Why Post-Concussion Headaches & Dizziness Persist (And How to Treat Them)

Why Headaches and Dizziness Can Persist

Importantly, clinical symptom recovery does not necessarily occur on the same timeline as underlying physiological recovery. Research using advanced fluid biomarkers and neuroimaging suggests that some neurobiological changes may persist beyond apparent clinical recovery, although these measures are not currently recommended for routine clinical decision-making (Tabor et al., 2023).

Persistent symptoms can also be influenced by cervical, vestibular, visual, autonomic, sleep, and psychological factors. This is why contemporary concussion management emphasizes identifying the specific physical contributors to an individual’s symptoms rather than treating persistent recovery as a single condition (Patricios et al., 2023).

When assessing persistent dizziness and headaches, clinical evaluation focuses on three primary physical contributors.

1. The Cervical Spine (Neck)

A force capable of producing a concussion places significant mechanical stress on the cervical spine. Rapid acceleration and deceleration during a mountain bike crash, ski fall, heavy tackle, or other impact can produce neck injuries alongside a concussion.
Cervical symptoms are common following a head impact, particularly among people who develop persistent issues. The upper neck contains a dense network of specialized sensory receptors that inform the brain of head position in space. When joints or soft tissues become stiff, inflamed, or guarded, altered positional signals sent to the brain can result in:

• • Cervicogenic Dizziness: A lightheaded, floating, or unsteady sensation of spatial disorientation.
  • Cervicogenic Headaches: Dull, aching pain originating at the base of the skull that radiates forward over the top of the head or behind the eyes.

2. The Visual and Vestibular Systems

Your sense of balance relies on constant coordination between your eyes (visual system), inner ear balance organs (vestibular system), and body joints (proprioception).

An impact can disrupt how the brain integrates signals across these sensory networks. When visual tracking and inner ear balance reflexes are out of sync, individuals often experience:

• • Visual Motion Sensitivity: Discomfort, fatigue, or heightened dizziness in busy visual environments like grocery stores or crowded spaces.
  • Ocular Motor Fatigue: Eye strain, difficulty focusing on screens, or trouble shifting gaze quickly between targets.
  • Gaze Instability: A sensation that the surrounding environment bounces, lags, or swims when turning the head.

3. Autonomic Nervous System Dysregulation

An impact can temporarily alter the autonomic nervous system, which subconsciously regulates heart rate, vascular tone, and blood pressure.

When autonomic control is altered, blood flow adjustments during changes in body position or physical exertion can lag, leading to:

• • Postural Lightheadedness: Feeling faint, dizzy, or lightheaded when standing up quickly.
  • Exercise Intolerance: A predictable spike in headache intensity or dizziness as soon as heart rate increases past a specific threshold.

The Value of Integrated, Collaborative Care

Addressing these interconnected systems requires a collaborative clinical evaluation:

• • Physiotherapy: Evaluates upper cervical spine joint mechanics, tissue irritability, and neck mobility to restore normal movement patterns.
  • Visual and Vestibular Screening: Assesses gaze stability and eye movement control to guide targeted, progressive tracking exercises.
  • Controlled Sub-Symptom Aerobic Conditioning: Uses objective gym equipment, such as stationary bikes or treadmills, to safely condition the autonomic nervous system without triggering symptom spikes.

Identifying the exact physical system driving your symptoms shifts recovery from passive waiting to structured, measurable progress.