A Complete Guide to Post-Concussion Syndrome
Post-concussion syndrome occurs when concussion symptoms persist for weeks, months, or years after sustaining a mild traumatic brain injury (mTBI). If you or a loved one received a post-concussion syndrome (PCS) diagnosis, you're probably wondering if it's treatable. (Short answer: yes!) You may also want to know how long recovery takes, what you can do to alleviate symptoms, and whether what you're experiencing is "normal."
We treat post-concussion patients every day and regularly answer these questions for our patients. This guide will help you understand post-concussion syndrome in depth by answering a number of questions, including:
What Is Post-Concussion Syndrome?
Post-concussion syndrome (PCS) is a condition that is typically associated with an injury to the brain caused by a concussive event (falls, car accidents, contact sports, etc). It doesn’t take a direct hit or loss of consciousness to constitute a concussion; many patients suffer concussion symptoms after whiplash or jostling of their brains.
After a head injury, the affected cells are unable to get enough oxygen to power the signaling in your brain. When you try to do something that those cells control, like recall words or learn new things, they are not able to complete the task due to the lack of oxygen. As a result, other neural pathways will develop in order to pass along the information. These pathways may not be the most effective and can cause the brain to work less efficiently.
Sometimes the injured cells are still not able to properly signal for enough oxygenated blood to complete the procedures that they used to do. Generally, the weak signals yield long-lasting concussion symptoms known as post-concussion symptoms (also known as post-concussion syndrome or postconcussive syndrome).
These symptoms can last for weeks, months, or even years after the concussive event. In general, if your symptoms have not gone away after three months, it could be time to look into available treatment options.
If you’re experiencing symptoms that won’t resolve after one or more concussions, you’re not alone. And you’re not crazy. On average, our patients improve by 75% after treatment at our center specializing in post-concussion therapy. To see if you are eligible for treatment, sign up for a free consultation.
Can Post-Concussion Syndrome Be Permanent?
No, post-concussion syndrome is not permanent. It can be more difficult to treat for some people due to other underlying factors, including cervical spine problems, that contribute to the long-lasting concussion symptoms they are experiencing.
In one of our published research articles we collected and analyzed data from 270 concussed patients. We were able to confirm the effectiveness of the fNCI-based and accelerated concussion treatment approach that we founded Cognitive FX on. (It was this research that inspired the founders to develop the clinic into the fully functional treatment center that it is today.) From this research, it was observed that patients had significant improvement in both objective and subjective data reporting after four days of EPIC Treatment. On average, the patients improved by 75% on the severity index score (severity of the dysregulation of blood flow in the brain). Of the 270 concussed patients, 62% percent of the patients reported an improvement of their post-concussion symptoms.
In our most recent research publication, we explain the fNCI (functional neurocognitive imaging, a type of functional MRI) that we use to develop a custom treatment program for our patients struggling with PCS. The publication also details how fNCI is able to reveal dysregulation within the brain by tracking blood-oxygen-level-dependent signaling.
fNCI is also used to show that neurovascular coupling (NVC) dysregulation, along with autonomic nervous system (ANS) dysregulation, plays a significant role in post-concussion syndrome. This research shows how the treatment program we offer is able to target and repair the dysregulations found in post-concussion syndrome. To understand more about the role neuroplasticity plays in our treatment program, dive into our blog post: Neuroplasticity Treatment: How It Can Help You Recover From a Brain Injury.
Note: To read more about the research mentioned, download a copy of “Developing the Standard of Care for Post-Concussion Treatment: Neuroimaging-Guided Rehabilitation of Neurovascular Coupling” and “Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging.”
Do Multiple Concussions Matter?
At this time there is no scientific proof that multiple concussions are the root cause of PCS. We simply do not know why some individuals develop PCS symptoms and others do not. This is a topic that is actively being researched. To learn about how multiple concussions can affect the brain read our post: Multiple Concussions: Long-Term Effects and Treatment Options.
Post-Concussion Syndrome Symptoms
Post-Concussion Syndrome (PCS) occurs when concussion symptoms like headaches, dizziness, lack of focus, irregular sleep patterns, or changes in mood remain longer than three months after the initial concussion. We compiled a list of common post-concussion symptoms reported by patients.
Cognitive symptoms from a traumatic brain injury can appear in various ways—difficulty remembering things, brain fog, difficulty concentrating, light sensitivity, and difficulty finding things. As shown in the graphic above, post-concussion symptoms come in a wide variety. Unfortunately concussive symptoms are not limited to the symptoms listed above; you may find you have sleep disturbances, difficulty finding words, or balance problems (when you did not before your concussion). Many patients also have psychological symptoms like irritability, anxiety, or depression.
Your specific symptoms may vary from the norm or they may be quite similar to what other patients experience. The good news is that it’s usually still treatable.
Post-Concussion Syndrome Symptoms Years Later
If you have persistent symptoms beyond a year, it is safe to say that the brain will not heal from that injury without treatment of post-concussion syndrome. When talking about the long-term effects of post-concussion syndrome, these symptoms often get worse over time instead of getting better. In adults, as the brain ages, there is a natural decline in mental function. When someone adds a complication such as post-concussion symptoms onto this natural decline in function, the symptoms tend to evolve over time causing a decrease in mental capability.
