Why am I Dizzy?
The most commonly related symptoms after a concussion are headache, dizziness, (1,2) postural disturbances/balance problems (1), and neck pain. Second only to headache, dizziness is present in upwards of 81% of concussions. (3,4)
In the presence of concussion, the sensation of dizziness could be caused from functional disturbances of the central nervous system, brain stem region in specific. (5,6) Additionally, the biomechanical forces experienced by an athlete during a concussive event are also capable of causing damage and dysfunction to the peripheral vestibular system in the inner ear, as well as the cervical spine. Injury to or dysfunction of any of these areas often times is sufficient enough to lead to a complaint of dizziness. (5)
In the presence of concussion and dizziness, the challenge of identifying the underlying cause and establishing an appropriate diagnosis becomes complicated. Currently, as standard practice, when performing an examination on a patient with a report of dizziness, a thorough history taking is considered as the “single most important element in reaching a correct diagnosis”. (7) The reporting of the patient’s symptoms is used to assist in determining what may be leading to the patient to report of sense of feeling dizzy. With the information gathered it then allows the physician to perform an exam that is more catered to that unique patient’s underlying cause vs performing a more generalized exam on every patient. This more comprehensive assessment will then ultimately lead to the physician arriving upon a treatment protocol that is targeted towards that individual patient.
Dizziness is often times used as a symptom descriptor for three main abnormal sensations: true vertigo (feeling of spinning), light-headedness, and feeling off-balance. In addition, there are a variety of triggers that are commonly associated with dizziness, often including eye, head, or body movements or environment triggers such as visual motion sensitivity. Given the diversity of sensations and activities that can lead to a patient with a subjective complaint of “I feel dizzy,” it is impossible to know precisely what is being experienced without additional questioning to further differentiate the meaning and triggers of the word dizzy.
I hope in this article you were able to get a better understanding of how complicated a subjective complaint of dizziness can be and the importance of finding a provider that is qualified and adequately trained to not only make an accurate diagnosis as to why you may be dizzy but also then know what to do for you whether that be in the form of actually treating you or just making the appropriate referral to a better suited provider. If you or someone you know are currently struggling with dizziness, click the contact us button at the top of this page and schedule a complimentary phone consult between you and the doctor to discuss how we may be able to help.
References:
1. Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, Collins MW, Lovell MR, Sparto PJ. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010 Jun;34(2):87-93. doi: 10.1097/NPT.0b013e3181dde568. PMID: 20588094.
2. Makdissi M, Darby D, Maruff P, Ugoni A, Brukner P, McCrory PR. Natural history of concussion in sport: markers of severity and implications for management. Am J Sports Med. 2010;38(3):464–71. doi: 10.1177/0363546509349491.
3. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med. 2011;39(11):2311–8. doi: 10.1177/0363546511410655.
4. Duhaime AC, Beckwith JG, Maerlender AC, McAllister TW, Crisco JJ, Duma SM, et al. Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: clinical article. J Neurosurg. 2012;117(6):1092–9. doi: 10.3171/2012.8.JNS112298.
5. Guskiewicz KM, Register-Mihalik JK. Postconcussive impairment differences across a multifaceted concussion assessment protocol. PM R. 2011;3(10 Suppl 2):S445–51. doi: 10.1016/j.pmrj.2011.08.009.
6. Lovell MR, Iverson GL, Collins MW, Podell K, Johnston KM, Pardini D, et al. Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale. Appl Neuropsychol. 2006;13(3):166–74. doi: 10.1207/s15324826an1303_4.
7. Al Saif A, Alsenany S. Sensitivity and specificity of the amer dizziness diagnostic scale (adds) for patients with vestibular disorders. J Phys Ther Sci. 2015;1:91–6. doi: 10.1589/jpts.27.91.