In the US, 44 million children and 170 million adults participate in sports, and there are approximately 3.8 million sports-related concussions annually [Mullally, 2017; Bramley, 2016]. Concussions are the mildest form of traumatic brain injury; it is a transient functional disorder caused by direct trauma, rapid acceleration-deceleration of the head, or blast forces. Post-concussion syndrome has been reported to occur in 30% to 80% of concussed individuals; this wide variation may reflect different reporting standards, as well as comorbid psychiatric and medicolegal issues. While it typically resolves within 3 months, post-concussion syndrome may persist in about 20% of concussed individuals.

Headache and dizziness are very common symptoms in concussion and post-concussive syndrome. Other symptoms include light and sound sensitivity, nausea, tinnitus, cognitive dysfunction (mental fog), problems with visual focus, sleep changes, depression, anxiety, and irritability. Dizziness may be due to direct CNS effects of the trauma (causing axonal injury and other microstructural damage), vestibular migraine, persistent postural-perceptual dizziness (PPPD), and neuropsychiatric disorders (e.g. anxiety, depression, post-traumatic stress disorder) [Fife, 2015]. Post-traumatic benign paroxysmal positional vertigo is not uncommon in concussion, but other post-traumatic injuries to the peripheral vestibular apparatus (e. g. perilymph fistula, otolithic injury, labyrinthine concussion) are rarely encountered.

It is very important to be evaluated by a physician familiar with concussions and vestibular disorders to help determine the cause of dizziness or vertigo after a head injury.


References

Bramley H, Hong J, Zacko C, et al. Mild traumatic brain injury and post-concussion syndrome: treatment and related sequela for persistent symptomatic disease. Sports Meds Arthrosc. 2016;24:123-129

Fife TD, Kalra D. Persistent vertigo and dizziness after mild traumatic brain injury. Ann Acad NY Sci. 2015;1343:97-105

Mullally WJ. Concussion. Am J Med. 2017;130:885-892