Post-Concussion Syndrome: Depression, Anxiety, and Other Emotional Symptoms
Brain injuries can damage connections that go from the cerebral cortex (the part of the brain that has a role in memory, attention, perception, cognition, and awareness) to the limbic system (the part of the brain that supports functions like emotions, behavior, and motivation). A brain injury is emotionally traumatic as well as cognitively debilitating. People can respond with frustration, anger, anxiety, and depression to their changed capabilities and life circumstances. It’s not uncommon for a mild head injury and PTSD (posttraumatic stress disorder) to go hand-in-hand.
After a concussive event it is common for someone to experience changes in their personality due to the damaged connections in the brain. Personality changes can occur due to how the brain interprets the information it is provided and how it processes this information. This can make it difficult for someone to understand the feelings they feel and make it difficult for them to express what they are feeling to others. To learn more about concussions and psychological factors read our post: Personality Changes After a Brain Injury or Concussion.
Post-concussion syndrome (PCS) can also cause memory loss. This is a common and frequently reported symptom we see at our post-concussion syndrome treatment clinic. A concussion can cause short-term and long-term memory issues. Read our blog post, Concussion Memory Loss: Recovery Stories From 6 mTBI Patients to learn about how memory loss has affected some of our patients.
In both cases, symptoms can be exacerbated by sleep problems.
Note: If you’re experiencing symptoms that won’t resolve after one or more concussions, you’re not alone. 95% of our patients experience statistically verified restoration of brain function. To see if you are eligible for treatment, sign up for a free consultation.
Post-Concussion Syndrome Tests
There is no one test available to prove you have post-concussion syndrome. Your doctor might want to order a scan of your brain to check for potential problems that could be causing symptoms of PCS. A computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be performed to detect structural brain abnormalities, however these scans will not identify the presence of PCS. If you're experiencing a lot of dizziness, you could be referred to a medical professional who specializes in ear, nose and throat complaints.
A referral to a psychologist or licensed counselor may be recommended if your symptoms include anxiety or if you're having problems with memory.
Fortunately, there are more tests for post-concussion syndrome than that. The fNCI we offer, various tests for physical symptoms, and self-reported symptom checklists can all be used in diagnosis. To learn more about PCS test options, you can read this post: Post-Concussion Syndrome Tests: How to Know If You Have Post Concussion Syndrome.
Diagnosing Post-Concussion Syndrome
Typically a person is diagnosed with post-concussion syndrome (PCS) when their symptoms last longer than three months and other potential causes for the symptoms have been observed but ruled out as the cause of the patient’s persistent symptoms. Neuropsychological evaluations can be done to diagnose post-concussion syndrome but these evaluations are not always accurate.
At Cognitive FX, we look at five biomarkers to conclude if a person has post-concussion syndrome. The more biomarkers a person has that are irregular, the greater chance they have had a concussion/post-concussion syndrome. These 5 biomarkers are:
On average, 4% of patients meet all five biomarkers, 43% meet four biomarkers, 88% meet three biomarkers, and 100% meet at least two biomarkers. It’s worth noting that 95% of non concussed people only meet 1 biomarker or below, making these biomarkers extremely helpful in diagnosis.
Are you seeking a post-concussion syndrome diagnosis? We can help. Sign up for a free consultation to learn what steps you can take next.
Can an MRI Detect Post-Concussion Syndrome?
In most cases, an MRI cannot detect post-concussion syndrome. An MRI uses magnets to look at protons (positively charged particles) in water. When thinking of a brain scan, that means the image is of the soft tissue in your head. It doesn’t show the skull bones well, but it will show the structure of your brain because that’s where the water is. The protons in water respond to a magnetic field differently based on what kind of tissue they’re in. By using MRI technology, we can look at those differences to determine what kind of tissue is being observed and the shape of that tissue. Because of this, a regular MRI is powerful at detecting serious issues in the brain like strokes, aneurysms, tumors, bleeding, and so forth.
Unlike structural damage caused by tumors or brain bleeds, mild traumatic brain injuries do not show up on standard brain imaging tests because the tissue is not damaged in an obvious way. Head trauma impacts the ability of neurons to signal for the right amount of blood to accomplish certain processes but does not impact the structure of the cells themselves. To learn more about the difference between an MRI scan and an fNCI scan read our post: Can an MRI Detect Post-Concussion Syndrome?
Post-Concussion Syndrome Treatment
Active Rehabilitation of Concussion and Post-Concussion Syndrome
At our post-concussion treatment clinic, we utilize the phenomenon called Post Exercise Cognitive Boost (PECB). In short, aerobic activity brings on an increase of essential neurotransmitters and proteins in your brain that help develop and promote blood flow. Due to this increase, your brain is more able to perform complex cognitive challenges for longer periods of time. Essentially, the PECB provides a window of time after exercise in which cognitive abilities are sharpened. Exercising consistently over time also has long-term benefits for your cognitive function. To learn more about our approach with active rehabilitation for post-concussion symptoms, you can read this post: Concussion Rehabilitation: Types of Therapy and How They Can Help You.
