From the Guidelines
The most effective treatment approach for chronic dizziness post-concussive syndrome 3 years after a concussion is an interdisciplinary coordinated rehabilitative treatment, which includes a combination of vestibular rehabilitation, graded physical exercise, oculomotor vision therapy, manual treatment, and psychological intervention. This approach has been recommended by recent guidelines, including a systematic review and meta-analysis published in JAMA Network Open in 2021 1. The study found that active management and treatment of post-concussive symptoms is crucial, and an interdisciplinary approach is the most effective way to address the complex needs of patients with persistent symptoms.
Some key components of this approach include:
- Vestibular rehabilitation therapy (VRT) to help retrain the brain to process balance information correctly
- Graded physical exercise to improve physical function and reduce symptoms
- Oculomotor vision therapy to address visual symptoms and improve eye movement
- Manual treatment, such as physical therapy or occupational therapy, to improve mobility and reduce pain
- Psychological intervention, such as cognitive behavioral therapy, to address psychological factors that can worsen symptoms
According to a systematic review and meta-analysis published in JAMA Network Open in 2021, an interdisciplinary coordinated rehabilitative treatment is recommended for patients with persistent post-concussive symptoms 1. The study found that this approach can improve symptoms and quality of life, and reduce the burden of post-concussive symptoms. The recommendation is based on the findings of several studies, including Rytter et al, Thastum et al, and Vikane et al, which demonstrated the effectiveness of an interdisciplinary approach in improving outcomes for patients with post-concussive symptoms 1.
Lifestyle modifications are also important, including maintaining regular sleep patterns, avoiding caffeine and alcohol, staying hydrated, and gradually increasing physical activity. A multidisciplinary team, including neurologists, ENT specialists, physical therapists, and psychologists, should work together to develop a personalized treatment plan that addresses the unique needs of each patient.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1). The treatment options for chronic dizziness post-concussive syndrome may include meclizine.
- Meclizine is used for treating vertigo, which can be a symptom of vestibular system diseases. It is not explicitly stated if meclizine is effective for chronic dizziness 3 years after a concussion, but it may be considered as a treatment option for vertigo associated with vestibular system diseases 2.
From the Research
Treatment Options for Chronic Dizziness
- Vestibular Rehabilitation Therapy (VRT) has been shown to improve perceived disability associated with dizziness post-concussion 3, 4, 5
- VRT is a relatively safe treatment option, with no adverse reactions or case reports 3, 4
- A combination of treatments, including sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, and pharmacological management, may be effective in managing concussion and persistent post-concussive symptoms 6
Diagnosis and Evaluation
- Post-concussive dizziness (PCD) can be divided into non-vestibular, central vestibular, and peripheral vestibular causes 7
- Identification of the peripheral component in PCD is important, as it can be remedied to a greater extent than the central component 7
- Diagnoses that may cause PCD include central vestibular disorders, Benign Paroxysmal Positional Vertigo (BPPV), labyrinthine dehiscence/perilymph fistula syndrome, labyrinthine concussion, secondary endolymphatic hydrops, temporal bone fracture, and malingering 7
Effectiveness of Vestibular Rehabilitation
- Studies have shown that VRT can reduce dizziness and improve gait and balance function after concussion 3, 4, 5
- VRT has been found to be effective in reducing post-concussion symptoms, including dizziness, in both children and adults 5
- Self-reported and performance-based outcome measures have been used to evaluate the effectiveness of VRT in patients with post-concussive symptoms 4