A concussion is a type of mild traumatic brain injury that occurs from a strong blow to the head. It can cause symptoms like headache, dizziness, fatigue, memory impairment, and mood changes. Post-concussion syndrome is when symptoms of a concussion last longer than usual.
Post-concussion syndrome is a continuation of some of the symptoms you may have experienced when you first got a concussion, like headache and confusion. Some of your initial concussion symptoms may go away.
The exact symptoms and severity can vary from person to person and may affect you physically, cognitively, or emotionally:
Physical Symptoms
- Headache
- Light sensitivity
- Insomnia (trouble sleeping)
- Hypersomnia (sleeping too much)
- Sound sensitivity
- Dizziness and poor balance
- Nausea
- Vision changes
- Fatigue
Cognitive Symptoms
- Foggy or slow thinking
- Easily distracted
- Difficulty concentrating
- Confusion
- Trouble remembering things
Emotional Symptoms
- Irritability
- Anxiousness
- Depression
When it happens: Post-concussion syndrome can occur after you’ve experienced some sort of head trauma that causes a concussion or other more severe type of traumatic brain injury. Accidental falls, sporting injuries, car accidents, and physical violence are some of the more common causes.
Why it happens: Concussion itself can damage your nerves and affect signaling between your brain cells, which can cause inflammation that may lead to concussion symptoms. In post-concussion syndrome, some of these underlying causes may not be totally resolved.
How often it happens: In 85-90% of people with a concussion, symptoms go away within a few days or weeks after the injury. However, the other 10-15% of people will still experience some symptoms weeks or months later.
Why only some people get it: Experts don’t yet fully understand why some people develop post-concussion syndrome while others don’t. There doesn’t seem to be a strong correlation between the severity of the initial injury and the risk of developing post-concussion syndrome. In other words, lingering symptoms can still happen even in people with mild initial injuries.
Risk Factors
You might be at higher risk for post-concussion syndrome if you:
- Are a woman
- Have had a previous concussion
- Have had chronic pain in the past
- Have had any mental health challenges
- Experience severe symptoms a few days after your concussion
Still, people who don’t have any risk factors can develop post-concussion syndrome.
Diagnosis of post-concussion syndrome often takes place in two stages: Diagnosis of the initial concussion and a later diagnosis of post-concussion syndrome.
How it’s Diagnosed
A medical history and physical exam are critical for diagnosing both concussion and post-concussion syndrome. That’s because no specific lab test or imaging test can identify a concussion. Your doctor will want to know about any head trauma and the symptoms that followed. They’ll also check for any signs of damage to your nervous system and examine your overall mental status. In some cases, your doctor may also request more detailed psychiatric evaluations.
Ruling Out Other Causes
Diagnosis may also involve ruling out other potential causes, which may require visiting a specialist. For example, someone with dizziness several months after a concussion may need to see an ear, nose, and throat (ENT) specialist. Or someone with vision problems may need to see an eye doctor.
Sometimes, an imaging technique like magnetic resonance imaging (MRI) can help rule out other causes and check for underlying damage. The findings are usually normal in post-concussion syndrome.
When the Diagnosis Comes
Most doctors won’t diagnose post-concussion syndrome until at least three months after an initial concussion. Once the symptoms last that long, they will upgrade the diagnosis from concussion to post-concussion syndrome.
Lingering symptoms may go away with time, but treatment may help reduce them or help you recover more quickly. Treatment will usually depend on your symptoms.
- For insomnia: You might need to make environmental and behavioral changes, like going to bed at a regular hour and reducing your caffeine intake. A short-term medication like Desyrel (trazodone) or melatonin may also help.
- For anxiety or depression: Cognitive behavioral therapy could be an important part of treatment. Medications, including selective serotonin reuptake inhibitors such as Prozac (fluoxetine), may also be beneficial.
- For headache: Your doctor may recommend pain-relieving medications like Advil (ibuprofen) or Elavil (amitriptyline), a type of antidepressant sometimes used for headaches. Other techniques to help with neck tension, like massage or physical therapy, may also help.
- For light sensitivity: Treatment might include wearing dark glasses outdoors.
- For dizziness: Your doctor may recommend vestibular rehabilitation therapy.
In general, experts don’t recommend complete rest past the first couple of days after your concussion. Instead, regular aerobic exercise (cardio) at a level that doesn’t worsen your symptoms may help quicken your overall recovery.
The best and only way to prevent post-concussion syndrome is to prevent concussion in the first place. Although you can’t prevent all injuries, the following are some ways to help lower the risk of concussion:
- Install stair gates and window guards to protect young children if they are in the home.
- Use age- and weight-appropriate restraints inside the car, including seatbelts or car seats.
- Always wear appropriate and well-fitting helmets during cycling and other activities.
- Keep your home well-lit and clear of obstacles, especially if older adults are in the home.
- Install handrails or use assistive devices if you’re at risk for falling.
Post-concussion syndrome itself won’t cause complications. Rather, the concussion itself—in particular repeated concussions—is what can lead to complications.
Traumatic encephalopathy syndrome (TES) is a condition that results from repetitive head impacts, typically from sports. If the brain tissue shows certain damage under a microscope (an exam that can be done after a person’s death), it might go by the name chronic traumatic encephalopathy (CTE). This condition can lead to symptoms such as problems with movement, mood changes, and dementia.
TES/CTE is not the same as post-concussion syndrome. If you’ve only had one concussion that led to your post-concussion syndrome, that isn’t thought to cause TES/CTE. However, people who’ve had thousands of repetitive head impacts, such as some football players, are at risk of developing TES/CTE years after their initial concussions.
In a majority of people with post-concussion syndrome, symptoms totally resolve within a few months. However, symptoms can be distressing while they last, especially if you thought that they would clear up more quickly. You may not be able to pursue all your normal work and leisure activities at your regular pace. Know that your symptoms are likely to be worse in the first few weeks, and then things will generally start to improve.
Don’t hesitate to call in other professionals as you recover. Your doctor may make specific recommendations about specialists who may be able to support you more fully.
