But if you experience lingering symptoms, including headache, dizziness, fatigue, trouble concentrating, insomnia, or mood changes, for weeks or months after the initial injury, you might be suffering from post-concussion syndrome. “It’s a controversial diagnosis because there’s debate about whether post-concussion syndrome refers to a unitary condition,” says Prin Amorapanth, MD, PhD, a clinical instructor of rehabilitation medicine at the Rusk Rehabilitation Center at the NYU Langone Medical Center in New York City. “There’s no real consensus about how to make the diagnosis. It depends very much on the clinician you’re speaking to.” There also isn’t a consensus about how long symptoms need to last for it to be considered post-concussion syndrome. Some clinicians use the presence of symptoms beyond two weeks as a cut-off to make the diagnosis, while others use three months or longer.
Symptoms and Risk Factors of Post-Concussion Syndrome
Generally, post-concussion syndrome is diagnosed after someone suffers a mild traumatic brain injury (TBI), or a concussion, and has three or more of the following symptoms:
HeadacheDizzinessFatigueIrritabilityProblems with memory or concentrationInsomniaA reduced tolerance for noise or light
Andrew Gregory, MD, an associate professor of orthopedics, neurosurgery, and pediatrics at the Vanderbilt University School of Medicine in Nashville, Tennessee, notes that there’s no way to know how long the syndrome will take to resolve — it could be weeks to months to a couple of years in severe cases. “It’s open-ended,” Dr. Gregory says. Surprisingly, there isn’t necessarily a correlation between the severity of the TBI and post-concussion syndrome — but there are other contributing factors at play. For example, people with co-occurring conditions (comorbidities) tend to take longer to recover, Gregory says. In particular, those who suffer from anxiety, depression, or attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) are more likely to experience post-concussion syndrome. People who suffer from chronic pain, such as migraines, appear to be more susceptible to long-lasting post-concussion symptoms, Gregory notes. There’s also some evidence that those with higher stress levels or a poor social support system in general may be especially vulnerable. “The trick is to try to tease out whether there are other things going on that could be contributing to the lingering symptoms,” Gregory says. There’s also some evidence that women report greater post-concussive symptoms. In a study published in June 2017 in the journal Psychiatry Research, researchers examined the gender disparity with post-concussion syndrome and looked at whether anxiety sensitivity (which is higher among women) or distress tolerance (which is lower among women) played a role. It turns out, higher anxiety sensitivity partly explained the gender disparity, which makes sense, as the researchers pointed out, because if someone interprets post-concussive symptoms as dangerous, it amplifies her perception and experience of the syndrome’s severity. Having a history of multiple concussions can also prolong recovery. In a study published in April 2016 in the journal Neurosurgical Focus, research into college athletes from a variety of sports found that recurrent concussions and certain concussion-related symptoms — especially retrograde amnesia (a loss of memory about how the injury happened) and difficulty concentrating — were most closely associated with a higher risk of developing post-concussion syndrome. “The more concussions you have, the longer it takes to recover and the less injury it takes to cause [a subsequent] concussion,” Gregory explains. “If you’ve had two concussions, your risk of having another one is twice as high; if you’ve had three concussions, it’s three times higher.”
How to Treat Post-Concussion Syndrome
Treating post-concussion syndrome can also be as challenging as it is to diagnose, partly because the symptoms are so varied and there isn’t a central cause. “The recognition of specific symptoms is what directs [specialized] treatment,” Dr. Amorapanth says. If you’re having balance problems, you might be sent for vestibular therapy. A small study published in October 2017 in the journal Gait & Posture found that when people with balance problems due to post-concussion syndrome did daily balance, visual, and neck strengthening exercises that were prescribed by a physiotherapist, they gained significant improvements in balance control (with their eyes open or closed) over the course of eight weeks. Lingering vision problems might warrant ocular therapy, whereas if you are struggling with mood or emotion regulation, you might be referred for psychotherapy or medication, such as antidepressants. In general, there are a few things anyone suffering from post-concussion syndrome should do while recovering:
Eat a healthy diet. It’s important to consume a healthy diet so your brain gets the macro- and micronutrients and the calories it needs for recovery and proper functioning, Amorapanth says. In particular, make an effort to consume plenty of essential fatty acids (from fatty fish, walnuts, chia seeds, and flaxseeds), because they help optimize memory and cognitive function, according to previous research published in the journal Surgical Neurology.Get exercise. Aerobic activity, under a clinician’s supervision, is crucial for recovery after a concussion because it supports the restoration of normal blood flow in the brain, as well as neuroplasticity, the rewiring of brain circuitry that’s crucial for rehabilitation, Amorapanth notes. Stop exercise immediately if you begin to experience any post-concussion symptoms, though.Practice good sleep hygiene. “For people recovering from a brain injury, sleep needs to be a priority,” Amorapanth says. “It’s a restorative state through which the brain recovers from the challenges of the day and consolidates new information and other changes.” If insomnia is giving you problems, talk to your doctor about whether you’d benefit from taking melatonin, which can reset your body’s internal clock to help you sleep at night, Amorapanth says.Manage stress. Taking steps to relieve stress can help ease the strain on your brain as you’re recovering, Amorapanth says. In fact, research published in August 2013 in the Journal of Head Trauma Rehabilitation found that after people with post-concussion syndrome participated in a weekly mindfulness-based stress reduction program, they gained significant improvements in their quality of life and self-efficacy, as well as smaller boosts in their working memory and attention after 10 weeks. Meanwhile, “resume school or work activities as soon as you can, but take breaks or extra time as you need it, and use earplugs” to minimize noise and distractions, Gregory says.
“Being evaluated by a clinician with specific experience in identifying the many possible presentations of concussion is crucial to successful diagnosis and treatment,” Amorapanth says. With the right interventions, you can enhance your chances of getting back to feeling and functioning like your usual self.
