Persistent post-concussive symptoms (Post-concussion syndrome)

Persistent post-concussive symptoms are symptoms of a mild traumatic brain injury that typically last longer than three months. Persistent post-concussive symptoms also are called post-concussion syndrome. The symptoms may include headaches, dizziness, and trouble with concentration and memory. Symptoms can last weeks to months.

A mild traumatic brain injury is known as a concussion. A concussion may be caused by a fall, car accident or contact sports injury. Other causes include violent shaking and movement of the head or body.

You don't have to lose consciousness to get a concussion. And a concussion doesn't always cause persistent post-concussive symptoms. The risk of having persistent post-concussive symptoms doesn't appear to be linked to how severe the injury was.

Persistent post-concussive symptoms in most people appear within the first 7 to 10 days after an injury and typically last longer than three months. But sometimes they can last for a year or more. The goal of treatment is to manage symptoms and to improve functioning and quality of life.

Persistent post-concussive symptoms can be different in each person. They may include:

• Headaches.
• Dizziness.
• Fatigue.
• Irritability.
• Anxiety.
• Depression.
• Trouble falling asleep or sleeping too much.
• Poor concentration and memory.
• Ringing in the ears.
• Blurry vision.
• Noise and light sensitivity.
• Nausea or vomiting.
• Neck pain.

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

When to see a doctor

See a healthcare professional if you experience a head injury that causes confusion, memory loss, vision changes, nausea, vomiting or a sudden, bad headache. Get medical help even if you never lost consciousness. Also see a healthcare professional if you lose feeling, can't move a part of your body, or have trouble speaking or writing.

If you get a concussion while playing a sport, don't go back into the game. Seek medical help so that the injury doesn't get worse.

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

Persistent post-concussive symptoms may result directly from the impact of the injury itself. Or symptoms may trigger other conditions such as migraines. Symptoms also may be related to other factors. These may include trouble with sleep, dizziness, stress and mental health. Your healthcare professional works with you to understand the cause of your symptoms and which treatments may help.

Risk factors for developing persistent post-concussive symptoms include:

• Age. Persistent post-concussive symptoms usually are reported in people ages 20 to 30. But studies also show that older adults are at risk of more serious and prolonged persistent post-concussive symptoms.
• Sex assigned at birth. 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.
• Anxiety. A history of anxiety is a strong risk factor.
• Prior headaches. People who have a history of headaches are at higher risk of having persistent post-concussive symptoms.
• Prior brain injury. A previous brain injury is linked to persistent post-concussive symptoms. But lasting symptoms also can happen after a single concussion.

The only known way to prevent persistent post-concussive symptoms is to avoid a head injury in the first place. You can't always prevent a head injury. But some tips for avoiding them include:

• Wear your seat belt. Buckle up every time you ride in a car or other motor vehicle.
• Be sure children are in the right safety seats for their ages. Children under age 13 are safest riding in the back seat, especially if your car has air bags. From birth to age 4, their car seats should face the rear. After outgrowing their rear-facing car seats and until at least age 5, they can face forward in the car seats. When children outgrow their forward-facing car seats, they should be moved to buckled booster seats in the back seat. When their seat belts fit properly without booster seats, they can move to seat belts. This usually happens between ages 9 and 12. All children age 13 and under should sit in the back seat.
• Wear a helmet. Wear a helmet when biking, roller-skating or ice-skating, skateboarding, riding a motorcycle, skiing, snowboarding, or any activity that could cause a head injury. It's also a good idea to wear a helmet when horseback riding or playing football, baseball or softball.
• Get annual eye exams. This is very important for older adults because vision problems may increase the risk of falls. If needed, get new glasses or contacts.
• Make your home safer. Remove small area rugs, improve lighting, install handrails and use safety gates for children. Prevent falls in older adults by talking to a healthcare professional about medicines that might cause dizziness or affect balance.

