Treatment & Recovery

A vestibular therapist (a specially trained physical or occupational therapist) can be very helpful for dizziness and balance problems, but not everyone needs one.

You likely need a vestibular therapist if:

• Dizziness lasting more than 2-4 weeks after concussion

• Balance problems affecting daily activities

• Difficulty with head movements (turning to look around)

• Motion sensitivity (cars, scrolling, crowds)

• BPPV that hasn't resolved with basic maneuvers

• Falling or fear of falling

• Visual problems related to head movement

You may be able to self-manage if:

• Symptoms are mild and improving

• You can tolerate basic VOR exercises

• No significant balance problems

• Responding well to home exercises (like those in apps)

What a vestibular therapist does:

• 1. Assessment: Identifies specific vestibular deficits

• 2. Diagnosis: Confirms or rules out conditions like BPPV

• 3. Customized treatment plan: Exercises matched to your specific issues

• 4. Manual techniques: Hands-on treatment when needed

• 5. Progression guidance: Knows when and how to advance exercises

• 6. Monitoring: Tracks progress and adjusts treatment

What to expect:

• Initial evaluation: 45-60 minutes

• Treatment sessions: 30-60 minutes, 1-2x/week

• Duration: 4-12 weeks typically

• Home exercises: 15-20 minutes daily

How to find one:

• Ask your doctor for a referral

• Search vestibular.org for certified providers

• Look for "vestibular rehabilitation" or "concussion" specialty

• Check credentials: PT or OT with vestibular certification

Most insurance covers vestibular therapy with a referral. The combination of professional guidance and consistent home exercise produces the best outcomes.

Many people can successfully do vestibular rehabilitation at home, but some situations require professional guidance.

Home-based rehab works well for:

• Mild-moderate symptoms

• Straightforward vestibular hypofunction

• People who are motivated and consistent

• Those with access to good quality guidance (apps, videos)

• Follow-up with a doctor for monitoring

You should see a professional if:

• Symptoms are severe (7+/10)

• You have BPPV (needs proper diagnosis and maneuvers)

• You're not sure what exercises to do

• Symptoms aren't improving after 4-6 weeks

• You have additional injuries (neck, vision problems)

• History of multiple concussions

• You're falling or at high fall risk

• You feel unsafe exercising alone

The case for professional help:

• Accurate diagnosis (determines treatment approach)

• Customized exercise prescription

• Hands-on treatment when needed

• Faster progress with expert guidance

• Accountability and motivation

• Can identify complicating factors

The case for home-based:

• More convenient and accessible

• Lower cost

• Exercises can be done more frequently

• Good apps provide structured progression

• Works well for motivated individuals

Optimal approach for most people:

• 1. Start with home exercises using a quality app

• 2. If not improving in 4-6 weeks, see a professional

• 3. Professional sets you up with customized program

• 4. Continue with app/home exercises between appointments

• 5. Return to professional if needed

Using apps like VOR Eye Rehab:

• Provides structured exercise protocols

• Guides progression based on symptoms

• Tracks your progress over time

• Good option for mild-moderate symptoms

• Best when combined with medical oversight

The best outcomes combine professional evaluation with consistent home practice.

Medication can help manage dizziness symptoms, but it's usually not the primary treatment. Here's what to know:

Medications that may help:

For acute vertigo (short-term use only):

• Meclizine (Antivert): Reduces spinning sensation

• Dimenhydrinate (Dramamine): For motion sickness component

• Ondansetron (Zofran): For severe nausea

• Benzodiazepines: For severe acute vertigo (ER use)

For vestibular migraine:

• Preventive: Beta-blockers, topiramate, amitriptyline

• Acute: Triptans if migraine headache present

For Meniere's disease:

• Diuretics: Reduce inner ear fluid

• Betahistine: Used in some countries

Important cautions:

Vestibular suppressants (meclizine, etc.):

• Should only be used short-term (days, not weeks)

• Long-term use slows recovery

• They prevent the brain from adapting

• May be appropriate during severe acute episodes only

Why medication isn't the main treatment:

• 1. Dizziness often responds better to rehabilitation

• 2. Suppressants can delay vestibular compensation

• 3. They treat symptoms, not underlying cause

• 4. Side effects include drowsiness, cognitive slowing

When medication is appropriate:

• Severe acute vertigo episodes

• Vestibular migraine prevention

• Meniere's disease management

• Bridge therapy while starting rehabilitation

Better long-term strategies:

• Vestibular rehabilitation exercises

• Lifestyle modifications

• Treating underlying conditions

• Gradual exposure to triggers

Bottom line:
Talk to your doctor before taking dizziness medication regularly. For most vestibular problems, exercises are more effective than medication, and medication can actually slow recovery if used long-term.

Recovery plateaus are common and frustrating, but there are evidence-based strategies to push through them.

Common reasons for plateaus:

1. Not challenging the system enough

• Exercises have become too easy

• Brain needs progressive challenge to continue adapting

• Solution: Increase difficulty (speed, duration, complexity)

2. Inconsistent practice

• Missing days or doing exercises sporadically

• Brain needs regular stimulation to adapt

• Solution: Schedule exercises like medication

3. Unaddressed contributing factors

• Neck problems

• Vision issues (convergence, tracking)

• Sleep problems

• Anxiety or depression

• Solution: Get evaluated for these issues

4. Wrong exercises for your problem

• May be doing exercises that don't target your specific deficit

• Solution: Professional reassessment

5. Central compensation limit reached

• The brain may have maximally compensated

• Some residual symptoms may persist

• Solution: Focus on adaptation strategies

Strategies to break through plateaus:

Intensify your program:

• Increase exercise frequency

• Add complexity (eyes closed, foam surface)

• Try new exercises targeting the same system

• Consider a "boot camp" approach (intensive daily exercises)

Add complementary treatments:

• Manual therapy for neck involvement

• Vision therapy for eye tracking issues

• Cognitive behavioral therapy for anxiety

• Aerobic exercise for overall brain health

Get reassessed:

• Professional re-evaluation can identify missed factors

• May need different exercise approach

• Consider second opinion

Optimize recovery factors:

• Sleep: Aim for 8+ hours

• Nutrition: Anti-inflammatory diet

• Stress: Implement stress management

• Exercise: Regular aerobic activity

Realistic expectations:

• Some improvement may be subtle but meaningful

• 100% recovery isn't always possible

• Function improvement matters more than symptom elimination

• Most people reach a "good enough" state

If you've plateaued, don't give up—reassess and adjust your approach.