What is Post-Concussion Syndrome?

Hard hits to the head in any sport, including ice hockey and football, can cause mild traumatic brain injury, which is essentially how a concussion is defined. Violent shaking or the impact of a car crash can also lead to a concussion.

As if an injury to the brain isn’t worrisome enough, there is also the possibility of developing post-concussion syndrome. Post-concussion syndrome refers to the persistence of various concussion symptoms long past the time of injury.

Researchers haven’t yet identified the reasons why some concussion victims suffer from post-concussion syndrome and others do not.

Some researchers believe the syndrome is caused by structural damage to the brain or disruption of the messaging system within the nerves, resulting from the impact that first resulted in a concussion. Others contend that the causes are rooted in psychological factors, since a number of the most common symptoms are also seen in people with anxiety, depression or post-traumatic stress disorder (PTSD).

Both the physiological impact of a concussion and the emotional reaction to it can contribute to post-concussion syndrome. You may be more susceptible if you have a history of PTSD, depression or anxiety, or if you have significant life stresses, poor coping skills or poor network of social supports.

Most people who suffer concussions recover within a few months, but, for others, symptoms linger on. These varied symptoms are generally labelled as post-concussion syndrome, a poorly understood and often misdiagnosed condition that can greatly affect quality of life.

Post-concussion syndrome is a difficult condition to diagnose because its symptoms can often be attributed to other causes and may also be vague.

Some of the most common post-concussion syndrome symptoms are

• Headaches
• Dizziness
• Problems with sleep

Other symptoms – physical, emotional and cognitive – include:

• Irritability or aggression on little or no provocation
• Apathy or lack of spontaneity
• Changes in personality
• Difficulty finding words
• Trouble in busy environments
• Light sensitivity
• Noise sensitivity
• Nausea/vomiting
• Difficulty following conversation that includes several people
• Difficulty initiating tasks
• Persevering at tasks.

In making a diagnosis, your physician may consider your history of head injury and symptoms, conduct a physical exam and request a magnetic resonance imaging (MRI) or computed tomography (CT) scan to check for any structural abnormalities in the brain. They may also attempt to rule out other causes of the symptoms, such as bleeding in the brain or infection.

There is no standard way of treating post-concussion syndrome. Your physician will provide and/or recommend treatment tailored to your individual symptoms. Everyone has a different mix of symptoms that occur with different frequencies. Education is a powerful tool in addressing post-concussion syndrome, because addressing the fears about the condition often help ameliorate symptoms.

If you have headaches, some of the medications used for migraines or tension headaches seem to be effective. Be aware that overuse of over-the-counter and prescription medications may lead to continuing symptoms.

For cognitive symptoms of post-concussion syndrome, time may be the best healer. Cognitive therapy may also be helpful, especially if it focuses on areas that need strengthening. Cognitive symptoms may increase with stress, so learning stress management techniques may lessen them; relaxation therapy is another option.

For cases of post-concussion syndrome that exhibit symptoms of depression or anxiety, the sufferer may opt for psychotherapy or request treatment with anti-depressants.

To improve quality of life, a course of physiotherapy may be suggested. Patients with post-concussion syndrome recover faster with physiotherapy than with rest alone, researchers have found (Schneider KJ et al. 2103). Physiotherapists may use various techniques, depending on symptoms. Manual therapy may calm the nervous system and acupuncture may improve sleep and headaches. Exercise therapy may help with balance and sensory reintegration.

There are no guaranteed ways of preventing post-concussion syndrome, but it is possible to take precautions against suffering a concussion in the first place.

Suggestions include:

• Avoid motor vehicle collisions: drive defensively and eliminate distractions such as phone calls or eating.
• Be cautious when playing sports: wear appropriate safety gear and avoid head collisions.
• Avoid tripping and falling by keeping clear paths indoors: be careful of throw rugs, watch placement of pet dishes and be aware of loose flooring.
• Educate yourself on concussions: be aware of risk factors, signs and symptoms, and how they can affect your health.

Your brain is precious – take good care of it and don’t return to your routines until you are completely symptom-free.