Dizziness and Vestibular Symptoms After Concussion
The room tilts when you stand up. Turning your head makes you feel like you’re on a boat. Busy places like the grocery store or a crowded hallway make you feel unsteady and nauseous. You’re not sure if you can trust your own balance anymore.
Post-concussion dizziness is one of the most debilitating symptoms patients experience, and it affects far more people than most realize. An estimated 30 to 65% of people who suffer a concussion develop vestibular symptoms. The good news is that targeted rehabilitation is highly effective, and the sooner you start, the faster you recover.
At Fredericton Family Chiropractic, Dr. Scott Brayall uses a combination of chiropractic care and vestibular rehabilitation to address the multiple causes of post-concussion dizziness.
What Post-Concussion Dizziness Feels Like
Dizziness after a concussion isn’t one thing. It takes many forms, and understanding what you’re feeling helps us understand what’s causing it. You might experience a spinning sensation (vertigo), especially with certain head positions. Maybe you feel unsteady or “off balance” when walking, or you get a sense that the floor is moving or tilting. Lightheadedness when standing up is common. You might feel sick in cars, elevators, or while scrolling on screens. Head movement might trigger nausea. Busy environments can feel completely overwhelming and disorienting. Walking in a straight line might feel harder than it should. You might have a sense that your balance just isn’t right even though you’re not falling. Dim lighting or uneven surfaces might make things worse.
These symptoms can range from mildly annoying to completely life-altering. Many patients reduce their activity, avoid driving, and withdraw from social situations because their dizziness makes daily life feel unsafe.
Three Sources of Dizziness After Concussion
Post-concussion dizziness is complex because it can come from multiple sources, and often it comes from more than one at the same time. Effective treatment requires identifying which systems are involved.
1. Vestibular Dizziness (Inner Ear)
Your vestibular system is a set of fluid-filled canals and sensors in your inner ear, and it’s your primary balance organ. A concussion can disrupt this system in several ways.
Benign Paroxysmal Positional Vertigo (BPPV) occurs when tiny calcium crystals in the inner ear become dislodged and float into the semicircular canals. This causes brief but intense spinning sensations triggered by specific head positions, things like rolling over in bed, looking up, or bending forward. BPPV is one of the most common causes of vertigo after concussion and is highly treatable with repositioning manoeuvres.
Central vestibular dysfunction occurs when the brain areas that process balance signals are affected by the concussion. This can cause persistent unsteadiness, motion sensitivity, and difficulty with visual-vestibular integration.
2. Cervicogenic Dizziness (The Neck)
This is the source of dizziness that’s most commonly overlooked, and most relevant to chiropractic care.
Your cervical spine contains a dense network of proprioceptors that tell your brain where your head is positioned and how it’s moving. These signals are critical for balance. When the cervical spine is injured during a concussion (which happens in the vast majority of cases), these proprioceptive signals become inaccurate.
Your brain then receives conflicting information. Your inner ear says one thing, your eyes say another, and your neck says something else entirely. This sensory mismatch creates dizziness, unsteadiness, and nausea.
Cervicogenic dizziness is a diagnosis of exclusion. It’s confirmed after vestibular pathology has been ruled out and cervical spine dysfunction has been identified. Clinical tests such as the head-neck differentiation test, cervical relocation test, and cervical torsion test help distinguish it from vestibular causes.
Research shows that cervicogenic symptoms increase from 7 to 69% in acute cases up to approximately 90% in patients with persistent post-concussion symptoms, making cervical spine assessment essential for anyone with ongoing dizziness.
3. Autonomic Dizziness
Concussions can disrupt the autonomic nervous system, which regulates blood pressure and heart rate. This can cause lightheadedness or dizziness when standing up (orthostatic intolerance), during physical exertion, or in hot environments. Autonomic dizziness often coexists with vestibular and cervicogenic causes.
Why Identifying the Source Matters
The treatment for each type of dizziness is different. BPPV is treated with specific repositioning manoeuvres. Central vestibular dysfunction is treated with vestibular rehabilitation exercises. Cervicogenic dizziness is treated with cervical spine mobilization, adjustments, and proprioceptive rehabilitation. Autonomic dizziness is managed with graded exercise and lifestyle strategies.
Many patients have been told to “wait it out” or have been treated for only one source when two or three are contributing. A thorough assessment that evaluates all potential sources is the first step toward effective treatment.
