Persistent post-concussive symptoms, also called post-concussion syndrome, occurs when concussion symptoms last beyond the expected recovery period after the initial injury. The usual recovery period is weeks to months. These symptoms may include headaches, dizziness, and problems with concentration and memory.
Concussion is a mild traumatic brain injury that usually happens after a blow to the head. It can also occur with violent shaking and movement of the head or body. You don't have to lose consciousness to get a concussion or experience persistent post-concussive symptoms. In fact, the risk of developing persistent post-concussive symptoms doesn't appear to be associated with the severity of the initial injury.
In most people, symptoms occur within the first seven to 10 days and go away within three months. Sometimes, they can persist for a year or more.
The goal of treatment after concussion is to effectively manage your symptoms.
Persistent post-concussive symptoms include:
Post-concussion headaches can vary and may feel like tension-type headaches or migraines. Most often, they are tension-type headaches. These may be associated with a neck injury that happened at the same time as the head injury.
See a doctor if you experience a head injury severe enough to cause confusion or amnesia — even if you never lost consciousness.
If a concussion occurs while you're playing a sport, don't go back in the game. Seek medical attention so that you don't risk worsening your injury.
Some experts believe persistent post-concussive symptoms are caused by structural damage to the brain or disruption of the messaging system within the nerves, caused by the impact that caused the concussion.
Others believe persistent post-concussive symptoms are related to psychological factors. The most common symptoms — headache, dizziness and sleep problems — are similar to those often experienced by people diagnosed with depression, anxiety or post-traumatic stress disorder.
In many cases, both physical damage of brain trauma and emotional reactions to these effects play a role in the development of symptoms.
However, some research shows that certain factors are more common in people who develop persistent post-concussive symptoms compared with those who don't. These factors include a history of depression, anxiety, post-traumatic stress disorder, significant life stressors, a poor social support system and lack of coping skills.
More research is still needed to better understand how and why persistent post-concussive symptoms happen after some injuries and not others.
Risk factors for developing persistent post-concussive symptoms include:
The only known way to prevent the development of persistent post-concussive symptoms is to avoid the head injury in the first place.
Although you can't prepare for every potential situation, here are some tips for avoiding common causes of head injuries:
No single test will prove you have persistent post-concussive symptoms.
Your doctor may want to order a scan of your brain to check for other potential problems that could be causing your symptoms. A computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be performed to detect structural brain abnormalities.
If you're experiencing a lot of dizziness, you may be referred to a doctor who specializes in ear, nose and throat complaints.
A referral to a psychologist or licensed counselor may be in order if your symptoms include anxiety or depression, or if you're having problems with memory or problem-solving.
There is no specific treatment for persistent post-concussive symptoms. Your doctor will treat the individual symptoms you're experiencing. The types of symptoms and their frequency are different for everyone.
Medications commonly used for migraines or tension-type headaches, including some antidepressants, antihypertensive agents and anti-epileptic agents, appear to be effective for post-concussion types of headaches. Medications are usually specific to the individual, so you and your doctor will discuss which are most appropriate for you.
Keep in mind that the overuse of over-the-counter and prescription pain relievers may contribute to persistent post-concussion headaches.
No medications are currently recommended specifically for the treatment of cognitive problems after mild traumatic brain injury. Time may be the best therapy if you have cognitive problems. Most of them go away on their own in the weeks to months after the injury.
Certain forms of cognitive therapy may be helpful, including focused rehabilitation that provides training in the specific areas that you need to strengthen. Some people may need occupational or speech therapy. Stress can increase the intensity of cognitive symptoms, and learning stress management strategies can be helpful to decrease cognitive symptoms. Relaxation therapy also may help.
Persistent post-concussive symptoms often improve after the affected person learns that there is a cause for his or her symptoms and that the symptoms will likely improve with time. Education about the disorder can ease a person's fears and help provide peace of mind.
If you're experiencing new or increasing depression or anxiety after a concussion, some treatment options include:
An emergency room doctor often makes the initial diagnosis of a concussion. Once discharged, you may seek care from your family doctor or primary doctor.
He or she may refer you to a doctor who specializes in brain and nervous system disorders (neurologist) or a brain rehabilitation specialist (physiatrist).
If you are referred to a specialist, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
Preparing a list of questions can help you 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 doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
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