Post-Concussion Dizziness: Symptoms, Causes, and Treatment
Sometimes after a concussion, things just don’t feel quite right. Maybe the ground seems to shift when you walk. Maybe turning your head too fast makes you nauseous. Maybe the grocery store has become your worst nightmare.
As a vestibular therapist, I specialize in treating these symptoms. And the first thing I want you to know is: what you're feeling is real, it's common, and in most cases, it gets better.
Let me walk you through what's happening in your body and what we can do about it.
Why Does a Concussion Make You Dizzy?
Dizziness is the second most common symptom after a concussion, right behind headache. But "dizziness" is actually a catch-all word that can mean very different things like spinning, floating, lightheadedness, feeling off-balance, or just a vague sense that something is "off." Understanding which type of dizziness you have is the first step toward fixing it.
Your balance system is incredibly complex. It relies on three sources of information working together:
Your inner ears (the vestibular organs), which detect head movement and gravity
Your eyes, which tell your brain where you are in space
Your body's sensors (proprioception), especially in your neck, feet, and joints
Your brain acts as the command center, constantly integrating all of this information to keep you upright and oriented. A concussion can disrupt any, or all, of these systems. That's why post-concussion dizziness can look so different from person to person.
The Most Common Causes of Post-Concussion Dizziness
1. Benign Paroxysmal Positional Vertigo (BPPV)
This is one of the most common, and most treatable, causes of dizziness after a head injury. It happens when tiny (microscopic) calcium carbonate crystals inside your inner ear get knocked loose by the impact and drift into one of the semicircular canals, where they don't belong. When you move your head in certain positions, like rolling over in bed, looking up, bending down… those crystals shift and send false signals to your brain, causing brief but intense spinning.
The good news? BPPV can often be fixed in just one or two visits using a simple, hands-on repositioning maneuver. No medication, no surgery, just guided head movements that move the crystals back where they belong. Studies show that nearly one in three concussion patients with persistent dizziness actually have BPPV, and many aren't diagnosed for weeks or even months after their injury. If your dizziness is triggered by specific head positions, make sure your provider tests for this.
2. Vestibulo-Ocular Reflex (VOR) Dysfunction
The vestibulo-ocular reflex is the system that keeps your vision stable when your head moves. Think about reading a street sign while walking… your head is bouncing, but the words stay clear. After a concussion, this reflex can become sluggish or inaccurate. The result? Blurry vision with head movement, difficulty reading, trouble following moving objects, and a general sense of dizziness during activity.
This is one of the hallmarks of the "vestibular subtype" of concussion, and it responds well to specific rehabilitation exercises designed to retrain this reflex.
3. Visual Motion Sensitivity
Some patients find that busy visual environments, scrolling on a phone, watching action movies, or walking through crowded spaces can trigger dizziness and nausea. This happens when the brain becomes overly reliant on visual information for balance and then gets overwhelmed by complex visual input. We call this visual motion sensitivity, and it's very common after concussion.
4. Balance and Gait Problems
Even without spinning or vertigo, many concussion patients feel unsteady on their feet. This can stem from disrupted communication between the vestibular system, the visual system, and the body's position sensors. You might notice it most when walking on uneven surfaces, in the dark, or in crowded environments.
The neck takes a hit during many concussions, especially whiplash-type injuries. Neck muscles and joints are packed with sensors that feed information to your balance system. When those structures are injured or tight, they can send garbled signals to the brain, contributing to dizziness and a sense of imbalance. This is why a good vestibular evaluation always includes a look at the neck.
What Does Vestibular Rehabilitation Actually Involve?
Vestibular rehabilitation therapy (VRT) is a specialized, exercise-based program designed to retrain your brain and body to process balance information correctly again. It's not a one-size-fits-all approach, so a good vestibular therapist will evaluate your specific deficits and build a program tailored to you. Research shows that customized programs lead to better outcomes than generic exercises.
Here's what a typical program might include:
Gaze stabilization exercises: These retrain the vestibulo-ocular reflex. You might practice keeping your eyes focused on a target while moving your head, starting slowly and gradually increasing speed and complexity.
Habituation exercises: If certain movements or environments trigger your symptoms, we use controlled, repeated exposure to those triggers. Over time, your brain learns to process those signals without overreacting. Think of it like building a tolerance.
Balance and gait training: We challenge your balance system in progressively harder ways — standing on foam, closing your eyes, walking with head turns — to rebuild your confidence and stability.
Canalith repositioning maneuvers: If BPPV is part of the picture, we use specific maneuvers (like the Epley maneuver) to move those displaced crystals out of the semicircular canal.
Cervical spine treatment: If the neck is contributing, manual therapy, stretching, and targeted strengthening can help quiet those faulty signals.
Home exercise program: Most of the work happens between visits. Expect to spend about 30 minutes a day on your exercises. Consistency is key.
Will It Make Me Feel Worse Before I Feel Better?
Honestly, sometimes, yes… temporarily. Some of the exercises are designed to provoke mild symptoms on purpose, because that's how the brain learns to recalibrate. It's a bit like learning any skill, you have to challenge yourself to make progress. But the symptoms should be manageable and short-lived. A skilled therapist will know how to dose the exercises so you're challenged but not overwhelmed.
How Long Does Recovery Take?
Most people with concussion-related dizziness see significant improvement within a few weeks of starting vestibular rehabilitation. For many, symptoms resolve within the first 7 to 10 days after the injury without any treatment at all. But for the 10 to 30 percent of patients whose dizziness persists beyond that window, targeted rehabilitation can make a real difference.
Recovery timelines vary depending on the severity of the injury, which systems are affected, and whether there are complicating factors like migraine, anxiety, or prior concussions. Some patients feel dramatically better after just a few sessions. Others need a longer course of treatment. The important thing is that progress should be measurable — if things aren't improving after several weeks of consistent therapy, it's worth reassessing the diagnosis and the treatment plan.
What About Medication?
Medications like meclizine or diazepam are sometimes prescribed for dizziness, but they work by suppressing the vestibular system which can actually slow down your brain's ability to compensate and recover. These medications may have a role in managing severe acute symptoms, but they are generally not recommended as a long-term solution. The goal of rehabilitation is to help your brain adapt, not to mask the signals it needs to learn from.
What Can You Do Right Now?
If you're dealing with post-concussion dizziness, here are a few practical steps:
Get evaluated properly. Make sure your provider tests for BPPV with a Dix-Hallpike test. Ask about a referral to a vestibular therapist, ideally one with specialized post-graduate training in vestibular rehabilitation.
Stay active within your limits. Complete rest beyond the first day or two is no longer recommended. Gentle activity such as walking, or light cycling can actually help your recovery, as long as it doesn't significantly worsen your symptoms.
Don't push through severe symptoms. There's a difference between mild provocation (which is therapeutic) and pushing yourself to the point of a major symptom flare. Learn to find that middle ground.
Be patient with yourself. Dizziness is invisible to others, which can make it isolating. It's okay to modify your environment by dimming the lights, taking breaks from screens, and avoiding overwhelming spaces while you begin to recover. But you don’t want to make these avoidance behaviors a long-term bandaid.
Know that recovery is the rule, not the exception. The vast majority of people with post-concussion dizziness get better, especially with the right treatment.
The Bottom Line
Post-concussion dizziness can be disorienting… literally and figuratively. But it is one of the most treatable aspects of concussion recovery. The key is getting an accurate diagnosis, starting targeted rehabilitation, and staying consistent with your program. Your brain is remarkably good at adapting and healing when given the right inputs.
If your world still feels like it's unstable or spinning weeks after your concussion, don't wait. Ask for help. A vestibular therapist can be the guide you need to get your feet, and your life, back on solid ground. If you want to learn more about how physical therapy can help, don't hesitate to reach out to StillPoint Balance & Dizziness. We serve patients across Austin, Texas and are happy to help you find care closer to home if you’re not in our area.
This information is intended for educational purposes and should not replace medical evaluation or diagnosis. If you are experiencing new or severe dizziness, consult a qualified healthcare professional.
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References
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The Efficacy of Vestibular Rehabilitation Therapy for Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Aljabri A, Halawani A, Ashqar A, Alageely O, Alhazzani A. The Journal of Head Trauma Rehabilitation. 2024 Mar-Apr 01;39(2):E59-E69. doi:10.1097/HTR.0000000000000882.
A Randomized Controlled Trial of Precision Vestibular Rehabilitation in Adolescents Following Concussion: Preliminary Findings. Kontos AP, Eagle SR, Mucha A, et al. The Journal of Pediatrics. 2021;239:193-199. doi:10.1016/j.jpeds.2021.08.032.
Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury (mTBI) (2021). Maj Thomas J. Bayuk DO, Amy O. Bowles MD, Lt Col Andrew W. Bursaw DO, et al. Department of Veterans Affairs.
