Objectives <p>To differentiate the clinical presentations, triggering factors, and concomitant symptoms between primary (p-PPPD) and secondary (s-PPPD) forms of persistent postural–perceptual dizziness (PPPD), categorized based on whether PPPD onset was secondary to an organic disease. Statistical analysis was performed to compare the clinical characteristics of the s-PPPD and p-PPPD groups, determine statistically significant differences, and guide clinical diagnosis and treatment.</p> Methods <p>According to the 2017 international expert consensus diagnostic and exclusion criteria for PPPD, 232 PPPD patients admitted to the Vertigo Unit of Nanjing Brain Hospital between September 2020 and September 2023 were enrolled. These patients were divided into an s-PPPD group (<i>n</i> = 82) and a p-PPPD group (<i>n</i> = 150). Statistical analysis of concomitant symptoms was carefully performed based on detailed data collection for each patient, including gender, age, disease duration, dizziness characteristics (features and frequency), presence of concomitant symptoms (such as nausea/vomiting), and presence of anxiety.</p> Results <p>The male-to-female ratio was approximately 1:2. Compared to p-PPPD patients, s-PPPD patients exhibited a higher prevalence of concomitant symptoms, such as nausea/vomiting, photophobia/phonophobia. Notably, among male patients, those with s-PPPD demonstrated significantly more pronounced nausea and vomiting symptoms compared to those with p-PPPD.</p> Conclusions <p>Secondary PPPD (s-PPPD) patients present with more concomitant symptoms. Specifically, male s-PPPD patients have a significantly higher proportion of nausea and vomiting compared to female p-PPPD patients.</p>