Why dizziness becomes chronic
After an inner ear infection, a bout of BPPV, a concussion or a vestibular migraine, the brain normally recalibrates over weeks. Sometimes it does not: the person avoids head movement because it provokes symptoms, the brain never gets the input it needs to adapt, and dizziness persists. In others, the nervous system becomes hypersensitive to motion and visual stimulation, a condition now called persistent postural-perceptual dizziness, or PPPD, which is one of the commonest causes of chronic dizziness and is often undiagnosed.
What vestibular rehabilitation does
Assessment first, to rule out ongoing BPPV, which can be fixed directly, and to identify the pattern. Then a programme of exercises that deliberately provoke mild dizziness in a controlled, graded way: eye and head movement exercises, balance tasks, and gradual exposure to the environments that trigger symptoms, such as supermarkets or screens. This retrains the brain to trust its balance signals again. For PPPD, this is combined with education and sometimes psychological approaches.
The evidence
Systematic reviews show vestibular rehabilitation reduces dizziness and improves balance and quality of life in chronic vestibular disorders, and it is recommended as first-line treatment. For PPPD, rehabilitation combined with education has the best evidence of any approach.
What to expect
Six to twelve weeks of home exercises, done daily, with reviews every one to two weeks. Symptoms often increase slightly at first as the exercises provoke them, then reduce. Improvement is gradual and depends on consistency.
When to see a doctor first
New dizziness with severe headache, double vision, difficulty speaking, weakness or numbness, or hearing loss needs urgent medical assessment. At Omnia in Chiswick, Vestibular First screens for these before treating.