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Dizziness After Head Injury: Exploring the Causes and Treatments

Woman putting hand on forehead because she has dizziness after head injury

If you are experiencing dizziness after a head injury, you are not alone. Between 30-65% of patients suffer from vertigo or imbalance at some point during recovery from a traumatic brain injury.

Most of the time, dizziness will fade on its own. If it doesn’t, however, there are therapies you can do to eliminate it.

In this article, we’ll discuss the most common causes of vertigo plus some exercises that can help treat it.

Common Causes of Dizziness After Head Injury

Not all dizziness after a head injury is identical. Some forms of dizziness will make you feel like the entire room is spinning (vertigo) while others cause you to lose your sense of balance.

Each type of dizziness has a different cause, and therefore requires specialized treatment. Some various causes of dizziness after head injury include:

  • Migraines and other headaches after brain injury.
  • Medications, such as blood pressure or anti-seizure drugs
  • Dehydration
  • Inner ear problems.
  • Pinched nerves in your neck
  • Damage to the cerebellum, the part of your brain responsible for balance.
  • Damage to the occipital lobe, the part of your brain that controls eye movement and vision.
  • Low blood pressure.

Of these causes, inner ear problems are perhaps the most common. In the next section, we will discuss the function of the inner ear and how it can affect your balance.

How Your Inner Ear Affects Your Balance

The inner ear is where part of the body’s vestibular system lies. It comprises two main parts: the semicircular canals and the otolith organs.

The semicircular canals are three, fluid-filled tubes lined with tiny hairs that monitor head motion. When you move your head, the fluid sloshes around and moves those hairs, which allows your brain to detect motion.

The otolith organs have a similar function, except they respond more to gravitational force. The crystals inside these organs detect when your body is moving up in an elevator, for example.

Sometimes after a head injury, the vestibular system becomes impaired. This can happen in three ways:

  • The crystals in your otolith organs can dislodge, which will throw off your balance. Doctors call this condition Benign Paroxysmal Positional Vertigo (BPPV)
  • The fluid in your inner ear can leak into your middle ear.
  • The nerve connecting the vestibular system to your brain can become damaged.

Damage to the brain regions responsible for balance will also cause dizziness.

Treating Dizziness After Brain Injury

To treat dizziness problems, you must address the root cause.

This means if low blood pressure or headaches are causing your dizziness, you’ll need to work with your doctor to get those under control. In addition, if your neck was injured in an accident, massage therapy may offer relief from vertigo.

Sometimes it’s difficult to tell where the dizziness is stemming from. Therefore, it is crucial to receive an examination from a vestibular specialist or physical therapist. They will perform a series of tests such as vision and balance tests to determine if your issues are stemming from the inner ear. Based on the results, the therapist will create a customized exercise plan to address your specific vestibular issue.

The following are a few treatments your therapist might recommend:

1. Gaze Stabilization Exercises

doctor holding finger up in front of woman's eyes to check if vision problems are causing her dizziness after head injury

The vestibular system plays an important role in vision. This relationship is seen most clearly in the vestibulo-ocular reflex. That reflex allows you to stay focused on an object even if your head is moving.

After a head injury, this reflex can become damaged, which will cause disorientation and dizziness.

Gaze stabilization exercises, also sometimes called eye exercises, were designed to restore that reflex. It involves several exercises of increasing difficulty. The following is a sample exercise:

  • Sit upright in a chair. When you can do the exercises for two minutes without getting dizzy, try them while standing.
  • Draw an X in the center of a piece of paper.
  • Hold the paper in your hand at arm’s length. Keep it at eye level.
  • While focusing your eyes on the X, turn your head side to side. Move as fast as you can without the X getting blurry.
  • Do this for 2 minutes or as long as you can handle.

To see the most improvement, you will need to practice the exercises several times per day. That’s because the more you exercise, the more you will activate neuroplasticity, which will allow your brain to re-establish a connection to your vestibular system.

2. Habituation Exercises

senior woman practicing balance exercises in exercise class

For patients who mostly experience dizziness during movement, a therapist may prescribe habituation exercises.

These exercises help reduce dizziness by exposing the person to the movement that triggers symptoms, such as picking something up off the ground. The goal is to build up a tolerance until those movements no longer affect you.

Your therapist will design the right exercise program that is equally challenging but manageable. Some examples of habituation exercises you might perform include:

  • Transitioning from a sitting position to laying flat on your back
  • Standing up and sitting back down again
  • While sitting up, bending forward until your head is between your knees

Like gaze stabilization exercises, the more you practice, the faster you will improve.

3. Epley Maneuver

The Epley maneuver was designed to move the crystals in your ear back into their proper place.

It involves moving the head into four positions and staying in each position for about thirty seconds.

A doctor or therapist must perform the Epley maneuver; you cannot do it on your own. It usually takes about fifteen minutes to complete and has an 80% cure rate.

If your doctor does not know how to do the Epley Maneuver, you can find a list of certified vestibular specialists here.

For a good demonstration of the Epley Maneuver, check out this video:

4. Brandt-Daroff Exercises

If the Epley Maneuver doesn’t work for you, the Brandt-Daroff exercises might.

Unlike the Epley, you can do these exercises on your own, though we always recommend having a therapist help you the first time.

Here’s how you do the Brandt-Daroff exercises:

  • Sit on the edge of your couch or bed.
  • Lie down on your left side. As you are going down, turn your head up at a 45-degree angle. Try to do both as quickly as possible.
  • Stay on your side, with your head looking up at 45 degrees, for 30 seconds.
  • Sit up straight for thirty seconds.
  • Repeat these steps on your right side.
  • Do five times on each side

Try to do these exercises at least twice a day. Here’s another video if you need to see the exercises in action:

5. Balance and Exertional Training

Finally, once your dizziness has improved enough, you can graduate to practicing balance exercises and cardio to improve your endurance.

This method is particularly useful for athletes with head injuries. The goal is to slowly build up the person’s stamina to the level it was before their injury.

It is important to challenge yourself during training, but not to overdo it. If you notice your concussion symptoms flaring up while exercising, take a break. Pushing yourself too hard can cause a setback.

But if you can strike the right balance between exertion and fatigue, your brain can begin to repair itself and you should notice your dizziness symptoms fading.

Overcoming Dizziness After Head Injury

Dizziness after a head injury is typically a temporary problem. If it does not resolve on its own, there are still other options available to you.

The best thing you can do is schedule a visit with a vestibular specialist who can determine the cause of your vertigo.

If there are no specialists near you, your physical therapists should be familiar with all the exercises in this article. Therefore, make sure to ask them if they can help you eliminate your dizzy spells.

With the right exercises and maneuvers, it’s possible to overcome dizziness and find your balance again.

Featured Image: ©iStock/AntonioGuillem

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