Dizziness and vertigo are common symptoms following head injuries like a concussion. Although these symptoms often resolve, they can become persistent and debilitating for some patients. The most frustrating part for patients is the lack of visible findings on examination or magnetic resonance imaging (MRI) to verify their symptoms.
For those that have never heard of vertigo, it is the sensation or feeling of being off balance. A patient often feels like they are spinning, or describe the world as spinning around them.
Causes of vertigo and dizziness
There are three pairs of canals located behind the ears, which are responsible for the vestibular system. The vestibular system is critical for balance and coordination, and prevents us from falling.
These canals detect acceleration of our head in relation to body movements and gravity, and counter the movements by repositioning our eyes, neck and limbs to keep our body upright and stable.1 Head trauma or a concussion can impact and disrupt this system, which may cause symptoms of vertigo and dizziness.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a common cause of vertigo following head trauma. The impact and forces due to trauma can cause debris in the inner ear canals to break free. As a result, the free-floating debris moves around in the inner ear and produces symptoms of vertigo and dizziness by signaling to your brain that you are moving when you are not.2
The incidence of BPPV in the general population is less than 3 per cent; however, the number of incidences due to secondary causes such as following head trauma are unknown.3 Most cases involve the posterior canal, and up to 10 per cent involve the lateral canal3 – both of which are specific parts of the vestibular system.
BPPV, secondary to head trauma, often presents in both ears.3,4 In comparison, most cases of BPPV not due to head trauma present in only one ear.3,4 These subtle differences can make treatment following head injury complicated, but not impossible.
Treating BPPV in concussion patients
The good news for people with vertigo is that the condition is more responsive to conservative measures by an experienced health care provider than to medications. The most common therapy involves canalith-repositioning maneuvers.3 These therapeutic maneuvers hold the head and body in various sequential positions to move the debris out of the affected canal, and can effectively eliminate symptoms.
In one study of 26 patients with BPPV, 81 per cent showed complete or moderate relief of symptoms following canalith-repositioning techniques.5 For those experiencing vertigo or dizziness, even moderate relief can have a dramatic impact on patient quality of life.
At CCMI, our practitioners are trained to identify and treat BPPV. If you think your symptoms may be the result of BPPV or are experiencing vertigo, dizziness or headaches following a concussion, visit one of our clinics for an assessment.
 Taneja, M.K., Taneja, V. & Varshney, H. (2014). Post-traumatic vertigo. Indian Journal of Otolaryngology; 20:95-98.
 Fife, T.D. & Giza, G. (2013). Posttraumatic vertigo and dizziness. Journal of Neuro-otology; 33: 238-243.
 Balatsouras, D.G., Koukoutsis, G., Aspris, A., Fassolis, A., Moukos, A., Economou, N.C., & Katotomichelakis, M. (2017). Benign Paroxysmal Positional Vertigo Secondary to Mild Head Trauma. Annals of Otologuy, Rhinology & Laryngology. 2017, 126(1),54-60.
 Katsarkas. A. (1999). Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic. Acta Oto-Laryngologica, 119(7), 745-9.
 Bahadir, C., Diracoglu, D., Kurtulus, D., Garipoglu, I. (2009). Efficacy of canalith repositioning maneuvers for benign paroxysmal positional vertigo. Clinical Chiropractic, 12: 95-100.