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The Link Between Dizziness, Headaches & TBI

The Link Between Dizziness, Headaches & TBI

How Binocular Vision Dysfunction Relates to TBI

Traumatic Brain Injury, or TBI, is a condition which many people in the U.S. suffer from. TBI causes a variety of different issues and symptoms, but the two that are seen most frequently are headaches and dizziness. Those with TBI are understandably troubled by these symptoms and their side effects, and patients often undergo exhaustive evaluations and testing in an effort to find answers and relief from their symptoms.

Specialists commonly consulted for evaluation include chiropractors, ENT / vestibular specialists / otologists, PM & R and psychiatrists. In many cases, those with TBI have tried many different therapies and medications, searching for the link between TBI and headaches, but often see little to no change in the frequency and severity of their symptoms. It has now become evident that a little-known visual condition called Binocular Vision Dysfunction is the cause of many occurrences of headaches and dizziness in these patients.

Binocular Vision Dysfunction, Superior Oblique Palsy & Vertical Heterophoria

In patients with Binocular Vision Dysfunction, the eyes are slightly out of alignment with each other. In other words, the line of sight from one eye doesn’t line up with that of the other one, which makes it extremely difficult for the eyes to see a single image. Doctors have found that TBI can bring on BVD, the two most recognized forms of which are Superior Oblique Palsy (SOP) and Vertical Heterophoria (VH).

A significant cause of SOP and VH seems to be a disconnect between the two systems that aim and focus the eyes: the visual (or oculomotor) system and inner ear (or vestibular) system. When the vestibular system doesn’t work correctly, a small and subtle misalignment of the eyes can occur. If left uncorrected, this misalignment can cause double vision, which the human body does not allow. To stop the double vision and realign the eyes, the oculomotor system shifts the eyes in the opposite direction, toward their original position. Then the defective inner ear system asserts itself again, moving the eyes out of alignment once more, forcing the visual system to make another correction.

This persistent cycle of misalignment followed by realignment can give rise to a variety of symptoms. These can include pain in the eyes and headaches caused by fatigue and eye muscle strain, along with motion sickness, nausea, lightheadedness, dizziness, nausea and anxiety, a result of the repetitive back-and-forth movements of the eyes.

Head tilt is another method the body uses to realign the eyes. As the head is tilted down toward the shoulder, the images in the eyes line back up. This corrects the misalignment, but can also lead to persistent neck pain.

People with BVD often experience additional symptoms along with dizziness and headaches. These can include:

  • Vestibular symptoms. Bad depth perception, nausea, motion sickness, drifting and/or instability when walking, poor coordination (symptoms also found in people with Meniere’s disease, sequelae of a stroke, MS and inner ear disorders).
  • Vision problems. Overlapping or double vision, blurred or shadowed vision (symptoms frequently seen in MS patients), issues with reflection or glare, sensitivity to light.
  • Pain symptoms. Pain in the upper back and achiness in the neck caused by head tilt (symptoms often felt by patients with spinal misalignment), a feeling of achiness in the face, pain when moving the eyes or general eye pain (symptoms also experienced by those with TMJ problems, sinus issues, migraines).
  • Reading difficulties. Problems with reading and comprehension, frequently losing one’s spot when reading, words blurring or running together when reading, accidentally skipping lines when reading (similar to the symptoms experienced by those with learning disabilities), trouble concentrating (comparable to someone with ADHD).
  • Psychological symptoms. Feeling anxious or unsettled in big crowds and large, open buildings with high ceilings, like a department store or mall (patients with agoraphobia or anxiety exhibit similar symptoms).

For some people who experience TBI and headaches, along with other symptoms of BVD, their symptoms may be few enough or mild enough to be more of an inconvenience than a serious problem in their lives. Others aren’t so lucky; some patients experience BVD symptoms that are so numerous or severe that they’re incapacitated and afraid or unable to leave the house.

Treatment of BVD

In order for patients to receive relief from the symptoms of BVD brought on by TBI, it’s necessary to have a NeuroVisual Evaluation to identify any slight vision misalignments that may be present. This comprehensive and detailed examination is needed because standard eye exams typically aren’t able to detect these small amounts of misalignment.

At Vision Specialists of Michigan, problems with visual misalignment, far vision and near vision are corrected through the use of special glasses with aligning lenses that contain prism. This treatment method is extremely effective; patients almost always experience a dramatic easing of their symptoms, and sometimes the symptoms go away completely.

