Persistent Postural-Perceptual Dizziness versus Vestibular Migraine: Clinical Overlap and Diagnostic Challenges

This is the authors' abstract. We don't add key points for this paper.

Persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM) are prevalent vestibular syndromes whose overlapping manifestations often confound their clinical presentation, differential diagnosis, and management. This review focuses on their conceptual definitions, diagnostic criteria, pathophysiological models, clinical presentation, assessment approaches, treatment implications, prognosis, and future perspectives. Both syndromes are characterized by similar symptoms including dizziness, disequilibrium, motion intolerance, visual intolerance, and spatial orientation difficulties, although temporal and symptomatic patterns, precipitating factors, migraine-related associations, and responses to postural or visual stimuli may help distinguish them. The current theoretical framework highlights dysfunctions in multisensory integrative processes and central vestibular networks, although their relative contribution is different in the two disorders. Thus, diagnosis relies primarily on a detailed history, including temporal progression of symptoms, associated features, and established classification criteria, along with pertinent bedside vestibular examination and selected objective tests to exclude alternative conditions and identify concomitant syndromes. PPPD and VM often coexist and an either/or approach may be inappropriate, and an approach focused on identifying the dominant syndrome while recognizing overlapping manifestations may be more helpful to clinicians. Future studies should aim at establishing biomarkers, standardized assessment procedures, consistent terminology, and longitudinal studies to develop clinical decision-making strategies for patients with complex presentations.