Best Steps to Treating MDDS (Mal de Debarquement Syndrome)

Best Steps to Treat MDDS (Mal de Debarquement Syndrome)

Learn about what MDDS is, how it can be treated, and other resources to learn more about MDDS management. 

Diagnosis Criteria for Mal de Debarquement Syndrome

Criteria for the diagnosis of Mal de Débarquement syndrome

  1. Non-spinning vertigo characterized by an oscillatory perception (rocking, bobbing, or
    swaying) present continuously or for most of the day.
  2. Onset occurs within 48 hours after the end of exposure to passive motion.
  3. Symptoms temporarily reduce with exposure to passive motion.
  4. Symptoms continue for >48 hours. (More on this in the next section)
  5. Symptoms not better accounted for by another disease or disorder.

MDDS diagnostic criteria has changed slightly to include a spectrum of time someone has been experiencing symptoms. This has been designed to help those get a diagnosis and begin treatment sooner which is a great addition. Here they are: 

  • MdDS in evolution: symptoms are ongoing but the observation period has been less
    than 1 month
  • Transient MdDS: symptoms resolve at or before 1 month and the observation period
    extends at least to the resolution point
  • Persistent MdDS: symptoms last for more than 1 month

3PD vs MDDS: What are the Differences?

When searching for answers and finding a diagnosis, it can be tough to know which description fits best. You can also have more than one vestibular condition to make diagnosis more challenging. Dr. Madison talks with Vestibular Group fit Members the differences between Vestibular Migraine, PPPD, and MDDS as well as treatment considerations if you have a combination of diagnoses.  

In this blog we’ll briefly talk about some differences between 3PD (persistent postural perceptual disorder) and MDDS


  • People typically feel worse in car
  • Will typically feel worse with walking/movement
  • additional 3PD criteria can be found in this blog post here.


  • People usually feel better in car 
  • Will tend to feel worse with walking 

Non-Motion Triggered Mal de Debarquement Syndrome

If you’re searching for answers, you might come across non-motion triggered MDDS. This area of vestibular research and classification is still up for debate. Some think this is a different form of chronic dizziness, or vestibular migraine, or something else. Time will tell where this ends up! 

MDDS Treatment: Dai Protocol

A very popular protocol for MDDS treatment is the Dai protocol. A 2018 research study by Dai et al show that 75% of those undergoing treatment had significant improvement when followed for 1 year. This protocol involves a few important tests and equipment to follow and is best to be done with a provider knowledgeable in this protocol. If you’re in a place where a provider isn’t familiar, they can read research and implement the protocol with you.

More information on the Dai protocol can be found here

A great treatment tool for MDDS or other visual vertigo can be found here through 360 Neuro Health. Talk to your provider before using to find the best dosage and progressions. 

Mal de Debarquement Syndrome Treatment Continued

There are more treatment considerations than the Dai protocol. Medications such as SNRIs/SSRIs and benzodiazepines have been shown to be a beneficial part of treatment for some. 

Other factors to consider as part of treatment include:

  • sleep
  • diet
  • exercise
  • stress management
  • vestibular exercises/VRT
  • mindset
  • neuromodulation

Dr. Shin Beh goes into detail on MDDS and treatment in his book Disembark, check it out here as well as other great books Dr. Beh has written. 


Interested in learning more? Check out this other blog post on Mal de Debarquement Syndrome


Want to learn more about MDDS,  and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life?  Find out more at this link: https://thevertigodoctor.com/about-group/


Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

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