Dizziness After a Concussion: Causes and Treatment
Clifton Physical Therapy
Dizziness is one of the most common symptoms after a concussion. In fact, it is reported as the second most common concussion symptom after headache. For many people, it improves as the brain recovers. For others, dizziness can last for weeks or months and interfere with walking, driving, working, exercising, or everyday activities.
Dizziness after a concussion does not always mean the same thing. Some people feel as though the room is spinning, while others feel lightheaded, unsteady, or as though they are walking on a boat. The cause may involve the inner ear, vision, the brain's ability to process sensory information, blood pressure regulation, or a combination of these factors.
What Does Dizziness After a Concussion Feel Like?
People experience post-concussion dizziness in different ways. You may have vertigo, which creates the sensation that you or the room is spinning. Others experience lightheadedness, a feeling of being faint, or disequilibrium, which is more like being off balance without a spinning sensation. Common descriptions include:
Feeling like the room is spinning or moving
Feeling lightheaded or faint
Feeling unsteady when standing or walking
Feeling as though you are floating or on a boat
Difficulty walking in a straight line
Feeling disoriented
Feeling as though you might fall
Nausea or vomiting
Blurred or unstable vision when moving your head
Ringing in the ears or difficulty hearing
Certain movements or situations can make symptoms worse. Turning your head, getting out of bed, bending down, walking through a busy store, looking at moving objects, or riding in a car may trigger dizziness in some people.
Dizziness may begin immediately after the concussion, but it does not always. Some people notice it several days later, particularly when other symptoms, such as severe headaches, begin to settle.
Why Can a Concussion Cause Dizziness?
Your brain keeps you balanced by combining information from three major systems: your inner ears, your eyes, and sensors in your muscles and joints. The brainstem and cerebellum help process this information and coordinate your movements.
The vestibular system in the inner ear detects head movement and helps your brain understand where you are in space. Your eyes provide information about what is around you and how your body is moving relative to your surroundings. Proprioception provides information about the position and movement of your body.
Normally, these systems send information that matches. After a concussion, one or more of them may not work normally or the brain may have difficulty putting their signals together.
For example, your eyes may tell your brain that something is moving while your inner ear signals that you are standing still. When those messages do not match, the brain can have difficulty determining what is actually moving. This visual-vestibular mismatch can cause dizziness, nausea, disorientation, and motion sensitivity.
A concussion can also affect the vestibular system itself. Damage or disruption involving the inner ear, vestibular nerve, brainstem, or cerebellum can interfere with the signals needed for balance and spatial orientation. Importantly, some subtle vestibular injuries may not be visible on routine imaging.
What Causes Dizziness After a Concussion?
There is not one single cause of post-concussion dizziness. Research and clinical evaluations show that people can have central and peripheral vestibular problems at the same time, and different causes may overlap. Some of the more common causes include:
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV occurs when tiny calcium crystals in the inner ear become displaced and move into one of the semicircular canals. When you change your head position, the displaced particles can send abnormal movement signals to the brain.
After a concussion or other head injury, BPPV may cause brief episodes of spinning when you roll over in bed, sit up, bend down, or turn your head. Canalith repositioning techniques, such as the Epley maneuver, may be used when BPPV is confirmed.
Vestibular Dysfunction
A concussion can affect the inner-ear structures, vestibular nerve, or the brain pathways that process balance information. This may result in persistent dizziness, vertigo, imbalance, motion sensitivity, or difficulty keeping your vision clear while your head is moving.
Visual-Vestibular Problems
Your eyes and inner ears normally work together to keep your vision stable while you move. After a concussion, this coordination can become less efficient. Busy environments, scrolling on screens, driving, moving crowds, ceiling fans, or flickering sunlight may then provoke dizziness or nausea.
Blood Pressure and Autonomic Changes
Some people develop difficulty regulating blood pressure after a concussion. A drop in blood pressure when standing or sitting up can cause lightheadedness or a sensation of faintness. This is sometimes referred to as orthostatic intolerance or postural hypotension and should be evaluated by an appropriate healthcare professional.
Other Factors
Medications can sometimes contribute to dizziness, particularly drugs that affect blood pressure or blood sugar. Vision problems, sensory-processing difficulties, and other medical conditions may also contribute. Because several factors can occur together, persistent dizziness deserves a proper assessment rather than assuming that the concussion itself is the only explanation.
How Long Does Dizziness Last After a Concussion?
For many people, dizziness improves as the brain recovers. The source material you provided reports that about 90% of concussion patients stop feeling dizzy within one to two weeks, although other concussion symptoms may continue.
However, recovery varies. Some people continue to experience dizziness, imbalance, or motion sensitivity for several weeks or months. Persistent symptoms do not necessarily mean that the concussion caused permanent damage. They may indicate that a specific problem, such as BPPV, vestibular dysfunction, visual-vestibular problems, or difficulty with balance, has not yet been identified and treated.
