Are you dizzy after a head injury? What is vestibular concussion?

Are you dizzy after a head injury? What is vestibular concussion?

Physical therapist Dr. Danit Macklin explains why you might feel dizzy after a concussion, what it means to have a vestibular concussion, what recovery can look like, and more!



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Danit Macklin, DPT 

Hi, I’m Dr. Danit Macklin. I’m a physical therapist specialized in vestibular and concussion rehab. And I’m really excited to talk to you today about concussions. So you just hit your head pretty hard, and you’re feeling dizzy. What just happened? Let’s talk about it. First of all, the brain has taken a hit, this hit is between the brain and the skull, that takes place inside the skull. This is why helmets don’t protect us from concussions, there are going to be different outcomes of the injury. Based on where the hit damage the brain, very frequently, people are hit on the side of their head, right here. That’s the temporal area, right by our ears. We have vestibular anatomy in our ears. And we have our vestibular system and the neurology of it, how is right here in the temporal area. So we can see how it’s very common for a concussion patient to have a similar symptoms, and have what might be referred to as the stimulator concussion. When the dizziness might be the primary concern, what’s going on acutely, immediately after an injury is that there’s what we call a metabolic cascade that takes place. Metabolism is how our body runs. And the brain has its own special metabolism. And it’s kind of picky about how things run up there. But it took a hit. So everything’s messed up, there’s increased energy requirements on this poor body part, because it’s responsible for healing itself. So that becomes an issue, because there’s less energy available, because it’s hurt. So at the end of the day, what we see very often, to me mimics what a cell phone does that drives us crazy. We are going to see after a concussion, difficulty sustaining energy, just like a phone that will not sustain a charge. And we will see that we have decreased connectivity. And that drives us crazy when we’re trying to send a text or an email, then we hit send, and we can’t get connectivity. But this is exactly what it looks like in our brain after the concussion. Because the highways those transmission lines are damaged. And it’s tired, and it’s really struggling. So just like a phone needs to be recharged frequently, when it can’t keep a charge. Keep that in mind after a concussion. Why is it so common for a concussion to be what we would refer to as a vestibular concussion, the temporal area of our head, and our brain is right near our ear. And inside our ears, is the anatomy of our vestibular system that really helps us understand where we are in space. And it communicates to the brain through this temporal area. That’s where its main centers are. So you can imagine how frequently a hit to the side of the head is going to cause dizziness. So what are the symptoms that you might be feeling after a vestibular concussion? Well, for one thing, you will probably be feeling dizziness, and difficulty balancing or frequent losses of balance. You could experience fogginess, and headaches, you could experience sleep disturbances, which could be sleeping a lot more, or sometimes a lot less. You can have noise sensitivity. And you may have problems with memory, and difficulty concentrating. Now your question is going to be what can I expect in terms of timing and progression after a concussion? How long is this injury going to last? So typically, what we’ll see in concussions, is that about 80 to 85% of the time, recovery will be spontaneous every day, they just feel a little bit better. And that’s great. Maybe there’s a setback here and there. But overall, every day, they’re getting a little better. And in people over 21, probably around the 10 day to two week mark, they’re really done, they feel fine. And for people under 21, who have really rapidly developing brains, that work of the brain slows down the recovery a little sometimes, and it might take four to six weeks for that gradual progression to feel a complete resolution. So that’s a good thing to keep in mind in terms of how to hit, maybe it’s gonna get better on its own. But it does sometimes take time. Sometimes people by the way, will feel better, like two days later, a day later. So it really it can still be a concussion and be resolved very quickly. And now let’s talk about it can be a concussion and it can last a lot longer than two weeks, a lot longer than six weeks. There are patients unfortunately that come in who have been having symptoms for very, very long periods of time. And treatment is still effective no matter how long it’s been since the injury. So how do you know if you’re in the group that’s recovering on your own, or if you’re in the group that isn’t recovering on their own vestibular patients, patients who present with dizziness, unfortunately, typically are going to fall into the second category. Dizziness is actually one of our prognostic indicators of potential for a longer recovery process. Typically, if you’re recovering on your own, you’re going to be getting better and better every day. So that may look like symptoms disappearing, you don’t have a headache anymore. Or it may be that you were only getting headaches in the morning. And now, you’re not