Persistent postural-perceptual dizziness versus vestibular migraine: A narrative review.

OBJECTIVE

This article reviews the differences and similarities between persistent postural-perceptual dizziness (PPPD) and vestibular migraine.

BACKGROUND

PPPD is considered a chronic functional vestibular disorder characterized by persistent dizziness, unsteadiness, nonspinning vertigo, and often exacerbated by upright posture, movement, or complex visual stimuli. Frequently misdiagnosed, PPPD shares overlapping features with vestibular migraine (VM), a common cause of episodic vertigo.

METHODS

A literature search was conducted covering articles published from January 2000 to March 2025 with a special focus on recent publications that discuss both PPPD and VM.

RESULTS

Although some propose that PPPD is a chronic form of VM, its historical classification as a functional disorder, distinct from the neurological basis of migraine, may suggest otherwise. This review explores PPPD's diagnostic criteria, pathophysiology, and the differential diagnosis of VM, emphasizing the importance of identifying migraine symptoms to guide treatment. Evidence supports migraine prevention and specifically flunarizine as a primary preventive treatment for VM, with emerging data on calcitonin gene-related peptide-targeted treatments showing promise. For PPPD, however, vestibular rehabilitation therapy is a cornerstone treatment.

CONCLUSION

A multidisciplinary approach addressing both conditions is critical for optimal patient outcomes. Studies on comorbid migraine treatment in patients with PPPD are warranted and may reveal distinct phenotypes within the same disease spectrum.