If dizziness continues beyond the expected recovery period or interferes with normal activities, it is worth having the symptoms evaluated rather than simply waiting for them to disappear.
How Is Post-Concussion Dizziness Diagnosed?
There is no single test that explains every case of dizziness after a concussion. A healthcare professional will usually start by asking when the dizziness began, what it feels like, what movements trigger it, and whether you have other symptoms such as headaches, vision problems, nausea, hearing changes, or difficulty walking. The evaluation may include:
Balance and gait testing
Eye movement and visual tracking assessment
Vestibular testing
Head movement and gaze-stability testing
Positional testing for BPPV
Assessment of neck movement and symptoms
Blood pressure measurements when standing and sitting
Review of medications and other medical conditions
The goal is to determine whether the dizziness is coming primarily from the vestibular system, vision, the nervous system, the neck, blood pressure regulation, or more than one source.
How Is Dizziness After a Concussion Treated?
Treatment depends on what is causing the dizziness. There is no single exercise or medication that works for everyone.
Vestibular Rehabilitation
Vestibular rehabilitation therapy (VRT) is commonly used when dizziness is related to vestibular or balance dysfunction. A physical therapist evaluates the specific deficits and develops exercises to help the brain better process information from the eyes, inner ears, and body. Treatment may include:
Gaze stabilization exercises to improve vision during head movement
Habituation exercises to gradually reduce dizziness triggered by specific movements
Balance and coordination exercises
Walking and movement activities
Exercises that combine head, eye, and body movements
Research supports the use of vestibular rehabilitation for appropriately selected patients. A 2022 systematic review of randomized controlled trials found a statistically significant improvement in Dizziness Handicap Inventory scores in favor of vestibular rehabilitation, although the researchers noted substantial differences among the studies.
A 2023 systematic review and meta-analysis of six randomized controlled trials also found that vestibular rehabilitation produced a significant reduction in perceived dizziness, with a standardized mean difference of −0.33.
For people with persistent dizziness, neck pain, or headaches after concussion, individualized cervicovestibular rehabilitation may be particularly useful. Research has found that this type of rehabilitation can shorten the time to return to sport in appropriate patients.
Canalith Repositioning for BPPV
If testing confirms BPPV, a clinician may perform a canalith repositioning maneuver, such as the Epley maneuver, to move the displaced inner-ear crystals back to their normal location.
BPPV should be properly diagnosed before attempting repositioning exercises because the correct maneuver depends on which canal and side are affected.
Gradual Physical Activity
Complete inactivity is generally not the goal of concussion recovery. Once medically appropriate, gradual physical activity can be part of rehabilitation. Research has found that subthreshold aerobic exercise can improve concussion symptom scores, while individualized multimodal rehabilitation may provide additional benefits for people with persistent symptoms.
Your activity level should be based on your symptoms and recovery stage. If exercise consistently causes a significant increase in dizziness or other symptoms, discuss the response with your healthcare provider or physical therapist.
What Can You Do at Home for Dizziness?
While you are recovering, a few practical steps can make daily activities safer and more manageable:
Stay adequately hydrated.
Move slowly when getting out of bed or standing up.
Avoid sudden head movements if they trigger symptoms.
Keep walkways clear to reduce your risk of falling.
Use a handrail or sturdy support if you feel unsteady.
Take breaks when screens, busy environments, or prolonged activity worsen symptoms.
Get consistent sleep.
Follow your healthcare professional's recommendations for gradually returning to physical activity.
Do not change medications on your own if you suspect they are contributing to dizziness. Discuss this with the prescribing clinician.
When Should You See a Physical Therapist?
Consider an evaluation if dizziness continues, repeatedly returns, or makes it difficult to walk, exercise, work, drive, read, or participate in normal activities.
A physical therapist trained in vestibular rehabilitation can assess your balance, eye movements, gaze stability, head movement tolerance, walking, and other factors that may be contributing to your symptoms. Treatment can then focus on the specific problems identified during the evaluation rather than relying on a generic set of exercises.
You should seek urgent medical attention after a head injury if you develop worsening or severe headache, repeated vomiting, increasing confusion, unusual behavior, weakness or numbness, seizures, loss of consciousness, difficulty waking, or other rapidly worsening neurological symptoms. These symptoms require medical assessment rather than routine vestibular rehabilitation.
Our physical therapists at Clifton Physical Therapy can assess your balance and vestibular function and create a treatment plan based on your needs. Call (973) 241-1338 to schedule an evaluation.
Clifton Physical Therapy
✆ Phone (appointments): (973)-241-1338
Address: 1059 Bloomfield Ave, Clifton, NJ 07012
