Dizziness: receiving a diagnosis, treatment duration, and concussions

Disclaimer: During our Dizziness Can Be Stubborn webinar, many inquirers asked for specific treatment recommendations for their particular scenario. Please be advised that as per our College regulations, I am not permitted to provide treatment advice for an individual’s symptoms without performing an assessment. Hopefully my more general responses will help answer your questions, but the best approach is to discuss your particular symptoms with your Doctor and Vestibular Therapist.

The difference between dizziness and vertigo 

Several people were wondering about the difference between dizziness and vertigo.  

Vertigo is defined as a sensation of motion taking place that isn’t actually occurring. In North America it conjures up the idea of spinning, but it could technically be other senses of motion as well. There are numerous causes but the most common is a sudden mismatch between what the ears are saying about your head position/motion. This could include causes like BPPV, an inner ear infection, inner ear trauma, Meniere’s disease, etc. The mismatch these conditions create causes nystagmus, which is an involuntary eye movement that will make it look like things are moving when they’re not. 

Dizziness a much more general ‘catch-all’ phrase used to describe the sensation of disturbed or impaired spatial orientation. 

You certainly don’t need to have vertigo for it to be a vestibular problem.

Also, be aware that many general practitioners diagnose people as having “vertigo” but the cause may not always be clear as vertigo is a symptom and not a diagnosis. They could mean that they think you have BPPV (Benign Paroxysmal Position Vertigo) where the crystals get out of place, in which case it is a diagnosis, but often that’s not the case.

People are often told that ‘vertigo’ is just something they have to live with and nothing can be done. Remember, vertigo is not a complete diagnosis, as mentioned above, and this sort of statement is not at all supported by the research if they are referring to vertigo from a vestibular disorder.

Q: I have had 3 episodes of severe vertigo - twice with a bad head cold with plugged ears for several days - vomiting with any movement 5 to 8 hours before I could move - 3rd time it just happened and I laid on floor for 15 hours. I assume this would likely be BPPV? 

A: Duration of symptoms give us very important clues when we’re trying to figure out what sort of vestibular problem a person has. The vertigo that people get from BPPV is very brief.  If you stop your head movement or get your head out of the position that triggers your vertigo, the spinning should stop in less than a minute if it is BPPV.  Vestibular conditions that can give episodes of longer vertigo include vestibular migraine – 5-72 hours, and Meniere’s Disease 20 – 12 hours (or up to 24 hours in “probable” cases).  

Check out this article from the Vestibular Disorder Association to learn more about the various types of vestibular disorders.

Receiving a diagnosis

Many questions pertained to having had symptoms for a long time and having trouble getting a diagnosis. Unfortunately, this is a very common scenario and is explained in this article from the Vestibular Disorder Association called Trouble Getting a Diagnosis?

Note that the diagnostic testing referred to in this article is not available in many parts of Canada and that often general practitioners here start with sending patients for vestibular rehabilitation assessment (and treatment if appropriate) as a first step before referring to a specialist, as that can take longer.

While not ideal, sometimes in rehabilitation we do not have a clear diagnosis, but can still address what we are finding like balance trouble, sensitivity to motion, etc.

The lab test with the ‘water in the ears,’ only tests one small part of the system and only represents slow head speeds in the horizontal plane, so just because it might come back normal doesn’t mean the entire vestibular system is normal. Vestibular physiotherapists do not typically perform this test and this is not a test for BPPV.

Q: Is there a technical term for the "goggles"? That way if we live outside Lifemark's service area we can look for someone with that equipment.

A: These are infrared video goggles.

How long will my vestibular rehabilitation last?

Age and gender do not affect the overall efficacy of vestibular rehabilitation.

Q: How long should a rehab be? Or does it really depend on someone's case? 

A: Yes, it very much depends on the diagnosis and on what other conditions that may also be at play. If it is BPPV, you might be fine in 2-3 sessions. With a one-sided inner ear issue and no other conditions that would slow down progress, you might be looking at ~ 6 weeks. If both ears are involved, then possibly a couple months with some residual symptoms. 

If the psychological impact of PPPD develops you might be looking at ~ 6 months of periodic care. After that, you can typically stop your vestibular exercises as long as you are staying active. Ongoing activity is particularly important if you have a bilateral vestibular problem, and in that case your therapist may recommend that you continue with a few select vestibular exercises indefinitely in order to maintain your gains.

Q: Have you treated a totally blind person and was it successful?

A: Actually yes, I have treated a few people who were blind and had success with reducing head motion sensitivity and improving balance.

Concussions, whiplash, and dizziness

Q: After my concussion, I was prescribed 2 pairs of glasses. Every time I change my glasses I become very dizzy, what do you recommend I do?

A: That ear-to-eye reflex that I mentioned during the webinar normally gets altered slightly when you change prescriptions. Most people have felt a little funny for a day or two when getting a significantly new prescription while the reflex adjusts, but with a concussion it can be tougher for that adjustment to take place if there is vestibular system involvement. 

If you must use two different pairs of glasses, I suggest you get tested by a vestibular therapist who knows how to test this reflex with the glasses on to see if there is a problem. (Lifemark Therapists do these routinely but if you see someone else, the tests to ask for are the Head Thrust Test and Dynamic Visual Acuity.)  

Q: How can you tell if your dizziness is from whiplash of the neck rather than vestibular? I tried vestibular rehabilitation already but couldn’t tolerate moving my neck even though I was diagnosed with unilateral vestibulopathy. 

A: We have a number of tests that help to differentiate the neck from the vestibular system as a contributor to symptoms. In general though, if your neck discomfort and dizziness ‘travel together’ (as in, when your neck acts up or settles down, so does your dizziness), then it’s probably at least part of the problem.  In that case, having therapy done on your neck should also help the dizziness. There are vestibular exercises that can be done where the head and trunk move together, so that you’re still stimulating the system but not via turning/aggravating the neck. 

Q: How can neck issues and/or TMJ issues cause vertigo?

A: It is doubtful that these can actually cause vertigo, however they may give a vague sense of dizziness or feeling ‘off.’ This is thought to be from altered feedback from the muscles and joint receptors about where the head is in space. 

Q: I have post-concussion issues long term with headaches and neck problems that cause dizziness, balance issues, and vertigo. Is any of this treatable?

A: Yes!, all of it is treatable with a combination of neck treatment, vestibular rehabilitation, balance training, and perhaps other medical management for headaches, etc. I suggest you find a therapist with a combined specialty of vestibular rehabilitation and concussion management, which many of our therapists do.

Q: Does dizziness that results from concussions (or in post-concussion syndrome) usually go away eventually? 

A: For this question I reached out to a vestibular colleague of mine who is also a concussion researcher. She said that most adults recover and are free of concussion symptoms within two weeks. For children and youth, 70% will be symptom-free within 30 days. Coming back to adults, in one of her recent studies, 73% recovered fully with treatment.

To learn more about vestibular rehabilitation, check out our services page. If you’re interested in booking an assessment with a vestibular therapist, you can do so online or find a clinic near you.