Vertigo After Concussion: Why It Happens and What Can Help
Vertigo and dizziness are common after a concussion, but not all post-concussion dizziness comes from the same problem.
You may feel like the room is spinning when you roll over in bed. You may feel dizzy when you move your head or walk through a busy environment. You may feel off-balance, visually overwhelmed, or lightheaded when you exercise.
And sometimes, you may have more than one of these problems at the same time.
One of the most important things to understand is that vertigo after a concussion isn't necessarily something you just have to wait out.
The first step is figuring out what is actually driving the dizziness so that treatment can be directed at the underlying problem.
Why Does a Concussion Cause Dizziness and Vertigo?
Your balance system is much more complicated than your inner ear alone.
Your brain constantly combines information from:
Your inner ears
Your eyes
Your neck
Your muscles and joints
Your brain's processing systems
Together, these systems tell your brain where your body is in space and how it is moving.
A concussion can disrupt the way these systems work together.
After a concussion, dizziness may come from a problem in the peripheral vestibular system, the central nervous system, the visual system, the neck, or a combination of several systems. Research reviews emphasize that post-concussion dizziness is heterogeneous, meaning there isn't one single cause or treatment that applies to everyone.
That's why simply treating "dizziness" isn't enough.
The goal is to figure out what is causing it.
BPPV Is a Common Cause of Vertigo After Concussion
One of the first things I want to rule out when someone develops true spinning vertigo after a concussion is BPPV, or benign paroxysmal positional vertigo.
BPPV occurs when tiny calcium carbonate crystals in the inner ear become displaced and move into one of the semicircular canals.
When you move your head, those crystals move and create an abnormal signal to the brain about your head position.
This can cause a sudden spinning sensation.
BPPV often causes vertigo when you:
Roll over in bed
Lie down
Sit up
Look up
Look down
Bend over
Turn your head
The spinning is usually brief and triggered by a particular position.
Head trauma is a recognized trigger for BPPV, making it particularly important to consider after a concussion. Post-concussive dizziness reviews also emphasize that BPPV can coexist with other vestibular and neurological problems.
How Do I Know If My Vertigo Is BPPV?
BPPV is more likely when your symptoms follow a very specific pattern:
You move your head into a particular position → the room spins → the spinning settles → you feel relatively normal until you move into that position again.
For example:
"Every time I roll onto my right side in bed, the room spins for about 20 seconds."
That's a very different pattern from:
"I feel dizzy all day, especially when I'm walking, exercising, looking at my phone, or moving through a grocery store."
Both people may describe themselves as "dizzy," but the underlying problem may be completely different.
A vestibular evaluation can help determine which pattern you're experiencing.
What If It Isn't BPPV?
This is where post-concussion dizziness gets more complicated.
BPPV is only one possible contributor. Other potential contributors include:
Vestibular dysfunction
The vestibular system may not be processing head movement and balance information normally after a concussion.
Visual dysfunction
Your eyes and brain may have difficulty working together during movement, focusing, tracking, or processing visually busy environments.
Vestibulo-ocular dysfunction
Your brain may have difficulty stabilizing your vision while your head is moving.
Neck dysfunction
The neck provides important information about head position and movement. Injury or dysfunction in the cervical spine can contribute to dizziness.
Autonomic dysfunction
Changes in the autonomic nervous system can contribute to lightheadedness, exercise intolerance, heart-rate changes, and feeling unwell with upright activity.
Vestibular migraine
Some people develop migraine-related dizziness or vertigo following a concussion.
Persistent postural-perceptual dizziness (PPPD)
Some people develop persistent dizziness or motion sensitivity that isn't explained by BPPV alone.
These conditions can also overlap.
That is one of the reasons post-concussion dizziness can be so frustrating: treating one contributor may improve part of the problem while another contributor continues to cause symptoms.
Can You Have BPPV and Other Post-Concussion Problems at the Same Time?
Absolutely.
This is an important distinction.
Imagine someone develops a concussion and then notices:
Spinning when rolling over in bed
Headaches
Sensitivity to busy environments
Dizziness when exercising
Difficulty focusing visually
The spinning when rolling over may be BPPV.
But BPPV wouldn't necessarily explain the exercise intolerance, visual sensitivity, or headaches.
In that situation, treating the BPPV may eliminate the positional spinning while other concussion-related problems still need to be addressed.
Post-concussive dizziness can involve both peripheral and central vestibular findings, and these conditions are not mutually exclusive.
This is why identifying the different contributors to your symptoms matters.
How Is Vertigo After Concussion Evaluated?
A good evaluation should go beyond simply asking, "Are you dizzy?"
A vestibular physical therapist may look at:
Positional testing for BPPV
Eye movements
Vestibulo-ocular function
Head movement tolerance
Balance
Walking
Visual motion sensitivity
Cervical spine function
Exercise tolerance
Symptoms with changes in position
The relationship between your symptoms and activity
The goal is to determine which systems are contributing to your symptoms and what needs to be treated.
Current reviews emphasize the importance of an individualized, mechanism-based assessment because post-concussion vestibular dysfunction is not a single condition with a single treatment.
How Is Vertigo After Concussion Treated?
Treatment depends on what is actually causing the dizziness.
If you have BPPV:
A canalith repositioning maneuver can be used to move the displaced crystals out of the semicircular canal.
If you have vestibular dysfunction:
Specific vestibular exercises can help your brain adapt to and better process movement and balance information.
If visual motion is contributing:
Treatment may include targeted visual and vestibulo-ocular exercises.
If your neck is contributing:
Cervical mobility, manual therapy, strengthening, and other appropriate interventions may be incorporated.