How We Treat Post-Concussion Dizziness
Chiropractic Care: Addressing Cervicogenic Dizziness
Gentle cervical spine mobilization and adjustments restore normal joint movement and improve the accuracy of proprioceptive signals from the neck. When your brain receives reliable information about head position, the sensory conflict that drives cervicogenic dizziness is reduced.
Research published in the British Journal of Sports Medicine found that a protocol addressing cervical dysfunction combined with vestibular therapy produced measurable improvements across multiple symptom systems. Patients who received combined cervical and vestibular rehabilitation were 3.91 times more likely to return to full activity within eight weeks compared to those who did not (Schneider et al., 2014).
A 2024 proof-of-concept trial also demonstrated that upper cervical mobilization increases parasympathetic activity, which supports more stable blood flow and autonomic regulation. Both of these contribute to reducing dizziness.
Vestibular Rehabilitation
For patients with vestibular-origin dizziness, we prescribe specific exercises designed to retrain the balance system. Vestibular rehabilitation is based on three key principles: adaptation (teaching the brain to recalibrate inaccurate vestibular signals), habituation (reducing sensitivity to movements that provoke dizziness), and substitution (training other systems to compensate for vestibular deficits).
Systematic reviews have consistently found that vestibular rehabilitation is effective for reducing dizziness, improving balance, and decreasing recovery time after concussion.
BPPV Management
If assessment reveals BPPV, we use evidence-based repositioning manoeuvres (such as the Epley manoeuvre) to return the displaced crystals to their correct position. This type of dizziness often resolves within one to three treatment sessions.
Exercises That Help
Gaze stabilization exercises involve focusing on a stationary target while moving your head side to side or up and down. This trains the vestibulo-ocular reflex to keep your vision stable during head movement. These exercises are the foundation of vestibular rehabilitation and are supported by multiple systematic reviews.
Habituation exercises use repeated, controlled exposure to movements or positions that provoke mild dizziness. Over time, your brain learns to tolerate these stimuli without triggering symptoms. This is particularly effective for motion sensitivity.
Balance training involves progressive balance challenges such as standing on one foot, standing on an unstable surface, or walking with head turns. These exercises force your brain to integrate vestibular, visual, and proprioceptive input more effectively.
Cervical proprioceptive training improves the accuracy of position sense from the neck. These include head repositioning drills (returning your head to a target position with eyes closed) and cervical joint position error training. Better proprioceptive accuracy means less sensory conflict and less dizziness.
Graded exposure to complex environments involves structured, progressive exposure to visually busy or motion-rich environments. This begins with simple stimuli in a controlled setting and gradually progresses to real-world situations like walking in a busy store.
When to Seek Care
If your dizziness hasn’t resolved within two weeks of a concussion, if you’re getting spinning sensations triggered by head position changes, if persistent unsteadiness is affecting your confidence walking, if you’re dealing with nausea or motion sickness that wasn’t there before the injury, if you’re avoiding activities because of dizziness, or if your dizziness gets worse in busy or visually complex environments, it’s time to get assessed.
Post-concussion dizziness is highly treatable when the source is correctly identified. Active rehabilitation produces significantly better outcomes than waiting.
Evidence and Sources
- Reneker JC et al. Sequencing and integration of cervical manual therapy and vestibulo-oculomotor therapy for concussion symptoms: retrospective analysis. International Journal of Sports Physical Therapy. 2021.
- Murray DA et al. Effectiveness of vestibular rehabilitation after concussion: a systematic review of randomised controlled trials. Journal of Clinical Medicine. 2022.
- Cheever K et al. The role of cervical symptoms in post-concussion management: a systematic review. Sports Medicine. 2021.
- Hides L et al. Autonomic nervous system and endocrine system response to upper or lower cervical spine mobilization in males with persistent post-concussion symptoms: a proof-of-concept trial. Journal of Manual & Manipulative Therapy. 2024.
- Reiley AS et al. How to diagnose cervicogenic dizziness. Archives of Physiotherapy. 2017.
- Alsalaheen BA et al. Vestibular rehabilitation as an early intervention in athletes who are post-concussion: a systematic review. International Journal of Sports Physical Therapy. 2023.
- Schneider KJ et al. Physical therapy evaluation and treatment after concussion/mild traumatic brain injury: clinical practice guidelines. Journal of Orthopaedic & Sports Physical Therapy. 2020.
- Schneider KJ et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. British Journal of Sports Medicine. 2014.