Persistent post-concussive symptoms (Post-concussion syndrome)

Overview

Persistent post-concussive symptoms — also called post-concussion syndrome — occurs when symptoms of a mild traumatic brain injury last longer than expected after an injury. These symptoms may include headaches, dizziness, and problems with concentration and memory. They can last weeks to months.

A mild traumatic brain injury is known as a concussion. It could happen as a result of a fall or auto accident, while playing contact sports, or from violent shaking and movement of the head or body.

You don't have to lose consciousness to get a concussion or experience persistent post-concussive symptoms. In fact, the risk of developing the symptoms doesn't appear to be linked with the severity of the injury.

In most people, symptoms appear within the first 7 to 10 days and go away within three months. But sometimes they can last for a year or more. The goal of treatment is to manage symptoms.

Symptoms

Persistent post-concussive symptoms include:

Headaches.
Dizziness.
Fatigue.
Irritability.
Anxiety.
Trouble falling asleep or sleeping too much.
Loss of concentration and memory.
Ringing in the ears.
Blurry vision.
Noise and light sensitivity.
Rarely, decreases in taste and smell.

Headaches after a concussion most often feel like tension-type headaches. These may be related to a neck injury that happened at the same time as the head injury. Or the headaches may feel like migraines.

When to see a doctor

See a health care provider if you experience a head injury that causes confusion or memory loss — even if you remained conscious.

If a concussion occurs while playing a sport, don't go back into the game. Seek medical attention so that the injury doesn't become worse.

Causes

More research is needed to better understand how and why persistent post-concussive symptoms happen after some injuries and not others.

Persistent post-concussive symptoms may develop as a result of the impact of the injury itself. Or persistent post-concussive symptoms may trigger other conditions such as migraines. Symptoms also may be associated with other factors, including trouble with sleep, dizziness, stress and problems with mental health. Your health care provider will work with you to understand the cause of the current symptoms and the treatments that are recommended.

Risk factors

Risk factors for developing persistent post-concussive symptoms include:

Age. Studies that increasing age is a risk factor for persistent post-concussive symptoms.
Sex. Women are more likely to be diagnosed with persistent post-concussive symptoms, but this may be because women are generally more likely to seek medical care.

Prevention

The only known way to prevent persistent post-concussive symptoms is to avoid a head injury in the first place.

Avoiding head injuries

Although you can't prepare for every potential situation, here are some tips for avoiding common causes of head injuries:

Fasten your seat belt whenever you're traveling in a car.
Be sure children are in age-appropriate safety seats. Children under 13 are safest riding in the back seat, especially if your car has air bags.
Use helmets whenever you or your children are bicycling, roller-skating, in-line skating, ice-skating, skiing and snowboarding. Also wear a helmet while playing football, batting or running the bases in softball or baseball, skateboarding, or horseback riding. Wear a helmet when riding a motorcycle.
Take action at home to prevent falls, such as removing small area rugs, improving lighting and installing handrails.

Diagnosis

No single test can prove you have persistent post-concussive symptoms.

Your health care provider may want to order a scan of your brain to check for other potential problems that could be causing your symptoms. A computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be performed to detect structural brain changes.

If you're experiencing dizziness, you may be referred to an ear, nose and throat specialist.

A referral to a psychologist or licensed counselor may be in order if your symptoms include anxiety or depression. Or if you're having problems with memory or problem-solving.

Treatment

There's no specific treatment for persistent post-concussive symptoms. Your health care provider will treat your symptoms. The types of symptoms and how often they occur varies from person to person.

Headaches

Medicines commonly used for migraines or tension-type headaches appear to be effective for post-concussion types of headaches. They include some medicines to treat depression, high blood pressure and seizures. Medicines are usually specific to the individual, so you and your health care provider will discuss which are best for you.

Keep in mind that the overuse of pain medicine may contribute to persistent post-concussion headaches. This can happen with pain medicine you get by prescription or that you buy at the store without a prescription.

Memory and thinking problems

No medicines are currently recommended for the treatment of memory and thinking problems after mild traumatic brain injury. Time may be the best therapy. Most of these symptoms go away on their own in the weeks to months after the injury.

Certain forms of cognitive therapy may be helpful, including focused rehabilitation in the areas that you need to strengthen. Some people may need occupational or speech therapy. Stress can make cognitive symptoms worse, so learning how to manage stress can be helpful. Relaxation therapy also may help.

Depression and anxiety

Symptoms often improve after people understand the cause of their symptoms and that symptoms will likely improve with time. Education can ease fears and bring peace of mind.

If you're experiencing new or increasing depression or anxiety after a concussion, some treatment options include:

Psychotherapy. It may be helpful to discuss your concerns with a psychologist or psychiatrist who has experience in working with people with brain injury.
Medicine. Antidepressants or anti-anxiety medicines may be prescribed to help manage anxiety or depression.

Preparing for an appointment

A primary care provider often makes the initial diagnosis of a concussion. Or the diagnosis might be made by a health care provider in the emergency room.

You may be referred to a brain and nervous system disorder specialist, also called a neurologist, or a brain rehabilitation specialist, also called a physiatrist.

If you're referred to a specialist, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your health care provider.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medicines, vitamins or supplements that you're taking.
Ask a family member or friend to go with you, if possible. Sometimes it can be hard to remember all of the information given during an appointment. A friend or family member may remember something that you missed or forgot.
Write down questions to ask your provider.

Preparing a list of questions can help you make the most of your appointment. List your questions from most important to least important in case time runs out.

For persistent post-concussive symptoms, some basic questions to ask your provider include:

Why are these symptoms still occurring?
How long will they continue?
Do I need any other tests? Do I need to do anything to prepare for the tests?
Are there any treatments available, and which do you recommend?
Are there any activity restrictions that I need to follow?
Are there any brochures or other printed material that I can take home? What websites do you recommend visiting?
When can I return to work?
When can I drive again?
Is it safe to drink alcohol?
Is it OK to take medicines that were prescribed before the injury?

In addition to these questions, don't hesitate to ask any other questions you have during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Being ready to answer them may give you more time go over any other points you want to cover. Your provider may ask:

How did the initial injury occur?
Have your symptoms been constant, or do they come and go?
What symptoms are you currently experiencing?
How often do the symptoms occur?
Does anything seem to improve your symptoms?
What, if anything, makes your symptoms worse?
Are your symptoms getting worse, staying the same or improving?