If autonomic dysfunction is contributing:
Your rehabilitation may need to include strategies targeting exercise tolerance and autonomic regulation.
If multiple systems are involved:
Treatment needs to address more than one piece of the puzzle.
Research supports targeted vestibular rehabilitation for people with persistent vestibular symptoms after mild traumatic brain injury, while newer reviews emphasize individualized assessment and treatment based on the specific dysfunctions identified.
Why Vestibular Rehabilitation Can Help After a Concussion
Vestibular rehabilitation isn't simply "balance exercises."
Depending on your symptoms, treatment may address:
Inner-ear dysfunction
Eye-head coordination
Motion sensitivity
Balance
Visual dependence
Walking
Head movement tolerance
Sensory integration
Exercise tolerance
The right exercises depend on what is actually impaired.
This is why I don't recommend simply searching for random "concussion vestibular exercises" online and doing all of them.
The right exercise can be incredibly powerful—but the exercise needs to match the problem you're trying to treat.
What If I Have Vertigo When I Lie Down After a Concussion?
If your primary symptom is brief spinning when lying down, rolling over, or changing head position, BPPV should be considered.
I've written a separate article specifically about this type of positional vertigo:
Vertigo When Lying Down? What It Means and How to Treat It
That article explains BPPV in more detail, including how the inner-ear crystals cause positional vertigo and how BPPV is treated.
If your vertigo is NOT related to a concussion, that article is also the better place to start.
What If My Dizziness Isn't Just Spinning?
This is an important distinction.
Post-concussion dizziness doesn't always feel like the room is spinning.
You may instead feel:
Lightheaded
Off-balance
"Floaty"
Unsteady
Like you're walking on a boat
Overwhelmed in grocery stores or crowds
Dizzy when exercising
Dizzy when looking at moving objects
Dizzy when moving your head
Worse when standing up
These symptoms can have different causes.
For example, autonomic dysfunction can contribute to dizziness and exercise intolerance after concussion, while visual or vestibular dysfunction can make movement and visually complex environments difficult.
If your symptoms don't sound like classic BPPV, don't assume that an Epley maneuver is the answer.
The more useful question is:
What system is contributing to my dizziness?
When Should You Get Evaluated for Post-Concussion Vertigo?
You don't need to wait months before having dizziness evaluated.
Consider getting assessed if:
Your dizziness is interfering with school or work
You can't exercise normally
You are avoiding activities because you feel unsteady
You have difficulty driving
You're struggling with busy environments
You experience repeated spinning episodes
Your symptoms are not improving
Your dizziness is interfering with sleep
You aren't sure whether your symptoms are BPPV or something else
Early identification of vestibular problems can help direct treatment rather than leaving you guessing about which exercises or strategies might help.
Can Vertigo After Concussion Go Away on Its Own?
Sometimes symptoms improve on their own.
But waiting isn't the only option.
If you're still experiencing dizziness or vertigo, the more useful approach is to determine what is contributing to the symptoms and address those factors.
This is particularly important because post-concussion dizziness can involve multiple systems, and different causes require different treatments.
You don't have to simply wait and hope your balance system figures itself out.
What Can I Do at Home?
While the right treatment depends on the cause, there are some general things you can do:
Keep moving
Avoid unnecessarily spending your day lying down or avoiding all activity. Appropriate movement and exercise are important parts of concussion recovery.
Pay attention to patterns
Notice whether your dizziness occurs with:
Position changes
Head movement
Exercise
Standing
Visual activity
Busy environments
These patterns can provide useful information about what's driving your symptoms.
Don't randomly perform BPPV maneuvers
If your symptoms aren't actually caused by BPPV, an Epley maneuver isn't going to address the underlying problem.
Get the right problem identified
This is often the most useful thing you can do.
The goal isn't to find a way to tolerate your dizziness. It's to figure out why you're dizzy and treat the contributing factors.
Can a Concussion Cause Long-Term Vestibular Problems?
Yes, some people continue to experience vestibular symptoms well after the initial injury.
Persistent symptoms don't necessarily mean that your brain is permanently damaged.
They may mean that one or more systems involved in balance, vision, movement, or autonomic regulation have not returned to normal function.
That distinction is important because many of these problems can be evaluated and treated.
Related Concussion Recovery Articles
If you're dealing with dizziness after a concussion, these articles may also help:
What Is a Concussion? Understanding What Happens to Your Brain
Learn what happens during a concussion, including the neurometabolic cascade and the brain's energy crisis.
Concussion Recovery Tips You Can Do at Home
Practical strategies you can use at home to support your recovery.
Post-Concussion Autonomic Dysfunction: Symptoms, Causes & What Helps
Learn how autonomic dysfunction can contribute to dizziness, exercise intolerance, and other persistent symptoms.
Why Does Exercise Make My Concussion Symptoms Worse?
Understand exercise intolerance and why the right exercise approach can be an important part of recovery.
Why Do I Still Have Concussion Symptoms Months Later?
Learn why concussion symptoms can persist and why identifying the factors contributing to them matters.
Looking for a More Structured Approach to Concussion Recovery?
If vertigo is only one of several symptoms you're experiencing after a concussion, treating the vestibular system alone may not be enough.
The Concussion Solution provides a structured approach to concussion recovery, with guidance addressing exercise, autonomic regulation, vestibular and visual systems, neck-related symptoms, sleep, and other factors that can contribute to persistent symptoms.
Learn More About The Concussion Solution
Looking for In-Person Concussion Care in Park City?
If you're in the Park City area and would prefer one-on-one concussion and vestibular physical therapy, Happy Brain Physical Therapy offers individualized care to identify what is contributing to your symptoms and create a targeted treatment plan.
Learn About In-Person Concussion Physical Therapy
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