REFERENCE · RECOVERY TECHNIQUE

Making a Plan for Flares and Changing Dizziness

When this may fit: When stronger periods of familiar dizziness disrupt daily life and you need a clear plan for support, activity and reassessment. [Clinical self-management and care planning; standalone efficacy untested]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For the Person With FND

A flare is easier to navigate when you do not have to make every decision while dizzy. The purpose of a written plan is to carry some of that work for you and the people helping you.

What counts as a PPPD flare?

PPPD involves symptoms on most days for at least three months. A flare is an increase above your usual pattern, not a separate brief diagnosis of PPPD. Symptoms can vary, but a new blackout, hearing change or neurological symptom should not be folded into the old explanation automatically. [1]

Build a small plan with your team

Part of the plan	What to record
My familiar pattern	The usual sensations, situations and way symptoms tend to settle.
What makes the situation safe	Seating, mobility aid, help with transfers, safe transport and a way to stop hazardous activity.
What remains manageable	An easier activity or position if useful; permission to pause practice if none is safe.
Other conditions	The existing migraine, ear, orthostatic or medication plan and who to contact.
How to restart	The last repeatable task and how you will decide it is appropriate to try again.
When this is different	Specific signs needing urgent help or a routine reassessment.

Keep the plan where you can find it, in a readable or spoken format. A supporter can help with your permission. It does not need a diary of every symptom or a perfect explanation of every trigger.

Returning to activity

Start from what is manageable now rather than trying to catch up. A smaller dose may be useful, but no minimum exercise amount applies during every flare. Repeated prolonged setbacks call for review of the task, illness contributors and practical demands. The relapse-planning component appears in rehabilitation packages; this template is an educational adaptation, not a validated prevention tool. [2][3]

If the usual plan no longer works

Seek review when falls increase, everyday function progressively declines, equipment needs change or the pattern no longer resembles the one assessed. Bring the plan and a few examples of what changed. Continuing disability deserves practical help even when a different treatment is not immediately available.

A setback does not erase what you learned or prove that you did too little. The plan is meant to support you, not grade you.

When to stop and seek assessment

Stop unsafe activity. Sudden or distinctly different dizziness with new weakness, double vision, speech trouble, inability to walk, severe headache, fainting or chest pain needs urgent assessment. Sudden hearing loss, head injury or persistent vomiting also needs prompt medical attention. Increasing falls or progressive loss of function warrants reassessment. Existing PPPD does not explain every new symptom. See the diagnostic and differential-assessment page.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Family, Friends, and Other Supporters

Know where the plan is and agree who to contact. Help with safety and essential tasks without adding exercises during the episode. Do not treat new symptoms as familiar simply because the person has PPPD, and do not turn each familiar flare into an argument about effort.

During a familiar flare, follow the agreed support and safety plan. Ask before taking over. New or substantially different symptoms need their own assessment; an exercise should never delay that care.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

Co-create thresholds for familiar fluctuations, clinical review and emergency care. Account for falls, hearing change, acute vestibular syndromes, orthostatic events, medicine changes and coexisting illness. Define an optional reduced activity plan rather than a compulsory minimum dose. Review caregiver needs, transport and access when symptoms persist.

Agree an accessible next step and review point. Consider meaningful activity, safety, access, effort and delayed effects alongside dizziness severity. Limited improvement is not grounds to withdraw assistance or infer lack of effort.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Research and Sources

This page expands original entry 13, Relapse plan. Examples and practical prompts are educational adaptations, not patient quotations or a reproduced treatment protocol. Original-entry numbering does not imply thirteen independently validated treatments.

Relapse management is one element of integrated rehabilitation, not a separately established method of preventing PPPD recurrence. Diagnostic criteria and individualized follow-up remain central. The template makes practical care explicit without promising that it will stop flares.

Citation	Source	What it supports and its limits	Figure
1	FND-CIT-0027 — Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research. 2017;27(4):191–208. DOI.	Diagnostic consensus; defines PPPD and differential assessment, not treatment efficacy.	—
2	FND-CIT-0192 — Herdman D, Norton S, Murdin L, Frost K, Pavlou M, Moss-Morris R. The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness. Journal of Neurology. 2022;269:4753–4763. DOI.	Small feasibility comparison of treatment packages; does not establish component efficacy or ACT benefit.	—
3	FND-CIT-0196 — Neurosymptoms.org. Functional Dizziness (PPPD). Specialist patient information. Accessed September 22, 2026.	Specialist explanation and treatment context; not a controlled treatment trial.	—

Sources checked: September 22, 2026 · Vestibular, neurological, lived-experience and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —