People who experience a concussion or mild traumatic brain injury experience a wide variety of symptoms secondary to temporary dysfunction of the brain. Fortunately, for most people, these symptoms usually resolve in a few days to a few weeks. Those symptoms can last longer for others, particularly in cases where dizziness is experienced immediately after the concussion. When this occurs, it’s referred to as persistent post-concussive symptoms or post-concussion syndrome. Early evaluation of dizziness after concussion can help direct you to the proper care and prevent prolonged symptoms.
Concussion and Vertigo Symptoms
Concussion symptoms happen when the entire brain undergoes a temporary energy crisis and a decrease in blood flow, disrupting brain function. These symptoms can include:
- Headache
- Dizziness
- Neck pain
- Brain fog
- Fatigue
- Sensitivity to light or sound
- Difficulty concentrating
- Sleep disturbance
- Mood changes
- Problem with memory and learning
- Blurred vision
- Intolerance to busy visual environments
- Delayed reaction time
- Imbalance
- Nausea
Dizziness after concussion can be lightheadedness, vertigo, or unsteadiness, and these symptoms have different causes. Dizziness is caused by how the brain processes input from and output to your eyes, ears, and body; concurrent injury to your neck, inner ear, or visual system; post-traumatic migraines; or decreased tolerance to physical activity.
How long does the dizziness last after a concussion?
Without treatment, dizziness after a concussion could last anywhere from one to three months. However, dizziness can last much longer for those with persistent post-concussive symptoms. In some cases, dizziness is known to last up to a year or more.
The cause of dizziness can vary from one individual to another, so it is important to be evaluated to determine the cause of your dizziness. Below you will find some potential causes of persistent dizziness from the .
Benign Paroxsymal Positional Vertigo
Inside the inner ear, tiny carbonite crystals help us sense where in space our head is. Benign paroxysmal positional vertigo is when the crystals have shifted, disrupting the sense of motion in certain positions. Vertigo treatment includes maneuvers by a trained physical therapist who uses specific positions to relocate them and resolve your dizziness.
Cervicogenic Dizziness
This is related to an injury to the neck from the force of a concussion. When joint mobility gets disrupted, there is a mismatch of sensory input into the brainstem from the eyes, ears, and body that causes a processing error and dizziness. Cervicogenic dizziness is treated with manual therapy and exercises to restore mobility, flexibility, strength, and the ability to sense the body’s position, orientation, and movement. This is sometimes complicated by post-traumatic migraine headaches or migraine-associated dizziness. Concurrent treatment with medications along with identification and treatment of triggers such as sleep dysregulation, diet, activity changes, hormonal changes, and stress reduction can help.
Central Vestibular Dysfunction and Oculomotor Abnormalities
When the brain cannot properly process information to and from the eyes, ears, and body, dizziness can occur. This type of dizziness can be treated with vision and vestibular rehab. These exercises work the motor control and stability of the eyes with and without head movement and include activities for balance and motor control of the body.
Persistent Postural-Perceptual Dizziness
If vestibular problems are left untreated, they can lead to Persistent Postural-Perceptual Dizziness. This condition causes a dysfunction in the processing of space and motion in the brain. Functional imaging of the brain shows the decreased activity of the vestibular areas and hippocampus and increased function in the visual regions leading to visual dependence and difficulty with spatial navigation and balance. This can be treated by vestibular therapy and concurrent treatment with medication and cognitive-behavioral therapy.
Autonomic Dysfunction/Exertional Intolerance
Dysregulation of heart rate and blood pressure can lead to exercise or activity intolerance causing dizziness with position changes and activity. This can be treated with cardiovascular exercise and monitoring with gradual exercise progression until you reach your age-matched max heart rate or return to your functional baseline. Your exercise starting point is determined by your prior level of conditioning and graded symptom threshold during exercise.
Dizziness can be disruptive to normal daily activities, and resolving this symptom as soon as possible can help the brain and sensory processing system to heal faster and more completely.
What are the stages of a concussion?
A concussion should follow the typical healing time frames for injured tissues of the body and resolve within one to three months. If one is experiencing symptoms beyond one month, they should seek guidance from a physical therapist. If properly treated, people should be able to return to their normal level of activity, sport, school, work, and social engagement within a few weeks. However, one may experience while another may experience a quicker recovery.
Persistent Post Concussive Symptoms
Research is taking place to understand why symptoms sometimes persist. There is some evidence from studies to show that certain risk factors may predict prolonged recovery from a concussion, including:
- Dizziness at time of injury
- Number of symptoms
- Severity of symptoms
- Number of previous concussions
Other possible risk factors at the time of injury include:
- Females (particularly at certain times of the menstrual cycle)
- Adolescents (~10-19 years old)
- Brain reserve/general health
- Pre-injury headache or migraine conditions
- High activity level right away after an injury
- Genetics
- Pre-existing eye disorders
- Emotional reserve (coping skills, fear, negative expectation)
- Autoimmune disorders
Explanation for Quicker
While research is in place to understand persistent symptoms, it’s also taking place to understand why symptoms resolve quicker in some cases. Factors associated with improved outcomes include:
- Early treatment
- Early education
- Interpersonal qualities such as perceived competence, tenacity, tolerance of negative affect, and positive acceptance of change
Education on topics helpful for early brain healing include:
- Sleep hygiene
- Stress management (breathing exercises, mindfulness, cognitive-behavioral training)
- Positive thought patterns
- Proper exercise for your stage in healing
- Good dietary habits
- Fluid intake habits
Resting for more than 48 hours can slow down recovery, but it is important to have guidance in your return to activity, as too much too soon can also slow healing. Your healthcare team will create a plan that helps resolve symptoms and follows a return to play/school guidelines. Working with a licensed physical therapist to set clear goals and celebrate your accomplishments as you progress can be helpful in your recovery.
A physical therapist will listen to your unique symptoms, examine those symptoms, and determine the unique cause of dizziness in your case. This will expedite your recovery and give you the resources to get back to life.
See related: Dizziness After COVID
Physical therapy can help
While post concussion dizziness can be a common symptom, it doesn’t mean it should go untreated. If you have experienced a concussion or know someone who has, ask for a referral to Physical Therapy. Physical Therapists will educate and walk you through your recovery from concussion. They will use vestibular rehabilitation, exercise, hands-on treatment for your neck, and coordinate with other health team members to resolve issues with your eyes, how you are coping with the injury, and your cognitive function.
No concussion is the same, and an evaluation by a Physical Therapist is vital to determine what areas contribute to your symptoms and get you on the right path to recovery as soon as possible to get back to the life you want. Visit our website to request an appointment online at the location near you.
Article By: Stephanie Osborn, PT, DPT, OCS, COMT
Stephanie began her physical therapy career 13 years ago. Stephanie loves working with patients after concussion and brain injury and believes in encouraging resilience after injury and providing comprehensive and holistic care. She specializes in manual therapy, vestibular, concussion, oncology, and gender health. Stephanie enjoys working with patients with concussions to reach their goals for a full recovery. Stephanie currently treats patients at Ivy Rehab Physical Therapy in Grand Haven, MI.