No single test can prove you have persistent post-concussive symptoms. A healthcare professional may start with taking your full medical history and may use these tests to help determine your diagnosis:

• A neurological exam. This includes testing your thinking and memory, senses, strength, coordination, and reflexes.
• Neurological testing. These tests further check your concentration, memory, language, thinking and planning skills.
• Imaging. You may need brain imaging such as a CT scan or an MRI scan. Healthcare professionals may recommend brain imaging if you have concerning symptoms, such as a very bad headache, memory loss or vomiting. Imaging also can check for structural brain changes, such as damage to brain tissue, and other conditions that may be affecting the brain. But images cannot see persistent post-concussive symptoms.
• Other specialists. You may see other healthcare professionals based on your symptoms. This may include physical therapy, occupational therapy, speech therapy, or a psychologist for anxiety or memory problems. For dizziness, you may see an ear, nose and throat specialist. For vision changes, you might go to an eye specialist, known as an ophthalmologist. Or you might see a specialist in visual symptoms related to traumatic brain injuries or neurological conditions, known as a neuro-optometrist.

There's no specific treatment for persistent post-concussive symptoms. Your healthcare professional treats your symptoms. The types of symptoms and how often they occur varies from person to person.

Headaches

Medicines that are often used for migraines or tension-type headaches may help. These may include medicines for treating depression, high blood pressure and seizures. Medicines are usually specific to the individual, so talk to your healthcare professional about which are best for you.

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

Memory and thinking problems

Time may be the best therapy for memory and thinking problems after mild traumatic brain injury. Most of these symptoms go away on their own in the weeks to months after the injury, but using a notebook or visual cues may help you manage these symptoms as your brain heals.

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.

Dizziness or vertigo

Dizziness is feeling faint, woozy or not steady. Vertigo is a false sense that your surroundings are moving. Dizziness and vertigo symptoms can be treated by a physical therapist specifically trained to treat balance symptoms.

Sleep symptoms

Trouble sleeping and other sleep symptoms are common after a concussion. Learning about good sleep habits, known as sleep hygiene, can help. This includes going to bed and waking up on a regular schedule. Sometimes medicines may be needed to improve sleep.

Vision

Vision changes also are common after concussion. These include blurry vision and sometimes double vision. Often vision changes get better on their own. Some people with persistent post-concussive symptoms may need to see a specialist who treats visual symptoms related to traumatic brain injuries, known as a neuro-optometrist.

Sensitivity to light and sound

For some people with persistent post-concussive symptoms, light and sound are bothersome. These symptoms tend to get better with time. But exposure therapy with a physical or occupational therapist may help these symptoms.

Irritability, depression and anxiety

Symptoms often improve once you understand the cause of your symptoms and that symptoms are likely to get better with time. Learning about persistent post-concussive symptoms can help ease fears and offer some peace of mind. If you have new or increasing depression or anxiety after a concussion, some treatment options may include:

• Psychotherapy. Talking with a psychologist, psychiatrist or social worker who works with people who have had a brain injury may help.
• Medicine. Medicines can treat depression and anxiety.
• Physical activity. Early, gradual exercise that avoids reinjury may help you feel better.

You first may see a member of your healthcare team, who makes the initial diagnosis of a concussion. Or the diagnosis might be made by a healthcare professional in the emergency room.

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

Here's some information to help you get ready for your appointment and know what to expect.

What you can do

Take these steps to help you prepare for your appointment.

• Write down any symptoms you're experiencing, including any that may not seem related 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 and the doses.
• 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 healthcare professional.

Prepare a list of questions to 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 healthcare professional include:

• Why are these symptoms still occurring?
• How long will these symptoms 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?

Don't hesitate to ask any other questions you have during your appointment.

What to expect from your doctor

Your healthcare professional 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 healthcare professional 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 improve your symptoms?
• What, if anything, makes your symptoms worse?
• Are your symptoms getting worse, staying the same or getting better?