How long after the injury should I come in?

Once you have been medically assessed and any emergency concerns are excluded, earlier is generally better — particularly because BPPV caused by the impact is straightforward to treat and needlessly miserable to live with. If your injury was months or years ago and symptoms have persisted, that is still very much worth assessing.

I was told to rest in a dark room. Is that still the advice?

Not for long. A short period of relative rest in the first day or two is sensible, but prolonged strict rest is no longer recommended and tends to prolong recovery. Current practice favors a graded return to activity kept below the level that significantly provokes symptoms. Your physician should guide the specifics.

Usually yes, and often it helps — but the dose matters. Part of what we assess is the point at which exertion provokes your symptoms, so exercise can be prescribed just under it and progressed as that threshold rises.

That is a medical decision, not ours. Standard imaging is typically normal after concussion, because the injury is one of function rather than structure — which is why a normal scan does not mean nothing is wrong.

Do I need a referral?

North Carolina is a direct access state, so you can usually start physical therapy without one. Some insurers require a referral for reimbursement, and we are happy to check that for you when you call.

We accept Medicare Part B and bill it directly. We are an out-of-network provider for Medicare Part C (Medicare Advantage). All other patients are cash-pay with pricing published up front, and we can provide a superbill for potential out-of-network reimbursement.

Post-Concussion Dizziness Treatment in Cary, NC

Dizziness after a head injury almost never has a single cause. The value of a proper vestibular assessment is separating the causes — because they respond to entirely different treatments.

What it feels like

The common thread is that ordinary things have become effortful. Reading, screens, busy rooms, turning your head to check traffic. People describe feeling a half-second behind the world.

It frequently arrives tangled up with headache, neck pain, poor sleep, and a short fuse — which makes it hard to tell what is causing what. That is exactly the knot an assessment is meant to untie.

Dizziness or fogginess brought on by head movement
Trouble reading or using screens; eyes tiring quickly
Feeling overwhelmed in busy or visually cluttered environments
Unsteadiness, particularly in the dark or on uneven ground
Symptoms flaring with physical exertion
Neck pain and headache alongside the dizziness

Why it is rarely one problem

A head injury delivers force to several systems at once, and dizziness can come from any of them. Most people who are still symptomatic months later have two or three of the following running together:

Vestibulo-ocular dysfunction — the reflex stabilizing your vision during head movement is no longer calibrated
Oculomotor and convergence problems — the eye-teaming that makes reading and screens comfortable
BPPV — the impact itself can dislodge inner ear crystals, and this is common and very treatable
Cervicogenic dizziness — from a neck that took the same force your head did
Exertional intolerance — symptoms reliably provoked by raising your heart rate
Visual motion sensitivity — busy environments becoming intolerable

How we assess it

The assessment is essentially a process of elimination, working through each possible contributor and establishing which are present and how much each is contributing.

That includes positional testing for BPPV, oculomotor and gaze stability testing using infrared goggles, an examination of the cervical spine, balance testing under varied visual and surface conditions, and a graded look at how you respond to exertion.

This is the step that gets skipped. Persistent post-concussion dizziness very often persists because one contributor was never identified — most commonly BPPV, which will not respond to any amount of general reconditioning but resolves quickly once treated.

How we treat it

Treatment follows the findings rather than a standard protocol, because a person whose main problem is convergence needs something quite different from one whose main problem is exertional.

Throughout, we work just below the level that provokes a significant flare — enough challenge to drive adaptation, not enough to cost you the following day. That threshold moves as you improve, which is why the program gets reviewed rather than handed over once.

If you are working toward return to sport, work, or school, we coordinate that with whoever is managing your care.

Canalith repositioning if BPPV is present — often the fastest single win
Gaze stability and vestibulo-ocular retraining
Oculomotor work for reading and screen tolerance
Treatment directed at the cervical spine where it is contributing
Graded exertion, progressed against your symptom threshold
Habituation for visual motion sensitivity

What to expect

Many people improve substantially within weeks once the right targets are identified — which is a more optimistic picture than people expect after months of being told to wait.

Recovery is not usually linear, and a bad week after a busy one is normal rather than a setback. What we watch is the trend across weeks.

Common questions about post-concussion dizziness

How long after the injury should I come in?: Once you have been medically assessed and any emergency concerns are excluded, earlier is generally better — particularly because BPPV caused by the impact is straightforward to treat and needlessly miserable to live with. If your injury was months or years ago and symptoms have persisted, that is still very much worth assessing.
I was told to rest in a dark room. Is that still the advice?: Not for long. A short period of relative rest in the first day or two is sensible, but prolonged strict rest is no longer recommended and tends to prolong recovery. Current practice favors a graded return to activity kept below the level that significantly provokes symptoms. Your physician should guide the specifics.
Can I exercise?: Usually yes, and often it helps — but the dose matters. Part of what we assess is the point at which exertion provokes your symptoms, so exercise can be prescribed just under it and progressed as that threshold rises.
Do I need a scan?: That is a medical decision, not ours. Standard imaging is typically normal after concussion, because the injury is one of function rather than structure — which is why a normal scan does not mean nothing is wrong.
Do I need a referral?: North Carolina is a direct access state, so you can usually start physical therapy without one. Some insurers require a referral for reimbursement, and we are happy to check that for you when you call.
How is this billed?: We accept Medicare Part B and bill it directly. We are an out-of-network provider for Medicare Part C (Medicare Advantage). All other patients are cash-pay with pricing published up front, and we can provide a superbill for potential out-of-network reimbursement.

Find out what is actually driving it

If the dizziness has outlasted everyone's expectations, the usual reason is that one of its causes was never identified.

Request an Appointment Call (919) 694-1980

Referring a patient? Download the referral form or fax (844) 458-1371.