Why concussion causes dizziness
A blow to the head can displace inner ear crystals, causing BPPV; disrupt the brain's processing of balance signals; strain the neck, which contributes its own sense of position; and heighten sensitivity to motion and visual stimulation. Often more than one is involved, which is why post-concussion dizziness can be confusing and slow to settle.
What assessment finds
Positional tests identify BPPV, which is treated directly. Tests of gaze stability show whether the eyes can stay fixed while the head moves. Balance testing and neck assessment show what else is contributing. Screening symptoms identify anyone who needs medical review before rehabilitation.
What treatment involves
Repositioning manoeuvres if BPPV is present. Gaze stabilisation exercises, where you keep your eyes on a target while moving your head, progressed in speed and background complexity. Balance and walking exercises with head movement. Graded return to reading, screens and busy environments. Neck treatment where relevant. Advice on activity, work and, for athletes, a staged return to sport.
The evidence
Randomised trials in adolescents and adults with persistent dizziness after concussion show that vestibular rehabilitation increases the rate of medical clearance to return to sport and reduces symptoms compared with rest and standard advice. International concussion guidelines recommend vestibular rehabilitation for persistent symptoms beyond the first couple of weeks.
Timing
Rehabilitation usually starts once the acute symptoms of the first few days have settled and a doctor has assessed the injury. Persistent dizziness beyond two weeks is the usual trigger for referral.
At Omnia
Vestibular First at our Chiswick clinic assesses and treats post-concussion dizziness, working alongside your doctor, with manual therapy for the neck and tai chi for balance available in the same clinic.