Vestibular Rehabilitation After Concussion: Restoring Balance, Reducing Dizziness, and Managing Migraine

Lisa Brekke, PT, DPT

After a concussion, many people expect headaches or fatigue—but when dizziness lingers, or everyday motion suddenly triggers migraine symptoms, it can feel confusing and overwhelming. Fortunately, vestibular rehabilitation therapy (VRT) is a powerful, evidence-based tool for treating these persistent symptoms and helping patients return to normal life.

What Is Vestibular Rehabilitation?

Vestibular rehabilitation is a specialized form of physical therapy designed to improve symptoms like dizziness, imbalance, visual disturbances, and motion sensitivity. It targets the vestibular system, which helps control balance, spatial orientation, and eye movements.

When the brain experiences trauma from a concussion, this system can become disrupted—especially in the brainstem, inner ear, or the pathways that integrate visual, balance, and movement information. That’s where vestibular rehab comes in.

1. Dizziness and Imbalance After Concussion

Dizziness is one of the most common symptoms after a concussion—reported in up to 80% of cases. For some, it resolves within a few days; for others, it can persist for weeks or months.

Common post-concussion dizziness causes:

• Vestibular hypofunction (the inner ear system is less responsive)

• Cervicogenic dizziness (from neck dysfunction)

• Benign paroxysmal positional vertigo (BPPV) (dislodged crystals in the inner ear)

• Visual-vestibular mismatch (eyes and balance system are out of sync)

Vestibular rehab uses specific exercises to retrain the brain and body to process movement and balance normally again. Treatment may include:

• Gaze stabilization exercises (like VOR x1 drills)

• Balance training on stable and unstable surfaces

• Habituation to reduce sensitivity to motion

• Manual therapy if cervical (neck) involvement is contributing

2. Vestibular Migraine Post-Concussion

Some people develop vestibular migraine after a concussion, even if they’ve never had migraines before. These episodes can feel like dizziness, vertigo, nausea, or light sensitivity—sometimes without a headache at all.

Vestibular rehab plays a key role in managing these symptoms, especially when combined with:

• Migraine education (diet, sleep, hydration, stress)

• Activity pacing and graded return to movement

• Collaboration with medical providers for pharmacologic management when needed

While migraines are neurologically complex, they often improve with a combination of vestibular therapy and lifestyle modification.

3. When to Refer for Vestibular Rehab

Vestibular rehab should be considered if a patient experiences:

• Dizziness or imbalance > 10 days post-concussion

• Motion sensitivity or visual disturbances (e.g., trouble reading or scrolling)

• Symptoms triggered by head turns, bending, or visual stimuli

• History or onset of vestibular migraine symptoms

Early identification and referral can significantly improve outcomes and reduce the risk of prolonged post-concussion syndrome.

Final Thoughts

Dizziness and migraine after concussion aren’t just “in your head”—they often reflect real, treatable disruptions in the vestibular system. With a targeted vestibular rehabilitation program, patients can regain their confidence, reduce symptoms, and get back to living fully.

Want to learn more or consult on a case?

Contact Brekke Rehab Consulting for vestibular rehabilitation expertise, continuing education, and consultation services tailored to concussion recovery.