don’t have too much of an effect. And if/when people may be prescribed something stronger like Stematil or Serc, they often describe a sense of brain fog that may help with their balance (a little bit) but really not with their overall brain-body function. What this suggests is that symptoms such as persistent postural perceptual dizziness may not actually have a single underlying cause. Instead, there may be a series of factors at play, and so instead of searching for the ONE THING that solves it all, we instead need to identify the various pieces of the puzzle.

  • One piece may solve 20% of the puzzle.
  • Another piece may solve 30% of the puzzle
  • And a third piece may solve 50% of the puzzle.

The caveat here is that the percent breakdown may actually be quite different from person to person. Thus, there may not be a one size fits all solution. Indeed if there was, a syndrome like PPPD would be so much easier to solve. Nevertheless, for all the work and research that has been done for people with PPPD, there is one very important piece of the puzzle that has not really been discussed: It is the relationship between dizziness and your neck (cervical spine).

Indeed, the cervical spine has been found to play a massive role in the treatment of so many other vestibular conditions including Meniere’s disease, benign paroxysmal positional vertigo (BPPV) … and yet it really hasn’t been considered for people with persistent postural perceptual dizziness. We find this exceptionally strange! One way or another, we cannot help but wonder if proper care and maintenance of your neck health may be one of the missing pieces of the puzzle to help with PPPD.

Persistent Postural Perceptual Dizziness and Upper Cervical Specific Chiropractic Care

There are three broad categories of nerve receptors in your neck:

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  • Pain receptors
  • Proprioceptors (which regulate muscle tone); and 
  • Pressure receptors (which regulate physical movements).

These latter two receptors tie into the exact same processing centres in your brain that are responsible for balance and equilibrium. So yes, your brain MRI might look completely normal … but what about your neck?! Many people with persistent postural persistent dizziness and other balance disorders are told that yes, they do have arthritis or degeneration in their neck, but that is common and not related to their conditions. But do you remember what we said about RISK FACTORS?

While that might be a true statement that degeneration doesn’t cause dizziness, it can certainly be a RISK FACTOR that puts extra stress on the sensory nerve endings in your neck, and may thus contribute to the development of some type of brain-balance-body related condition. There is an especially dense population of these types of proprioceptors and pressure receptors involved in the area in your upper neck, which is also known as the upper cervical spine. The upper cervical spine is comprised of the top two vertebrae in your neck (called the atlas or C1, and the axis or C2), which have a special relationship in maintaining the structural integrity of your brainstem and spinal cord; and also in facilitating the flow of fluid to, from and within your brain.

Frequently, if/when people have problems with the alignment, motion, and/or stability of these vertebrae in the upper neck (even if they don’t have any broken bones or dislocations) they can experience a wide array of problems including balance disorders. Here then is where a unique form of healthcare known as the Blair upper cervical technique may be able to help.The Blair technique is part of a special division of general chiropractic known as upper cervical specific. Upper cervical specific is a collection of methods including the Atlas Orthogonal and NUCCA techniques that focus on the alignment of the atlas and axis because of their influence on brain-body-balance function. In other words, when there is a problem with your upper neck, it means that your brain and body are not as healthy as they otherwise should be.

Unlike general spinal manipulation, there is no twisting or cracking with the Blair procedures. The method includes first a series of diagnostic tests looking at your posture, muscle, and nerve function to identify if you may have a problem with your neck that could be affecting your balance; and then a series of precise, customised diagnostic images to identify the exact location, directions and degree of misalignment in your neck. With this information, a Blair upper cervical chiropractic doctor is able to make a recommendation and perform a series of corrections designed just for you in order to restore the alignment, motion, and stability through your upper neck by addressing the underlying cause. 

Thus, the purpose of upper cervical care is to allow the body to do what it is designed to do: heal itself. If you are looking for a natural approach to healthcare and have not yet seen an upper cervical-specific chiropractic doctor to help your persistent postural persistent dizziness, we would like to help you. Our practice is located in North Lakes (north Brisbane) and works with people from around southeast Queensland and interstate to improve their overall quality of life. Click the Contact Us link on the top of this page, or call us at 07 3188 9329 to schedule a no-obligation consultation to discuss your particular needs so that you can decide if upper cervical care is right for you.

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