What Is Post-Concussion Syndrome?
Post-concussion syndrome is a set of symptoms that can occur after a head injury. A concussion is a mild traumatic brain injury that involves confusion and memory loss, with or without a loss of consciousness. Post-concussion syndrome typically occurs after concussions but may also occur after more severe head injuries . Post-concussion syndrome is reported in 30 to 80 percent of people that experience a mild or moderate traumatic brain injury .
Symptoms include headaches that begin days to months after the injury and can be present as tension headaches or even migraines. Other likely symptoms include pain shooting to or from different areas of the head, dizziness, nausea, visual changes, difficulty concentrating, and mood changes.
Treatments include at-home remedies, medications for headaches or to address mood changes, as well as talk therapy.
You should discuss with your physician whether your symptoms can be a result of a previous concussion.
How common is Post-Concussion Syndrome?
Symptoms that never occur with Post-Concussion Syndrome:
- Severe headache
Post-Concussion Syndrome is also known as
- Post-concussive syndrome
Post-Concussion Syndrome Symptoms
People with post-concussion syndrome usually develop symptoms that are most severe seven to 10 days after the traumatic brain injury [3,4]. These symptoms tend to gradually improve, with most people experiencing improved symptoms by one month after the injury.
The most common symptom of post-concussion syndrome is headache. This develops in 75 percent of people with post-concussion syndrome and can be described by :
- Timing: Headaches may begin days to months after the traumatic brain injury.
- Tension headaches: This is the most common type, which causes a band-like pressure or aching pain across the head and usually occurs daily and may be constant or intermittent.
- Migraine headaches: These cause a pounding or throbbing severe pain on one side of the head.
- Less commonly: Pain involving the jaw joint, pain in the back of the head, shooting pain across the face, or pain over the scalp can occur.
Other symptoms that are likely in post-concussion syndrome include:
- Dizziness: This is experienced by about half of people with post-concussion syndrome. The dizziness may be a sensation of lightheadedness, or a feeling that the room is spinning around them ("vertigo").
- Nausea, visual changes, and/or light sensitivity (photophobia): The visual changes may appear as shimmering lights across the field of vision and are known as an aura.
- Difficulty concentration and remembering
- Anxiety, depression, irritability, and/or personality change: The person may be more sensitive to noise, emotional excitement, or crowds. Some people may experience symptoms of post-traumatic stress disorder (PTSD), which may involve flashbacks, nightmares, and avoidance behaviors.
Post-Concussion Syndrome Causes
The specific cause of post-concussion syndrome is unknown but is believed to be due to a combination of trauma and psychogenic factors.
Injury to the brain resulting in structural and functional changes
Traumatic brain injury can cause changes in the volume and function of certain areas of the brain months to years after the injury. These changes could explain some of the symptoms seen in post-concussion syndrome.
Psychogenic factors such as anxiety and depression
Psychogenic factors may predispose some people to develop post-concussion syndrome since post-concussion syndrome can also cause some psychiatric symptoms. People who develop post-concussion syndrome may already have more underlying psychiatric conditions, such as anxiety or depression, and thus may have more limited social support or coping skills. Since psychiatric conditions can amplify pain symptoms, these factors may contribute to the symptoms seen in post-concussion syndrome.
Treatment Options and Prevention
Most people with post-concussion syndrome will have complete improvement in symptoms in three months, even without treatment. However, the following treatment options, including at-home remedies and support, medications specifically for headaches, and psychotherapy or other medications can be helpful [6-8].
At-home treatments and further support
Remedies that can be done at home and with guidance from a medical professional include:
- Reassurance and education: Having a support system as well as learning about the syndrome can provide substantial relief.
- Cognitive training exercises: This includes using a notebook and visual imagery and may help those with trouble concentrating or remembering. More complicated cognitive rehabilitation programs exist and may be beneficial for some people, but these tend to be costly and research has not shown that they provide definitive benefit for people with post-concussion syndrome.
Medications to treat headaches
Medications to treat headache include:
- Main options: amitriptyline, propranolol, and/or indomethacin may be used.
- IV options: People whose headaches that are not relieved by oral pain medications may benefit from receiving a course of intravenous headache medications such as dihydroergotamine or metoclopramide (Reglan).
- Reducing use: In some people with post-concussion syndrome, headaches may be caused by using too many pain medications. In these cases, gradually reducing the number of pain medications may help alleviate headaches.
Psychotherapy and other medications
Psychotherapy and/or medications may benefit those with anxiety or depression. This includes:
- Cognitive Behavioral Therapy (CBT): This helps people alter their patterns of thinking to improve their emotional state.
- Medications: Options include sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), or escitalopram (Lexapro), among others.
When to Seek Further Consultation
If you experience any symptoms of post-concussion syndrome after an episode of traumatic brain injury, such as headaches, dizziness, difficulty concentrating, anxiety, or depression, you should go see your physician. He or she can perform an examination and possibly order imaging studies to rule out other underlying conditions, then offer you the appropriate treatment.
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Do you have trouble sleeping?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- How severe is your headache?
- Any fever today or during the last week?
- How long has your current headache been going on?
The above questions are also covered by our A.I. Health Assistant.
- RCS resources. Concussion Legacy Foundation. CLF Link
- Evans RW. Postconcussion syndrome. UpToDate. Updated August 22, 2018. UpToDate Link
- Coppel D. Mind, body and sport: Post-concussion syndrome. NCAA. NCAA Link
- Recovery from concussion. Centers for Disease Control and Prevention. Updated June 26, 2017. CDC Link
- Lucas S. Characterization and management of headache after mild traumatic brain injury. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Published 2015. NCBI Link
- Barlow KM. Postconcussion syndrome: A review. Journal of Child Neurology. 2016;31(1):57-67. NCBI Link
- Broshek DK, De Marco AP, Freeman JR. A review of post-concussion syndrome and psychological factors associated with concussion. Brain Injury. 2015;29(2):228-237. NCBI Link
- Blume H. Understanding migraine headaches after concussion. American Migraine Foundation. Published May 30, 2016. American Migraine Foundation Link