A concussion is a mild traumatic brain injury that occurs when the brain moves or twists inside the skull, often due to a bump, blow, or jolt to the head or body. This sudden movement can cause temporary disruption to brain function. Dizziness is a frequently reported symptom following a concussion, significantly affecting daily activities.
Understanding Concussion-Related Dizziness
Dizziness after a concussion stems from the brain’s altered ability to process balance and spatial orientation. The vestibular system, a complex network in the inner ear and brain, provides information about motion, head position, and spatial direction. A concussion can disrupt this system, leading to unsteadiness, lightheadedness, or a spinning sensation. This can also affect how the brain integrates visual information with inner ear signals, contributing to disorientation.
Post-concussion dizziness can involve vestibular system dysfunction, changes in blood flow, or neurotransmitter disruptions. While many cases resolve within days or weeks, persistent symptoms often indicate a specific balance system issue requiring targeted attention.
Why Lying Down Can Trigger Dizziness
Dizziness triggered or worsened by head position changes, such as lying down or rolling over, often points to Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a common cause of vertigo after a concussion. This condition occurs when tiny calcium carbonate crystals, called otoconia, dislodge from their normal location in the inner ear’s utricle.
Normally, otoconia help the brain sense linear movement and gravity. After a head injury, these crystals can migrate into one of the semicircular canals, fluid-filled tubes that detect rotational head movements. Once in the canals, displaced crystals interfere with normal fluid flow, sending confused signals about head movement. This mismatch between actual head position and inner ear signals results in brief, intense spinning sensations (vertigo) with specific positional changes.
When lying down, the gravitational pull on these displaced crystals shifts, causing them to move within the semicircular canal. This movement triggers spinning or unsteadiness. Positional dizziness can also occur when looking up or bending over.
Diagnosis and Treatment for Positional Dizziness
Diagnosing positional dizziness after a concussion involves a comprehensive evaluation by a medical professional. The Dix-Hallpike maneuver is a common diagnostic test: the healthcare provider rapidly moves a patient from sitting to lying with their head turned. Characteristic eye movements (nystagmus) and vertigo confirm BPPV and identify the affected ear and canal.
For treating BPPV, specific maneuvers reposition the displaced otoconia. The Epley maneuver is a widely used technique for posterior canal BPPV, involving controlled head and body movements to guide crystals back to the utricle. Other maneuvers, such as the Lempert (BBQ) Roll for lateral canal BPPV or Brandt-Daroff exercises, may be prescribed. These repositioning maneuvers are often performed by a trained physical therapist or other healthcare provider.
Vestibular rehabilitation therapy (VRT) is another treatment approach, especially if dizziness persists or if there are other balance issues. VRT involves tailored exercises that help the brain adapt to and compensate for altered signals from the vestibular system. These exercises include gaze stabilization, habituation exercises, and balance training, gradually improving stability and reducing dizziness. Professional medical evaluation ensures an accurate diagnosis and a personalized treatment plan.
Managing Recovery from Dizziness
Recovery from concussion-related dizziness varies among individuals; many experience improvement within days to weeks. For some, symptoms might linger longer, sometimes indicating post-concussion syndrome if they last beyond three months. Gradual return to activities and avoiding triggers are self-care strategies that support recovery. This includes limiting screen time, ensuring adequate rest, and maintaining a regular sleep schedule.
The brain needs time to heal and recalibrate. While complete rest is not always recommended, avoiding strenuous activities or those risking another head injury is advised, especially in the initial days. If dizziness persists beyond a few weeks or symptoms worsen, continued medical consultation is necessary. Healthcare providers can reassess the situation, identify underlying causes, and adjust the treatment plan for a smoother, more complete recovery.