Post Concussion Syndrome
Dizziness
Call time on Dizziness post concussion
Test and Treatments.
Symptoms of
Dizziness in Concussion Syndrome
Acute dizziness is a commonly-reported problem following concussion whilst a chronic dizziness or vertigo is a symptom that can remain and be life changing. For the purpose of this page we will use dizziness to describe and include, vertigo, light-headedness, motion sensitivity, wobbly or simply mis-match of visual and balance that is experienced or can be objectively measured by the VOMS protocol.​
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Evidence has suggested that up to 80% of those who sustain a concussion frequently report dizziness/vertigo in the first few days, and 25% of concussion sufferers experience the dizziness persist for months after the trauma, some reporting symptoms for 2 to 5 years or even longer.
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Dizziness is not just limited to the sensation of “spinning” either. Other symptoms and side effects might include balance dysfunction; feeling faint or blacking out; double vision and other eye symptoms after concussion; nausea and vomiting; and more. The multiple co-inhabiting symptoms is boune out of the close interaction of the vestibular and ocular neural networks. The connection from the middle ear (source of our balance / gyroscopic mechanism) to the brain follows a network of cranial nerves where the visual and vestibular network co-exist. This is essential to co-ordinate what we see with a real world orientation. Vestibular and Ocular Proprioception.
Causes of dizziness after a concussion
The symptom of feeling dizzy after head trauma rarely occurs in isolation; instead multiple factors often contribute to the problem.
Causes are believed to be,
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migraine or vestibular migraine
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central vestibular system damage
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central nervous system dysfunction
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accompanying neck or whiplash injury
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labyrinthine concussion (damage to the inner ear)
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Evaluation by a qualified healthcare provider is necessary to determine the cause of the prolonged nature of the symptoms. As with any medical condition, there may be more than one reason that a person experiences dizziness and vertigo.
Common triggers of post-concussion dizziness
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Certain head movements
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Medications
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Anxiety and/or stress
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Dehydration
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Prolonged bed rest
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Migraines
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Certain patterns
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Lights, especially flickering lights
In addition, a recent observational study noted that computer screens and television triggered dizziness in half of adolescents who had endured a sports-related concussion; this is an anecdote that has been reported by numerous patients in clinic and online social communities.
It is thought that these triggers are associated with eye movement and motion sensitivity, and the light from these screens may also lead to the onset of post-concussion symptoms—particularly if migraine symptoms are prominent after the concussion.
Another study found that younger children with a diagnosis of concussion are more susceptible to visually-induced dizziness. These environmental triggers included:
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Completing school work
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Sports participation
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Computer use
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Riding in a car or bus
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Watching TV or cinema movie
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Looking at a striped or moving surface​
It is important to speak with your healthcare provider for evaluation of your dizziness so that an accurate diagnosis can be made and a list of avoidable triggers can be discussed and developed.
Prognosis & outcomes
Post-concussion syndrome prognosis depends on a variety of factors, however for most people, symptoms resolve within one year of the inciting injury. However, as we noted previously, dizziness can last for several years, ultimately disrupting patients’ lives. In fact, dizziness and vertigo have been linked to psychological distress, work-related disability and prolonged recovery duration for those with post-concussion syndrome.
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​Not surprisingly, other chronic symptoms that occur after a concussion (such as headaches or anxiety) have been associated with higher instances of vestibular and balance dysfunction. The type of head trauma also makes a difference in the outcomes experienced by patients; specifically, dizziness that stems from blast-induced injuries among military members has been shown to get worse over time.
Treatment of post-concussion syndrome dizziness & vertigo
It is imperative that patients be evaluated for all symptoms after a concussion, in order to identify other possible causes of dizziness. Some treatment options to better manage post-traumatic vertigo and concussion-related dizziness include:
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Physical and cognitive rest followed by a multi-sensory modulated return to activity. VOM modulated exercise program (VOM-MEP)
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Anti-vertigo or anti-nausea medications
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Migraine-specific treatments (if migraine vertigo is also suspected)
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Minimizing other environmental triggers, such as screen time or Blue/Violet Light Glasses.
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Gradual activity increases with a multi-sensory pulsed reintroduction
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Canalith repositioning procedure- a physical therapy maneuver used in cases where the gravity-sensing ear crystals have been dislodged during the precipitating injury.
