The terminology defining the symptoms following a concussion can be confusing. Technically, the diagnosis for the symptoms immediately following a mild head injury is a “concussion.” When those symptoms last longer than one month, the diagnosis becomes “post-concussion syndrome,” which is a complex condition of a prolonged recovery following a concussion.
It is currently unknown what causes post-concussion syndrome. There are several theories, including disruption of the messaging system within the nerves, structural damage, or psychological factors. Or quite possibly, a combination of the physiological effects of brain trauma plus the emotional reactions to these effects that are playing a role in the continuation of symptoms.
What correlates best with the chance a concussion will progress to post-concussion syndrome is a high number and severity of symptoms when the concussion is first sustained. That said, the correlation is far from perfect, which means someone can have a fairly mild bump to the head and have symptoms for two months while another has a severe blow to the head in a hockey match and be cleared in two weeks.
We also know that if one has certain conditions before the concussion is sustained, the chance for post-concussion syndrome is increased. These conditions include a learning disability like ADD or ADHD, migraine headaches, seizure disorder, or emotional problems with anxiety, depression, or panic attacks.
Symptoms, Diagnosis and Treatment
Some of the symptoms patients might experience include headaches, dizziness, feeling tired, feeling irritable or anxious, memory problems or difficulty paying attention, trouble sleeping, and easily bothered by light or noise. We also know that stress, anxiety, lack of sleep and depression can exacerbate these symptoms.
Do you need brain imaging to diagnosis this? Usually, no. Brain imaging is normal in post-concussion syndrome. A diagnosis is clinically made based off your history of head injury along with the pattern and duration of your symptoms, as well as neurological findings such as deficits in cognition, balance, eye movements, sleep or emotional deficits.
Treatment can involve rehabilitation therapies, such as cognitive therapy for problems with memory, concentration, and slowed processing speed; vestibular therapy for difficulties with balance; ocular therapy for eye tracking deficits; or cervicogenic physical therapy for upper neck/occipital headaches. Other therapies include counseling for emotional problems with anxiety or depression, prescribed exercise, medication management, stress reduction techniques and a graded return to all activities (school, work, sports, etc).
Ellen McKinnon is a board-certified family nurse practitioner with Emerson Hospital’s Dr. Robert C. Cantu Concussion Center in Concord, Mass. To learn more, call 978-287-8250 or visit emersonhospital.org/concussion.