Dizziness After Concussion or Head Injury

Dizziness is one of the most common symptoms following a concussion or mild traumatic brain injury (mTBI). It may occur immediately after the injury or develop days later as the brain and balance system recover.

Although most people improve within a few weeks, persistent dizziness should not be ignored. A specialist vestibular assessment can often identify the underlying cause and guide appropriate treatment.

Can a Concussion Cause Dizziness?

Yes. A concussion can affect multiple parts of the balance system, including:

• The inner ear (vestibular system)

• The brain's balance processing centres

• Vision

• Neck muscles and joints

• The autonomic nervous system

Sometimes more than one system is affected, meaning patients may have several causes of dizziness at the same time.

Symptoms of Post-Concussion Dizziness

Symptoms vary considerably but commonly include:

• Feeling off balance

• Vertigo (a spinning sensation)

• Lightheadedness

• Rocking or swaying sensations

• Motion sensitivity

• Visual motion intolerance

• Difficulty concentrating ("brain fog")

• Headaches

• Nausea

• Fatigue

• Neck pain

• Difficulty walking in busy environments

• Feeling worse when turning the head quickly

Many people notice that symptoms worsen when they are tired or under stress.

What Causes Dizziness After a Head Injury?

Several conditions may develop following concussion:

Benign Paroxysmal Positional Vertigo (BPPV) - BPPV is one of the most common causes of dizziness after head trauma. The injury can dislodge tiny calcium crystals within the inner ear, leading to brief episodes of spinning dizziness when lying down, rolling over in bed or looking upwards. Fortunately, BPPV is often highly treatable with repositioning manoeuvres.

Vestibular Concussion - The balance organs or balance nerves may be temporarily affected by the injury, resulting in persistent dizziness and imbalance during recovery.

Persistent Postural-Perceptual Dizziness (PPPD) - Some people develop persistent dizziness long after the original injury has healed.

Symptoms are often worse in:

• Supermarkets

• Crowds

• Busy visual environments

• Shopping centres

Visually Induced Dizziness - Following concussion, the brain may become overly reliant on visual information. This can make scrolling on phones, watching moving objects or walking through busy environments particularly uncomfortable.

Vestibular Migraine - Head injury may trigger vestibular migraine in susceptible individuals. Symptoms may include dizziness, headache, light sensitivity and motion intolerance.

Neck Related Dizziness - Concussions are frequently associated with neck injuries. Pain and dysfunction affecting the cervical spine can contribute to dizziness and imbalance.

Why Do I Feel Dizzy Months Later?

Although many people recover within weeks, some continue to experience symptoms because:

• An underlying vestibular disorder has not been diagnosed.

• The brain has not fully compensated for the injury.

• Visual dependence has developed.

• BPPV remains untreated.

• PPPD has developed.

• Vestibular rehabilitation has not yet been started.

Persistent symptoms do not necessarily mean permanent damage has occurred.

How Is Post-Concussion Dizziness Diagnosed?

A detailed clinical history is essential.

Assessment may include:

• Hearing tests

• Video Head Impulse Test (vHIT)

• Videonystagmography (VNG)

• Caloric testing

• Vestibular Evoked Myogenic Potentials (VEMP)

• Positional testing for BPPV

• Computerised Dynamic Posturography

• Balance and gait assessment

• Cervical screening where appropriate

These investigations help determine which part of the balance system has been affected.

Treatment

Treatment depends on the underlying diagnosis:

Vestibular Rehabilitation Therapy - Individualised exercises help retrain the brain and improve balance.

Treatment for BPPV - Canalith repositioning manoeuvres such as the Epley manoeuvre often resolve positional vertigo rapidly.

Visual Motion Desensitisation - Gradual exposure to visually challenging environments can reduce symptoms over time.

Neck Rehabilitation - Where appropriate, physiotherapy may help address cervical dysfunction contributing to dizziness.

Managing Vestibular Migraine - Lifestyle advice and medication may help reduce migraine-related symptoms.

Graduated Return to Activity - A gradual increase in physical and cognitive activity is often recommended as symptoms improve.

When Should I Seek Medical Advice?

You should seek assessment if:

• Dizziness persists for more than two to four weeks after a concussion.

• You experience vertigo when moving your head.

• You feel unsteady walking.

• Busy environments worsen your symptoms.

• You are struggling to return to work, school or sport.

Seek urgent medical attention if you experience:

• Worsening headaches

• Repeated vomiting

• Increasing confusion

• Weakness or numbness

• Difficulty speaking

• Loss of consciousness

• Seizures

• Double vision

How Can Northern Balance Clinic Help?

At Northern Balance Clinic, we provide comprehensive assessment of persistent dizziness following concussion and head injury.

Using advanced vestibular testing, we can identify conditions such as:

• Benign Paroxysmal Positional Vertigo (BPPV)

• Vestibular concussion

• Vestibular migraine

• Persistent Postural-Perceptual Dizziness (PPPD)

• Visually induced dizziness

• Bilateral vestibular loss

• Neck-related dizziness

By identifying the precise cause of your symptoms, we can recommend targeted treatment to support your recovery and help you return to normal activities with confidence.

Book an Assessment

If you are still experiencing dizziness, imbalance or motion sensitivity after a concussion or head injury, our specialist vestibular clinicians can provide a detailed assessment to determine the underlying cause and recommend the most appropriate treatment.