The cause of persistent postural-perceptual dizziness (PPPD) is considered to be chronic dysfunction of the regulatory system for maintaining equilibrium in general and that of the vestibular system in particular, which causes a persistent sensation of dizziness and/or unsteadiness. The pathogenetic mechanisms of PPPD are associated with impaired adaptation to an acute vertigo or unsteadiness episode due to various causes (vestibular, lipothymic, or emotional). Patients severely experience PPPD, which often leads to avoidant behavior and even disability. The timely diagnosis of this disorder and the use of right treatment, including vestibular rehabilitation, antidepressants, and cognitive behavioral therapy, are of great importance. Currently developed new treatments for PPPD are highly therapeutically effective. Among the medicines, Ginkgo biloba extract has been shown to be effective in improving vestibular compensation.

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Introduction. Dizziness and headache are among the most frequent complaints in neurological practice, which significantly reduce the quality of life of patients, so the development of effective methods of managing patients with persistent postural perceptual vertigo (PPPD) and migraine is an urgent task.Objective. To study and optimize typical management practices of patients with PPPD and migraine.Materials and methods. Twenty-two patients aged 39.3 ± 10.2 years with PPPD and migraine according to the diagnostic criteria of the Classification of Vestibular Disorders of the Barany Society were examined. During the study we used Hospital Anxiety and Depression scale, Beck Depression Inventory, State-Trait Anxiety Inventory, clinical otoneurological examination, otoneurological questionnaire, Dizziness Handicap Inventory, videonystagmography. After the diagnosis was made, the patients were prescribed a complex treatment. To relieve an acute attack of vertigo, dimenhydrinate was prescribed, as well as the combined drug cinnarizine 20 mg + dimenhydrinate 40 mg Arlevert, which in a number of studies showed high efficacy and good tolerability. One month later, the patients were examined in the dynamics.Results. Patients with PPPD had migraine without aura (54%), migraine with aura (14%), and vestibular migraine (32%). The level of anxiety was significantly higher in the group of patients with PPPD and vestibular migraine. There was moderate severity of dizziness in all groups of patients, after one month against the background of ongoing therapy severity of dizziness significantly decreased in all groups. Diagnoses “PPPD” and “vestibular migraine” were not set beforehand in any of the examined patients.Conclusions. The study showed a low level of diagnosis of PPPD and vestibular migraine. Management of patients with PPPD and migraine requires a complex approach.

Persistent postural perceptual vertigo (PPPV) and vestibular migraine (VM) are common causes of vertigo. However, despite the typical clinical presentation of PPPV and VM, these diagnoses are rarely made, and dizziness is considered a consequence of other diseases, such as cerebrovascular disorders (chronic cerebral ischemia, vertebrobasilar insufficiency), cervical spine instability, or the manifestation of vegetative dystonia syndrome. This article describes a clinical case of a patient with PPPV and VM. The diagnosis is based on the clinical presentation matched with the diagnostic criteria and an in-depth examination using additional methods to rule out other causes of dizziness. Current evidence on clinical and instrumental diagnostics of the disorders is presented.

Persistent postural perceptual dizziness (PPPD) is the most common cause of vague chronic vertigo and severely limits patients' quality of life.Limited data are available on comorbidities, the typical treatment of patients with PPPD, and the efficacy of combination therapy for PPPD.Objective: to identify comorbid disorders and evaluate the efficacy of complex therapy in patients with PPPD.Material and methods. Sixty patients (mean age 42.5±13.8 years) with PPPD were studied. All patients were prescribed complex treatment that included antidepressants (selective serotonin reuptake inhibitors), vestibular exercises, and an educational program. In 28 patients, Arlevert (combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as drug therapy. A clinical otoneurologic examination, videonystagmography, assessments by Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Spielberger State-Trait Anxiety Inventory (STAI), Dizziness Handicap Inventory (DHI) and otoneurologic examination were performed at baseline and at the end of treatment (mean, one month).Results. All patients had previous misdiagnoses, among which vertebrobasilar insufficiency and chronic cerebral ischemia predominated. Thirty two (53.33%) patients with PPPD had anxiety-depressive disorders (ADD) as the main comorbidity, 20 (33.33%) patients had migraine, 8 (13.33%) patients had previously had peripheral vestibular disorders that were not diagnosed. The severity of dizziness according to the otoneurological questionnaire and the DHI decreased after one month of therapy in the group with PPPD and ADD from 44.00±16.80 to 29.6±12.80 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 49.20±14.04 to 31.60±17.69 points (p<0.001), in the group with PPPD and migraine – from 43.58±16.28 to 28.50±7.20 points (p<0.001). The severity of anxiety and depression according to BAI decreased in the group with PPPD and ADD from 30.00±6.99 to 16.12±4.16 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 28.40±8.35 to 16.60±4.62 points (p<0.001), in the group with PPPD and migraine – from 24.11±3.80 to 14.26±3.43 points (p<0.001). The severity of depression according to BDI decreased in the group with PPPD and ADD from 9.62±5.26 to 6.25±3.20 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 14.80±8.26 to 8.40±5.37 points (p<0.001), in the group with PPPD and migraine – from 11.32±5.10 to 6.53±3.44 points (p<0.001). The severity of anxiety according to HADS decreased in the group with PPPD and ADD from 13.75±3.20 to 9.25±2.43 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 12.40±5.77 to 7.80±3.83 points (p<0.001), in the group with PPPD and migraine – from 14.26±3.16 to 8.74±2.18 points (p<0.001).The severity of depression according to HADS decreased in the group with PPPD and ADD from 4.88±4.12 to 3.88±3.09 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 8.40±3.58 to 5.60±2.88 points (p<0.001), in the group with PPPD and migraine – from 5.74±3.11 to 3.47±2.32 points (p<0.001). Situational anxiety according to STAI decreased in the group with PPPD and ADD from 47.62±6.57 to 40.12±3.68 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 58.20±7.85 to 48.00±7.65 points (p<0.001), in the group with PPPD and migraine – from 46.26±7.01 to 35.68±5.11 points (p<0.001). Personal anxiety according to STAI decreased in the group with PPPD and ADD from 52.25±10.73 to 42.12±7.06 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 58.40±5.64 to 48.60±6.77 points (p<0.001), in the group with PPPD and migraine – from 53.32±8.78 to 40.63±5.60 points (p<0.001).Conclusion. Patients with PPPD are often misdiagnosed with cerebrovascular disease. The most common comorbid disorders in PPPD are anxiety disorders and migraine, and less commonly peripheral vestibular disorders. An integrated approach to the management of patients with PPPD, including treatment of comorbid disorders, is effective.