getting headaches in the morning at all. Whereas if you’re getting headaches only in the morning, and then you start getting them in the afternoon, and then they become constant. Or if you only had headaches, and then you start having dizziness, and then you start having sleep issues. Also, that’s the wrong direction. If symptoms are worsening, if headaches that started in the morning, are now going on through the afternoon, or becoming constant. Or if the dizziness is worsening, or new symptoms are arising, this is an indication of the concussion not getting better. That means that you might be going into the chronic place. And it’s a really good idea to think about following up with a specialist is the emergency room the only place to go after you’ve had a concussion. So you’re probably thinking that you can definitely see your primary care physician, or in the case of a pediatric patient, the pediatrician. And that’s a great idea when someone gets hit in the head, and it’s bad enough that it’s a concussion, or even a concern for concussion during that acute period of time, so that immediate after injury, it’s a little bit of a judgment call for yourself if you’re the injured one, but more so for the people around you who know you. After all, if you’re the one who sustained the injury, you may not be in the best position to be making judgment calls. But you do want to use your judgment about whether or not you need to go to the emergency department. The concern that we’re looking for is neurologic changes. And those would be things like changes in memory, the person can’t remember what they just said, the mood is really different. easygoing person is feeling more intense, or vice versa, the physical balance could be off. But just generally being off to the people who know that person the best. So it’s never a bad idea to go to the emergency department, the worst thing you’re going to do is wait a long time. And it’s a great way to rule out a more serious injury, you may or may not undergo imaging at the emergency department, because they don’t image everyone as they shouldn’t. They’re going to take a history and do their protocol as to whether or not the mechanism of injury warrants imaging. Either way, if they diagnose a concussion, then typically what they’re going to say is follow up or go rest. So the emergency room, urgent care, primary physician, these are all great places to be seen after an injury. Don’t always need imaging. And think about the fact that for your providers, concussion can almost be a diagnosis of exclusion, that we have to rule out that these symptoms aren’t coming from something else, and they are coming from the head injury. How about for a chronic patient. So we talk about the fact that the majority of patients will recover from a concussion from this mild traumatic brain injury on their own. Something like 85% of people will just start feeling better right away the next day, the next day, and they just get better. People who don’t have that experience, people who are having worsening symptoms, or have significant symptoms that are not getting better. They need to start seeing specialists. But what I think is really important to understand is that it takes a team approach a brain, our brains are responsible for our whole body. So it makes a lot of sense that it’s going to take a team to evaluate and treat every part that may have sustained damage. So people who would be involved on the medical team would be the medical doctor that can be a neurologist, maybe a sports medicine doctor, and they have a huge role to play in diagnosing, often are prescribing medicine, and often are the quarterback of the team purely prescribing the patient who they should see next. Sometimes they’ll send patients to Audiology for testing. Typically not even though it’s called a vestibule or concussion, it would be a little bit unkind to put a concussed patient through the vestibular testing that we do for patients that are Dizzy without this type of injury. But audiology could be involved. For me as a doctor of physical therapy, I’m proud to say that physical therapists are a huge part of the recovery and the healing process. And we have so much to contribute. And that’s something that even many of my colleagues aren’t aware of. So we’re still trying to bring an awareness to that. And as I mentioned that I would like to just add in that, often, the provider you see, may not be the right provider, you might have to go through a few people, because not every provider treats concussions all the time. And concussion as an area of treatment, is going through a huge amount of research. So the treatments that we’re using, are actually sometimes changing even while we’re seeing our patients. And so you need to find the right specialist for you. And the wonderful news is that if you visit the Vita provides referral resources to find providers who are committed to the vestibular community, who are listed there because of their commitment to you to patients to trying to help you get the care you need. In addition, also provides social support. And that can be priceless, to hear from others and know that what you’re going through, other people have gone through and have recovered. The most important thing is to be nice to yourself after this type of injury. And remember to just take it easy. Find someone you trust that you can talk to and know you’re going to get better. Have a great day