Vestibular Rehabilitation

Dr. Lisa Brannigan

Dr. Deepak Kumar
AuD (Audiological Scientist)

Acute dizziness is a commonly-reported problem following concussion, so much so that there are multiple clinical definitions that include it as an identifying sign of post-concussion syndrome. However, it can be incredibly difficult to properly diagnose post-traumatic dizziness and vertigo.

80% of those who sustain a concussion frequently report vertigo in the first few days after a head injury, and it can often last up to a week or more. On the other hand, post-concussive dizziness can persist for weeks or months after the trauma, and even become a chronic problem in one out of five patients.

Dizziness is not just limited to the sensation of “spinning” either. Other symptoms and side effects might include: light-headedness; vertigo; motion sensitivity; balance dysfunction; feeling faint or blacking out; double vision and other eye symptoms after concussion; nausea and vomiting; and more.

Causes of dizziness after a concussion

The symptom of feeling dizzy after head trauma rarely occurs in isolation; instead multiple factors often contribute to the problem. There is much question over exactly what are the root causes of post-concussion dizziness, and each patient has unique experiences that must be considered.

Evaluation by a qualified healthcare provider is necessary to determine the cause of the prolonged nature of the symptoms. Formal vestibular assessment is absolutely required as it can help in determining cause. As with any medical condition, there may be more than one reason that a person experiences dizziness and vertigo.

Common triggers of post-concussion dizziness

Generally speaking, there are a variety of triggers or things that can that can bring about an episode of vertigo and dizziness. Some common triggers include:

  • Certain head movements
  • Medications
  • Anxiety and/or stress
  • Dehydration
  • Prolonged bed rest
  • Migraines
  • Certain patterns
  • Lights, especially flickering lights

Prolonged watching of screens can trigger dizziness in adolescents post concussion.  It is thought that these triggers are associated with eye movement and motion sensitivity, and the light from these screens may also lead to the onset of post-concussion symptoms—particularly if migrainous symptoms are prominent after the concussion.

These environmental triggers included:

  • Completing school work
  • Sports participation
  • Computer use
  • Riding in a car or bus
  • Watching TV or cinema movie
  • Looking at a striped or moving surface

It is important to speak with your healthcare provider for evaluation of your dizziness or vertigo so that an accurate diagnosis can be made and a list of avoidable triggers can be discussed and developed.

Prognosis and outcomes

Post-concussion syndrome prognosis depends on a variety of factors, however for most people, symptoms resolve within one year of the inciting injury. However, as we noted previously, dizziness can last for several years, ultimately disrupting patients’ lives. In fact, dizziness and vertigo have been linked to psychological distress, work-related disability and prolonged recovery duration for those with post-concussion syndrome.

Not surprisingly, other chronic symptoms that occur after a concussion (such as headaches or anxiety) have been associated with higher instances of vestibular and balance dysfunction. The type of head trauma also makes a difference in the outcomes experienced by patients; specifically, dizziness that stems from blast-induced injuries among military members has been shown to get worse over time.

Treatment of post-concussion syndrome dizziness and vertigo

The best treatment for symptoms after concussion starts with formal audio-vestibular assessment by a qualified and specially trained audiologist/audiological scientist. It is equally imperative that patients be evaluated for all symptoms after a concussion, in order to identify other possible causes of dizziness. Some treatment options to better manage post-traumatic vertigo and concussion-related dizziness include:

  • Physical and cognitive rest
  • Anti-vertigo or anti-nausea medications
  • Migraine-specific treatments (if migrainous vertigo is also suspected)
  • Minimizing other environmental triggers, such as screen time
  • Gradual activity increases
  • Canalith repositioning procedure- a manoeuvre used in cases where the gravity-sensing ear crystals have been dislodged during the precipitating injury.
  • Exercise based vestibular rehabilitation