The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult vestibular-trained physical therapist, neuro-optometrist, or concussion specialist for individualized guidance. Benign paroxysmal positional vertigo (BPPV) happens after concussion when otoconia (calcium carbonate crystals) dislodge from the utricle and migrate into semicircular canals during head trauma (Silverberg et al., 2020). Post-traumatic BPPV occurs in 15-30% of concussion patients. Symptoms include brief spinning vertigo lasting less than 60 seconds triggered by specific head positions (lying down, rolling over, tilting head back). Posterior canal BPPV most common (85-90%). Horizontal and anterior canal BPPV less common. Diagnosis uses Dix-Hallpike test for posterior/anterior canal and roll test for horizontal canal. Treatment with canalith repositioning maneuvers (Epley, Semont, BBQ roll) resolves 70-90% within 1-3 treatments. Concussion dislodges otoconia into canals. Otoconia dislodge into canals. Post-traumatic BPPV in 15-30% of concussions. 15-30% of concussions. Epley maneuver treats 70-90%. Epley maneuver treats 70-90%. How BPPV Develops Otoconia normally sit on utricular macula. Otoconia on utricular macula. Head trauma dislodges otoconia. Head trauma dislodges otoconia. Dislodged otoconia migrate into semicircular canals. Migration into canals. Canalithiasis: otoconia free-floating in canal. Canalithiasis free-floating. Cupulolithiasis: otoconia attached to cupula. Cupulolithiasis attached to cupula. Position changes move otoconia. Position changes move otoconia. Inappropriate cupular deflection causes vertigo. Inappropriate cupular deflection causes vertigo. Canal Involvement Patterns Posterior canal BPPV 85-90%. Posterior canal BPPV 85-90%. Horizontal canal BPPV 10-15%. Horizontal canal BPPV 10-15%. Anterior canal BPPV rare. Anterior canal BPPV rare. Multiple canal involvement more common post-concussion. Multiple canal involvement more common post-concussion. Bilateral involvement more common post-trauma. Bilateral involvement more common post-trauma. Post-Traumatic BPPV Features Higher recurrence rate than idiopathic BPPV. Higher recurrence rate than idiopathic. Multiple canal involvement more common. Multiple canal involvement more common. Bilateral involvement more common. Bilateral involvement more common. Reduced treatment response. Reduced treatment response. More treatment sessions required. More treatment sessions required. Symptoms often develop days to weeks after concussion. Symptoms days to weeks after concussion. Symptoms Brief spinning vertigo under 60 seconds. Brief spinning vertigo under 60 seconds. Triggered by lying down. Triggered by lying down. Triggered by rolling over in bed. Triggered by rolling over. Triggered by tilting head back. Triggered by tilting head back. Triggered by bending forward. Triggered by bending forward. Nausea during episodes. Nausea during episodes. Nystagmus visible during episodes. Nystagmus visible during episodes. No hearing changes. No hearing changes. No auditory symptoms. No auditory symptoms. Diagnosis Dix-Hallpike test for posterior/anterior canal. Dix-Hallpike for posterior/anterior. Roll test (supine head turn) for horizontal canal. Roll test for horizontal. Nystagmus pattern identifies canal. Nystagmus pattern identifies canal. Upbeating torsional nystagmus posterior canal. Upbeating torsional posterior canal. Horizontal geotropic or apogeotropic nystagmus horizontal canal. Horizontal geotropic or apogeotropic horizontal canal. Down-beating nystagmus anterior canal. Down-beating anterior canal. Treatment Canalith repositioning maneuvers. Canalith repositioning maneuvers. Epley maneuver for posterior canal. Epley maneuver posterior canal. Semont maneuver alternative. Semont maneuver alternative. BBQ roll (Lempert) for horizontal canal. BBQ roll for horizontal canal. Deep head hanging for anterior canal. Deep head hanging anterior canal. Vestibular rehabilitation for residual symptoms. Vestibular rehab residual symptoms. Prognosis 70-90% resolution within 1-3 treatments. 70-90% resolution 1-3 treatments. Higher recurrence rate post-trauma. Higher recurrence post-trauma. Residual symptoms possible. Residual symptoms possible. Vestibular rehabilitation for residual symptoms. Vestibular rehab residual symptoms. Supporting Mobility Routine These exercises support BPPV recovery through cervical mobility and nervous system regulation. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. How long does BPPV last after concussion? BPPV episodes last less than 60 seconds each but can recur with position changes for weeks to months without treatment. With Epley maneuver, 70-90% resolve within 1-3 treatments. Post-traumatic BPPV has higher recurrence rate than idiopathic BPPV. Multiple treatments sometimes needed. Vestibular rehabilitation supports residual symptoms. Can I diagnose BPPV myself after concussion? No. Dix-Hallpike test requires trained provider to identify nystagmus pattern and canal involvement. Self-diagnosis may miss horizontal canal BPPV or misidentify other vestibular disorders. Vestibular-trained physical therapist, ENT, or neurologist provides diagnosis. Post-traumatic BPPV often multiple canal involvement requiring specialized assessment. Why does BPPV recur after concussion? Post-traumatic BPPV has higher recurrence rate than idiopathic BPPV due to multiple otoconia dislodgment, bilateral utricular damage, and altered utricular macula function. Recurrence rate up to 50% in first year. Persistent vestibular dysfunction contributes. Follow-up with vestibular therapist supports management of recurrence. Is BPPV serious after concussion? BPPV is not dangerous but is disabling and can cause falls. BPPV does not damage brain or inner ear function. Treatment with Epley maneuver highly effective. Untreated BPPV increases fall risk, particularly in elderly. Post-traumatic BPPV requires prompt diagnosis and treatment to reduce disability and fall risk. Can I do the Epley maneuver at home? Modified Epley maneuvers can be performed at home after initial diagnosis and instruction by vestibular therapist. Home Epley useful for recurrent BPPV. Home treatment less effective than provider-performed Epley for initial treatment. Post-traumatic BPPV often benefits from professional-performed maneuvers due to multiple canal involvement. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed