A concussion results from a forceful impact or jolt to the head or body that causes the brain to move rapidly within the skull. This movement temporarily disrupts normal brain function, leading to a variety of symptoms, including vertigo or dizziness. Vertigo is the illusion of movement, often described as feeling like you or your surroundings are spinning, tilting, or swaying. Experiencing vertigo is frequent in the acute phase following a concussion, confirming a direct link between head trauma and balance system disruption.
The Primary Causes of Post-Concussion Vertigo
The onset of vertigo after a head injury signals a disturbance in the body’s balance system, which integrates input from the inner ear, eyes, and neck. Post-concussion vertigo is often categorized into three origins that determine the appropriate treatment. The most frequently identified cause is Benign Paroxysmal Positional Vertigo (BPPV).
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV occurs when the physical force of the trauma dislodges calcium carbonate crystals (otoconia) from their normal location in the inner ear’s utricle. The concussive force allows them to migrate into one of the semicircular canals. Once inside the canals, these displaced crystals respond inappropriately to gravity and head movements. This sends false signals to the brain that the head is spinning rapidly. BPPV symptoms are brief, intense episodes of spinning vertigo triggered by specific changes in head position, such as rolling over in bed or looking up.
Vestibular System Disruption
A concussion can damage the neural structures that process balance information, leading to instability. This dysfunction is divided into peripheral and central categories. Peripheral disruption involves the inner ear structures, including the vestibular nerve that transmits signals to the brain. Damage here results in a constant sense of imbalance or difficulty maintaining visual focus during head movements. Central vestibular disruption involves injury to the brain’s processing centers, such as the brainstem or cerebellum. This damage prevents the brain from correctly interpreting inner ear signals, leading to chronic unsteadiness and sensitivity to complex visual environments.
Cervicogenic Dizziness
Cervicogenic dizziness originates from the neck, which is often injured alongside a concussion due to the whiplash mechanism. The cervical spine contains proprioceptors, sensory receptors that inform the brain about head and neck position. When neck ligaments and muscles are strained, this proprioceptive input becomes corrupted. This faulty input creates a sensory mismatch, causing the brain to receive conflicting information from the eyes, inner ear, and neck. The resulting feeling is typically vague unsteadiness, disequilibrium, or “fuzziness,” rather than true spinning vertigo. This dizziness is often exacerbated by specific neck movements or when the neck is held in a strained position.
Assessing and Diagnosing the Source
Accurately identifying the specific cause of post-concussion vertigo is important because treatment differs significantly for each condition. Diagnosis begins with a clinical history to understand the nature and triggers of the dizziness, followed by a physical examination using specific tools.
Dix-Hallpike Maneuver
The Dix-Hallpike maneuver is the gold standard for detecting BPPV. During this test, the patient is quickly moved from a seated to a supine position with their head turned and extended. A positive result is the reproduction of spinning vertigo accompanied by upbeat-torsional nystagmus, an involuntary eye movement that confirms displaced crystals.
Videonystagmography (VNG)
To assess vestibular system disruption, Videonystagmography (VNG) is often employed. The VNG uses infrared goggles to record and analyze eye movements while the patient follows targets or is placed in various positions. The specific patterns of nystagmus observed help differentiate between a peripheral problem and a central nervous system issue.
Dynamic Posturography
Dynamic posturography, specifically the Sensory Organization Test (SOT), provides an objective measure of functional balance control. The patient stands on a force plate while visual and support surfaces are manipulated across six conditions. The resulting sway pattern helps determine the relative contribution of the three balance systems—vision, somatosensory/proprioception, and vestibular—to the patient’s instability. Abnormal scores in conditions isolating vestibular input suggest a vestibular disorder, while poor performance challenging proprioception may indicate a cervicogenic component.
Targeted Rehabilitation and Recovery
Treatment for post-concussion vertigo depends on the correct diagnosis and aims to address the underlying physiological problem.
BPPV Treatment
For BPPV, treatment involves Canalith Repositioning Maneuvers, such as the Epley maneuver. This procedure uses a sequence of precise head and body movements to mechanically guide the displaced otoconia out of the semicircular canal. The treatment is often effective, with many patients achieving symptom resolution in one or two sessions.
Vestibular Rehabilitation Therapy (VRT)
Vestibular system disruptions are managed through Vestibular Rehabilitation Therapy (VRT), an exercise-based program. Gaze stabilization exercises retrain the vestibulo-ocular reflex to keep vision clear during head movement. Habituation involves repeatedly exposing patients to controlled movements or visual environments that provoke dizziness, gradually desensitizing the brain. VRT also includes balance retraining on varying surfaces or with compromised visual input to encourage the brain to compensate for damaged inner ear function. This adaptation helps the brain prioritize reliable sensory information.
Cervicogenic Dizziness Therapy
Cervicogenic dizziness requires a physical therapy approach focusing on the neck structures. Treatment involves manual therapy techniques, such as joint mobilization, to restore normal movement and reduce muscle tension in the cervical spine. Cervical proprioception training teaches the patient to accurately sense their head position. These exercises help correct the faulty input causing disequilibrium and restore coordinated function between the neck and the balance centers.