How do patients with a concussion typically describe their dizziness?

How Patients with Concussion Typically Describe Their Dizziness

Patients with concussion most commonly describe their dizziness as a nonspecific sensation of lightheadedness, feeling "off balance," or general unsteadiness rather than true rotational vertigo or room-spinning sensations. 1, 2

Primary Descriptive Patterns

Non-Rotational Dizziness (Most Common)

• Concussion patients typically report vague, nonspecific dizziness rather than classic vertigo, distinguishing them from patients with peripheral vestibular disorders like BPPV 1, 2
• Common descriptors include:
  • Lightheadedness 1
  • Feeling "off balance" or unsteady 1
  • Nausea without spinning 1
  • Feeling "in a fog" 1
  • General dizziness without clear rotational component 1, 2

Symptom Characteristics

• Dizziness is the second most common symptom after headache in concussion patients 2
• Symptoms are typically continuous or fluctuating rather than episodic 1, 3
• Unlike BPPV, concussion-related dizziness does not follow the classic pattern of brief (<1 minute) episodes triggered by specific head positions 1
• Approximately 37% of adolescent concussion patients report feeling lightheaded or dizzy with postural changes, though this does not meet criteria for orthostatic hypotension 4

Clinical Differentiation from True Vertigo

Key Distinguishing Features

• True rotational vertigo (room-spinning sensation) is NOT the typical presentation of concussion-related dizziness 1, 5, 6
• When concussion patients do report vertigo, it often indicates a coexisting peripheral vestibular injury such as BPPV (43.9% of cases) or labyrinthine concussion rather than the concussion itself 2, 7
• The absence of a confident description of spinning argues against inner ear dysfunction and supports central (concussion-related) etiology 5

Associated Symptoms and Context

Multifactorial Presentation

• 90% of concussion patients with dizziness demonstrate multifactorial dysfunction involving central pathways, cervical spine, and sometimes peripheral vestibular components 7
• Nearly all (97.8%) have oculomotor control deficits contributing to their dizziness sensation 7
• 70.7% demonstrate motion sensitivity 7
• 82.9% have cervical dysfunction, with 26.8% meeting criteria for cervicogenic dizziness 7

Functional Impact

• Dizziness severity directly predicts reduced physical activity levels during recovery, with each point increase in dizziness rating correlating with approximately 1,000 fewer steps per day 8
• Patients often modify movements to avoid provoking symptoms 1
• The sensation may be accompanied by balance problems, difficulty concentrating, and feeling slowed down 1

Critical Clinical Pitfall

Do not assume absence of true rotational vertigo rules out vestibular pathology—up to one-third of patients with atypical histories (including vague dizziness) may still have positive Dix-Hallpike testing revealing BPPV 1. However, the primary concussion-related dizziness itself typically presents as nonspecific lightheadedness rather than vertigo 1, 2.