Morning Dizziness and Nausea: Could It Be Post-Concussion Syndrome?

Dizziness and dry heaving upon waking up: Could it be a post-concussion syndrome?

Dear Dr.
Huang,
Hello.
In late August 2014, I experienced a direct impact to the back of my head when I hit the floor.
That day, I had severe vomiting and unsteadiness while walking.
I went to the emergency room the next day, received injections and medication, and after about a week, I recovered.
Last year, around April or May 2015, I had a temporary habit of waking up at 6 AM to jog for about two weeks.
One morning, I suddenly woke up feeling dizzy, with dry heaving and difficulty walking.
After 1-2 days, I sought medical attention.
The doctor conducted a preliminary examination and a brain CT scan, both of which showed no issues.
I was later prescribed "Nuanming tablets + Ning'er dizziness tablets," and after about 3-5 days, I saw improvement.
This Tuesday, I started experiencing dizziness again upon getting out of bed (about 30 seconds of dizziness after sitting up) along with dry heaving.
I noticed some tightness in my neck.
For the past two days, after resting in bed for 1-2 hours after waking up, the dizziness has improved.
However, I am unsure if this dizziness and dry heaving are related to the concussion I had two years ago.
I am concerned that the dizziness might affect my memory and study performance since I have a major exam coming up in the middle of this year.
Could you please recommend a relevant department or hospital in Taipei for further examination or treatment?
Thank you very much for taking the time to respond!
Best regards.

Amanda, 20~29 year old female. Ask Date: 2016/03/03

Dr. Huang Yingzhe reply Neurology

Based on the timeline, the brain CT scan performed last year should not be related to the concussion from the year before.
Many people experience dizziness, which often requires a period of monitoring.
It is recommended to first consult an otolaryngologist, and if there are concerns, then see a neurologist.

Reply Date: 2016/03/03

More Info

Post-Concussion Syndrome (PCS) is a complex disorder that can occur after a concussion or mild traumatic brain injury (TBI). It is characterized by a variety of symptoms that can persist for weeks, months, or even longer after the initial injury. Common symptoms include headaches, dizziness, fatigue, irritability, difficulty concentrating, and sleep disturbances. Your history of a concussion in 2014, followed by episodes of dizziness and nausea, raises the possibility that your current symptoms could indeed be related to PCS.

The symptoms you describe—morning dizziness and nausea—are not uncommon in individuals who have experienced a concussion. The fact that you had a significant impact to the back of your head, followed by immediate symptoms such as vomiting and instability, suggests that you may have sustained a concussion at that time. The subsequent episodes of dizziness and nausea, particularly after waking up, could be manifestations of PCS, especially since you noted that these symptoms improved with rest.

It's important to note that PCS can be exacerbated by stress, anxiety, and physical exertion. Given that you mentioned preparing for an important exam, it's possible that the stress associated with studying could be contributing to your symptoms. Additionally, the tightness in your neck could indicate tension or muscle strain, which can also lead to dizziness and discomfort.

To address your concerns, it would be advisable to consult with a healthcare professional who specializes in brain injuries or neurology. They can conduct a thorough evaluation, which may include a detailed medical history, physical examination, and possibly imaging studies such as an MRI or CT scan to rule out any structural issues. A referral to a neurologist or a concussion specialist would be beneficial for further assessment and management.

In terms of treatment, PCS is often managed through a combination of approaches. Cognitive behavioral therapy (CBT) can be effective for addressing anxiety and cognitive difficulties. Physical therapy may help with vestibular rehabilitation if dizziness is a significant issue. Additionally, lifestyle modifications, such as ensuring adequate sleep, managing stress, and gradually returning to physical activity, can be important components of recovery.

As for your concern about how these symptoms might affect your memory and studying, it's crucial to prioritize your health. If you find that your symptoms are impacting your ability to study or concentrate, it may be worth considering a temporary adjustment to your study schedule to allow for adequate rest and recovery.

In summary, your symptoms of morning dizziness and nausea could indeed be related to your previous concussion, potentially indicating Post-Concussion Syndrome. Seeking evaluation from a specialist in this area will provide you with the best guidance for managing your symptoms and ensuring that you are in optimal health for your upcoming exams.

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