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Health condition · Clinically reviewed

Post-concussion vestibular syndrome, when dizziness and imbalance outlast the head injury.

Persisting dizziness, unsteadiness and visual-motion problems after a head injury usually have identifiable causes - and most respond to targeted, active rehabilitation.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, Bárány Society criteria and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice, including vestibular rehabilitation and structured oculomotor assessment after concussion.

Key facts

Post-concussion vestibular syndrome at a glance.

The essentials, in plain English - what it is, why it has more than one cause, and how it is treated in the UK today.

  • What it is

    Dizziness, imbalance or visual-motion problems that persist after a head injury and trace back to the balance system - the inner ear, the brain’s eye-movement pathways, or both.

  • Often several causes

    Positional inner-ear vertigo (BPPV), vestibular injury, eye-movement dysfunction, neck-related dizziness, migraine-type symptoms and anxiety frequently sit together.

  • Typical pattern

    Spinning or rocking, unsteadiness, and blurred or swimming vision in busy places or on screens - usually worse with head movement.

  • Testing

    Bedside positional and eye-movement tests come first. Hearing and vestibular tests are done in an audiovestibular or ENT service when needed.

  • Core treatment

    Repositioning manoeuvres for BPPV and vestibular rehabilitation for the rest - both are active treatments, not rest.

  • Outlook

    Many people improve with targeted rehabilitation. Symptoms that are not settling deserve a specialist look rather than more waiting.

Why this guide matters

Dizziness after a head injury has causes worth finding.

“It’s just the concussion” is rarely the whole story. The three points below shape everything else on this page.

  • Several causes often coexist

    Positional inner-ear vertigo, vestibular injury, eye-movement dysfunction, neck-related dizziness, migraine-type symptoms and anxiety can all contribute at once - each needs its own answer.

  • Some causes are quickly treatable

    BPPV can often be resolved with a repositioning manoeuvre in a single visit. Finding it early avoids weeks of unnecessary symptoms.

  • Rest and avoidance backfire

    Prolonged rest and avoiding movement slow the brain’s adaptation. Structured, graded activity is the evidence-based route to recovery.

How the diagnosis is made

From first symptoms to a named cause.

The steps a UK clinician or audiovestibular service will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History of the injury

    What happened, when symptoms began, what triggers them, and whether there is hearing change, headache or neck pain.

  2. 02

    Assessing

    Positional testing

    Dix-Hallpike and supine roll tests look for the characteristic eye movements of BPPV after a head injury.

  3. 03

    Assessing

    Eye-movement and VOR examination

    Smooth pursuit, saccades, convergence and the vestibulo-ocular reflex - the eyes’ ability to stay fixed while the head moves.

  4. 04

    Confirming

    Balance, gait and neck

    Standing and walking tests, plus a neck examination to judge how much is coming from the cervical spine.

  5. 05

    Confirming

    Audiometry and vestibular tests

    Hearing tests, video head impulse testing and caloric testing in a specialist audiovestibular or ENT service.

  6. 06

    Planning

    Imaging only if red flags

    MRI is reserved for new neurological signs, unexplained progression or findings that do not fit an inner-ear cause.

  7. 07

    Planning

    A multi-factor plan

    Each contributor is named and treated - repositioning, rehabilitation, neck care, sleep, migraine and anxiety support.

Typical timeline: bedside answers at the first visit, specialist tests within weeks if needed.

Symptoms

What it actually feels like.

A mix of balance, visual and energy symptoms that flare with movement and busy surroundings. And the features that mean urgent review.

  • Spinning or rocking

    True vertigo, or a rocking, boat-like sensation - often brief and positional in BPPV, longer-lasting when the inner ear is injured.

  • Unsteadiness

    A feeling of being off balance when walking, turning or standing in the dark, sometimes with veering to one side.

  • Nausea

    Queasiness or sickness triggered by movement, travel or busy visual scenes.

  • Blurred or swimming vision

    Difficulty focusing during head movement, or discomfort in supermarkets, crowds and on scrolling screens.

  • Worse with head movement

    Rolling over in bed, looking up, bending down or turning quickly reliably brings symptoms on.

  • Tiredness

    The balance system works harder after injury, so fatigue builds quickly and late-day symptoms are common.

  • Brain fog

    Trouble concentrating or thinking clearly, often worse when dizziness or visual strain is at its peak.

  • Red flag - hearing or new signs

    Sudden hearing loss, double vision, facial weakness or speech change alongside dizziness needs urgent assessment.

Treatment

How it is treated in the UK.

Treat what is found: repositioning for BPPV, vestibular rehabilitation for the rest, and support for sleep, migraine, neck and anxiety alongside.

  • Canalith repositioning

    For BPPV - the Epley or Semont manoeuvre (posterior canal) or a roll manoeuvre (horizontal canal) moves displaced crystals out of the sensitive canal.

  • Gaze stabilisation

    Exercises that keep the eyes fixed on a target while the head moves, retraining the vestibulo-ocular reflex after inner-ear injury.

  • Habituation exercises

    Repeated, graded exposure to the movements that provoke symptoms so the brain gradually turns down its over-reaction.

  • Balance and gait retraining

    Progressive standing and walking tasks on firm and soft surfaces, with eyes open and closed, to rebuild confidence and stability.

  • Oculomotor and visual-motion work

    Pursuit, saccade and convergence exercises, and graded exposure to busy visual scenes and screens, guided by a vestibular or concussion physiotherapist.

  • Graded exercise and activity

    Gradual aerobic activity and return to normal routines - prolonged rest and avoidance tend to prolong dizziness rather than shorten it.

  • Neck treatment

    Manual therapy, posture and strengthening work when cervicogenic dizziness or neck pain is part of the picture.

  • Sleep, migraine, anxiety and medicines

    Treating sleep, migraine-type symptoms and anxiety helps recovery. Vestibular suppressants belong to short-term use only, as they slow compensation.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, international consensus criteria and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, ENT or audiovestibular clinician knows your injury and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Head injury: assessment and early management (NG232).

  • Patricios JS et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med 2023.

  • von Brevern M et al. Benign paroxysmal positional vertigo: diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 2015.

  • Staab JP et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD). Consensus document of the Bárány Society. J Vestib Res 2017.

  • Bhattacharyya N et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg 2017.

  • Hall CD et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline. J Neurol Phys Ther 2016.

Red flags

When dizziness needs urgent attention.

Most post-injury dizziness is managed with rehabilitation. These features are different - seek urgent help through 999, A&E or NHS 111 as appropriate.

  • Sudden hearing loss

    A rapid drop in hearing in one ear, with or without dizziness, needs urgent same-day or next-day ENT or audiology assessment.

  • Facial weakness

    A drooping face or new weakness alongside dizziness points to a neurological cause and needs emergency assessment.

  • Double vision

    New double vision that is not explained by known eye-movement dysfunction needs prompt medical review.

  • Speech change

    Slurred or altered speech, or new difficulty swallowing, alongside dizziness is an emergency.

  • Severe or worsening headache

    A sudden severe headache, or one that is escalating, especially with vomiting or drowsiness, needs urgent care.

  • Clear fluid from the ear or nose

    Watery discharge after a head injury can be cerebrospinal fluid from a skull-base injury and needs urgent assessment.

  • Severe neck pain with dizziness

    New severe neck pain with dizziness after trauma should prompt urgent review to exclude injury to the neck arteries.

  • Limb weakness or numbness

    New weakness, numbness or clumsiness on one side, or marked loss of coordination, warrants emergency assessment.

  • Symptoms getting worse

    Dizziness that is progressing instead of settling, or new confusion, seizures or repeated vomiting, needs same-day medical review.

Living with it

Recovery is active, and paced.

Four things that make the biggest difference day to day - keeping moving, protecting sleep, pacing busy visual settings and bringing others along.

A quiet reminder

Mild, brief symptom increases during exercises are expected.

Your clinician will tell you how much is acceptable. If symptoms are severe or worsening, stop and seek advice rather than pushing through.

  1. 01 Move

    Keep moving, don’t avoid

    Avoiding the movements that provoke dizziness feels sensible but slows recovery. Follow the graded exercises you have been given.

  2. 02 Rest

    Protect your sleep

    Regular sleep and wake times, and a calm hour before bed, make a real difference to dizziness and brain fog the next day.

  3. 03 Screens

    Pace busy visual environments

    Build up time on screens, in shops and in crowds in short, planned steps rather than long, symptom-provoking bursts.

  4. 04 Support

    Tell work and family what to expect

    Recovery can be uneven. Explaining that symptoms flare with fatigue and busy settings helps others support pacing.

Frequently asked

Everything we get asked about post-concussion dizziness.

Quick answers on causes, BPPV, scans, rest and medication.

  • What is post-concussion vestibular syndrome?

    It is a way of describing dizziness, imbalance and visual-motion problems that persist after a head injury and arise from the balance system. It is not a single disease - often several causes overlap, including positional inner-ear vertigo, vestibular injury, eye-movement dysfunction, neck-related dizziness and migraine-type symptoms.

  • Can a head injury cause BPPV?

    Yes. A blow to the head can dislodge the tiny crystals in the inner ear, which then move into a semicircular canal and cause brief spinning on changing head position. It is one of the most treatable causes of dizziness after injury, and canalith repositioning often helps quickly.

  • How is it different from post-concussion syndrome?

    Post-concussion syndrome describes the wider pattern of persisting symptoms such as headache, sleep change, mood and concentration problems. Post-concussion vestibular syndrome focuses on the dizziness, balance and visual-motion part, which has its own tests and its own rehabilitation.

  • Will I need an MRI scan?

    Usually not. Assessment for dizziness after a head injury relies mainly on history and bedside testing. MRI is kept for red flags such as new neurological signs, sudden hearing loss with other features, or symptoms that are getting worse or do not fit an inner-ear explanation.

  • Should I rest until the dizziness goes away?

    A short period of relative rest in the first days after injury is reasonable, but prolonged rest and avoiding movement tend to make dizziness last longer. Guided vestibular rehabilitation and gradual return to activity are the usual approach.

  • Are dizziness tablets a good long-term answer?

    No. Vestibular suppressant medicines can help severe spinning or sickness for a short time, but taking them for longer blunts the brain’s ability to adapt and can slow recovery. Rehabilitation, not medication, is what retrains the balance system.

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