Schedule a NeuroVisual Examination

The team at Vision Specialists of Michigan wants to help you find relief from dizziness and headaches caused by TBI. Call us at (248) 258-9000 or fill out our screening questionnaire to get started on the path to recovery.

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Dr. Sandy DiPonio earned her optometry degree from Illinois College of Optometry in 1996. She is a highly skilled and experienced eye care professional dedicated to giving her patients of all ages excellent and compassionate care. She has a wide variety of experience in binocular vision, pediatric and adult eye care, ocular disease and contact lens fitting. She strives to provide each of her patients the best quality of life they can achieve with their vision through knowledge and education of treatment options.

Dr. DiPonio is a member of the American Optometric Society and Michigan Optometric Society.

Dr. Sally Hoey has been practicing optometry since graduating from Michigan College of Optometry in 2001. During her time in optometry school, she developed an interest in binocular vision, culminating in a senior thesis involving binocular vision.

Prior to joining Vision Specialists of Michigan, Dr. Hoey specialized in the diagnosis and treatment of vision-related learning problems as well as other binocular vision disorders. Her other areas of interest include specialty contact lens fittings and treating dry eye. Dr. Hoey strives to provide her patients with clear, comfortable vision while meeting their individual needs at the same time.

Dr. Hoey had the opportunity to provide eye care on an optometric mission trip to Guyana, South America and vision screenings at a local medical clinic. She is a member of the American Optometric Association, Michigan Optometric Association, Metropolitan Detroit Optometric Society and the College of Optometrists in Vision Development.

Dr. Jennifer Place graduated with honors from Michigan College of Optometry in 2001.

Before joining Vision Specialists of Michigan, she specialized in treating pediatric and adult patients with binocular vision disorders and vision-related learning problems, as well as fitting specialty contact lenses and managing various types of ocular disease. She enjoys working with patients with unique visual needs, and she takes great pride in providing all patients with highly customized care.

Dr. Place has volunteered for Opening Eyes, a program that provides eye exams to the athletes of the Michigan Special Olympics, and she participated in an international mission to St. Lucia to provide eye care to those in need. Dr. Place is a member of the Detroit Optometric Society, the Michigan Optometric Association, the American Optometric Association, the College of Vision Development, and the Optometric Extension Program Foundation.

Dr. Mary Jo Ference has been practicing optometry since 1990 upon graduating from Ferris State University- Michigan College of Optometry, and is certified in Low Vision Rehabilitation. She has worked at Sinai-Grace Hospital systems for over 20 years before joining Vision Specialists of Michigan in 2013 to work with binocular vision disorders. Her clinical areas of expertise include visual rehabilitation of pediatric and adult patients who have suffered from brain trauma, injury or disease. She has taught both optometry and ophthalmology residents at Sinai Grace Hospital. Dr. Ference has sat on numerous boards, including Sinai Grace Hospital, Berry Out-Patient Surgical Center, and Seedlings Braille Books for the Blind. She is actively involved in area school districts to provide education, training and access for students, teachers, OT’s and PT’s to eye care service rehabilitation information. Dr. Ference has lectured extensively nationally and internationally.

Dr. Debby Feinberg began practicing Optometry in Oakland County in 1983, upon graduating from Illinois College of Optometry. She joined her father, Dr. Paul C. Feinberg, at Mall Optical Center, which was located in Summit Place Mall.

Since 1995 Dr. Feinberg has been developing the field of NeuroVisual Medicine which is the optometric subspecialty that identifies and treats neurological / medical symptoms that originate directly or indirectly in the visual system.

Dr. Feinberg has been performing pioneering work with Binocular Vision Dysfunction (BVD), a condition where a vision misalignment (frequently subtle) creates difficulties with the two eyes working together to create a single 3-dimensional image, and difficulties with the two eyes following that image as it moves.

The symptoms caused by BVD are not usually associated with problems with the visual system, and include headache, dizziness, anxiety and panic, persistent post-concussive symptoms, gait instability and balance problems, frequent falls, neck pain, motion sickness, nausea, and reading and learning problems.

In 2004. Dr. Feinberg established Vision Specialists of Birmingham, specifically designing the practice to accommodate the needs of the NeuroVisual Medicine patient.

In 2011, the office moved to its current location in Bloomfield Hills and updated its name to Vision Specialists of Michigan.