Understanding Concussion Vertigo: Causes and Treatment Options

Concussions come with symptoms that can show up immediately or gradually over time. Perhaps the most uncomfortable of all post-concussion symptoms is vertigo. Vertigo is a sensation that you’re spinning or the world is spinning around you. Think of the feeling you get after you get off a roller coaster or a spinny ride. This symptom can happen all at once or be a background symptom most of the time. Regardless of presentation, vertigo can quickly become disabling and affects quality of life in all areas. This article will outline the potential causes of post-concussion vertigo and available treatment options.

What Causes Concussion Vertigo?

Vertigo can stem from issues in the vestibular organ itself or from damage to an area of the brain called the cerebellum. Stress, preexisting migraine attacks, blood flow issues, and unmanaged anxiety can also contribute to concussion vertigo. Effective treatment is dependent on identifying the underlying cause. Understanding this condition is crucial as it affects balance and coordination and can significantly impact daily functioning. The following are common sources of post concussion vertigo. 

1. Damage to the Vestibular System

A concussion can cause the inner ear or vestibular system to malfunction, resulting in dizziness, vertigo, and balance problems. The vestibular organ senses rotational and translational movements (forward, backward, side to side) and gives you a perception of gravity. Damage to the organ (peripheral vertigo) and its ability to accurately send signals into the brain can be a primary cause of vertigo after a concussion.

2. Cerebellar Damage

The cerebellum sits behind the brain stem and regulates its activity. When errors occur, the cerebellum’s job is to correct them so you don’t perceive them. Because of the cerebellum’s anatomy, damage is typical following a concussion, especially those involving whiplash. Traditional vestibular exercises may not be the best approach if the cerebellum is damaged.

3. Migraine-associated Vertigo

If you’re already susceptible to migraine attacks, especially vestibular migraines, a concussion can make attacks more frequent and intense. The genetics of migraine make certain areas unstable during attacks, and post-concussion vestibular damage can further destabilize the vestibular system.

4. Blood Flow Changes and Dysautonomia

A concussion can temporarily alter blood circulation to critical areas of the brain that control balance and spatial orientation. Ongoing dysautonomia, which is characterized by an imbalance in the fight-or-flight/rest-and-digest systems, can alter blood flow to the vestibular organ. This affects the signals coming into the brain and can take a slight imbalance and make it big.

5: Anxiety

The feeling of vertigo produces stress hormones. These stress hormones can mimic anxiety or amplify preexisting anxiety. This stress response alters blood flow and snowballs into creating more anxiety. Managing the source of vertigo and adopting good coping habits are both ways to mitigate anxiety associated with concussion vertigo.

6. Post-Traumatic Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a condition in which tiny crystals in the inner ear are dislodged, leading to severe dizziness with changes in head positions. The crystals are part of the vestibular organ called the otolith, which senses translational movements. After a head injury, the crystals can fall into the vestibular organ and affect fluid movement, leading to vertigo. Repositioning maneuvers and vestibular re-calibration exercises are effective ways to reduce BPPV symptoms.

7. Cervicogenic Vertigo

Neck injuries that often accompany concussions can lead to dizziness and vertigo due to disrupted joint and muscle function in the cervical spine. This type of injury creates a mismatch between what the neck says and what the vestibular system says, creating central vertigo. Musculoskeletal therapies such as massage, chiropractic, or acupuncture effectively treat cervicogenic dizziness.

8: Visually Induced Vertigo 

Disruptions in the pathways that control eye movements are a common source of dizziness after a concussion. Because of the interplay between the eyes and the vestibular system, busy visual environments like grocery stores and large crowds can create a mismatch between what the eyes see and what the vestibular system senses, creating vertigo. This is another form of central vertigo. Treatment often involves a tandem of vision therapy and vestibular rehab.

Treatment Options for Concussion Vertigo

Addressing concussion vertigo involves a combination of therapeutic strategies and medical interventions tailored to the individual’s specific symptoms and severity:

1. Vestibular Rehabilitation Therapy (VRT)

Vestibular Rehabilitation Therapy (VRT) is a form of physical therapy specifically designed to address and alleviate the symptoms of post-concussion vertigo. This therapy focuses on strengthening the vestibular system to improve balance and spatial orientation. VRT is primarily effective for peripheral vertigo, which is a problem with the organ’s function. VRT includes maneuvers for BPPV and “habituation” exercises to help restore standard signals coming from the vestibular organ.

2. Manual Therapy

Cervicogenic vertigo often responds well to manual therapy. These types of therapy, which include chiropractic, acupuncture, massage, craniosacral therapy, and several others, aim to correct the signals the neck muscles and joints send into the brain. Suppose the neck alone is the source of the dizziness. In that case, manual therapy is an effective and fast method to treat post-concussion vertigo. Efficacy will hinge on ensuring the neck is the only source of vertigo, not combined with other potential sources like the eyes or autonomic system.

3. Vision Therapy

Specialized eye doctors usually perform vision therapy under their guidance. They will assess the function of your eye movements. They may prescribe prism lenses to temporarily help the eyes work together. Vision therapy exercises are performed over the course of several months to strengthen eye muscles and prevent long-term reliance on prism lenses.

4. Functional Neurology

Functional neurology is more effective in treating central vertigo. Central vertigo refers to either damage to the cerebellum or a combination of factors that all simultaneously contribute to vertigo. The goal of functional neurology is to integrate the eyes, vestibular system, and cervical spine together to ensure there are no mismatches between signals. Treatment often involves therapies for the eyes, neck, vestibular system, and autonomic system performed in a single rehab program. This form of treatment is often found after trying other forms of therapy, so early detection of multiple sources of concussion vertigo is crucial to ensuring a fast recovery.

5. Anxiety Management

Managing anxiety during concussion recovery can be an important step due to the effect vertigo has on the stress response. Vertigo attacks create fast and powerful productions of stress hormones, which can mimic the feeling of intense anxiety. When paired with preexisting anxiety, this stress output can amplify anxiety and make it debilitating. Proper management of underlying symptoms paired with emotional regulation techniques like CBT, meditation, deep breathing, and meditation work well to manage anxiety associated with concussion vertigo.

6. Gradual Return to Activity

Gradually returning to activities following post-concussion vertigo is essential for a safe recovery. It is important to start with light, non-strenuous activities and gradually increase the intensity as symptoms improve. Monitoring symptoms during the gradual return to activity is also important, as it helps in identifying any triggers or limitations, thus allowing for adjustments to the plan as needed. Additionally, open communication with employers, coaches, or instructors can facilitate a smooth transition back to work, sports, or academic activities while prioritizing the individual’s well-being.

Conclusion

Concussion vertigo can be disabling and challenging to treat without the appropriate diagnosis. Identifying all possible causes and working with a healthcare professional to choose the appropriate therapies is crucial to ensuring a complete and fast recovery. The big thing to remember is deciding whether it’s central or peripherally based. This means identifying if it is actually a real issue with the function of the organ (peripheral) or if it is a combination of variables happening all at once (central). Hopefully, this article will shed light on how to effectively navigate the complex world of concussion vertigo.

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*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients are advised to consult their medical provider or primary care physician before trying any remedies or therapies at home.