Medication for Post-Concussion Syndrome
Medications often come with side effects and/or long-term consequences. If you’re taking multiple medications to manage post-concussion symptoms, extra strain is put on your liver. Anything you can do to relieve or minimize symptoms without medication is usually better for your overall health. To learn more, read our blog: 50+ Medications for Concussions and Post-Concussion Syndrome: What Works, What Doesn’t, and What to Do Instead to learn more about the impact medications can have on you.
Natural Remedies for Post-Concussion Syndrome
We tend to stay out of the supplements conversation, but there are a few natural remedies we have seen our patients taking that you may find helpful as well:
B12 (also known as folate) is known to help with mental fatigue and irritability because it can be quickly broken down and provide the body with energy. (This is why drinks like 5-hour Energy contain B12 along with other B vitamins).
Curcumin is the key active ingredient in turmeric. Curcumin and turmeric were shown to have antioxidant and anti-inflammatory effects.
Magnesium plays a role in the transportation of calcium and potassium ions across cell membranes, a process that is important in nerve impulse conduction and normal heart rhythm.
Melatonin is a hormone found naturally in the body. Some take melatonin to adjust the body's internal clock. It is most commonly used for improving sleep or insomnia.
Top Doctors for Post-Concussion Syndrome
We understand that you may not be able to travel to our office in Provo, Utah for post-concussion syndrome therapy. Instead you may want to see what your options are for clinics in your local area. Because we want to help you make an informed decision about your health care options, we have created a blog explaining how to find the best concussion clinics in the United States. The blog post answers questions like “Do I need to go to a concussion clinic?” “What types of services does a clinic offer?” and “How can you tell if a concussion clinic is good or not?” To learn more about concussion treatment options across the U.S read our post: How to Find the Best Concussion Clinics Near You.
Post-Concussion Syndrome Recovery
Many studies have found that PCS recovery time varies drastically. Some recover after a couple of weeks without any long-term side effects, others struggle with symptoms for the rest of their lives. Studies even go as far to state that, “PCS may be permanent if recovery has not occurred by 3 years” (Hiploylee et al. 2017).
Fortunately, we’ve seen many patients with old injuries make significant progress after treatment. Just because you’re having symptoms years after a head injury doesn’t mean they can’t improve with professional guidance!
For more information about post-concussion syndrome recovery, please read our extensive guide here.
Post-Concussion Syndrome Recovery Time
A recent study found that only 27% of sufferers meeting criteria for post-concussion syndrome at three months post-injury eventually made a full recovery (Bigler et al., 2017). In the article “Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury” which was published in the May 2017 issue of JAMA Neurology, it states that many concussion patients experience the evolution of symptoms five years after mild TBI, not the resolution of symptoms. 72% of patients had worsening symptoms after five years. This clearly shows that chronic concussion symptoms are likely to progress over time, rather than resolve. This can leave PCS sufferers with little or no hope of recovery.
Many research sources say that PCS is not treatable. Some state that therapies such as cognitive therapy, occupational therapy, and vision therapy can be used to reduce symptoms, but those lingering symptoms will last for the rest of their lives. However, since EPIC treatment actually treats the source of the problem, it can drastically reduce symptoms and in some rare cases cure all symptoms.
On average, our patients report a 60% improvement in their symptoms in one week. We performed a follow-up research fNCI on 28 previous EPIC patients approximately one year post EPIC treatment. The average amount of time between the completion of EPIC and the follow-up fNCI was 329 days. We found that patient’s scores, on average, continue to improve — indicating that EPIC Treatment makes permanent changes in the brain to regulate neurovascular coupling and restore healthy brain function.
Patient Recovery Stories
It’s one thing to learn about the science behind EPIC Treatment (the program we offer), but we understand that it’s important to hear about real recovery stories, too. In addition to filmed testimonials, we have posts about several patients who wanted to share their recovery stories. We’ll keep adding more stories to our blog, but in the meantime, you can catch up on these stories:
We interviewed Myrthe van Boon, who came to Cognitive FX in October 2018. Her post-concussion symptoms — including chronic pain, overwhelm, light sensitivity, and more — were caused by a fall she had experienced 13 years ago while on a skiing trip. She discovered Cognitive FX after a friend had sent her a link to a blog post about Alies’ recovery journey and experience at Cognitive FX. Read more about Myrthe’s incredible concussion recovery journey.
We also had the opportunity to interview Sam Gray, who didn’t experience a concussion, making him unlike most patients we see. When Sam was 11 years old, a blood vessel in his brain broke. For 33 years Sam had been living with symptoms from the brain trauma. Sam discovered Cognitive FX from his older sister who had taken her son in for treatment after a skiing accident. Learn more about Sam’s amazing TBI recovery journey and how he is doing now as an EPIC graduate.
Another past patient we interviewed came to Cognitive FX from Canada! Sam was an avid soccer player in middle school. During one of her games, she was body checked by an opposing player. Although she didn’t hit her head, the whiplash that occurred began her five-year struggle with concussion symptoms. She exhausted all of the resources around her in the search for a cure. Her mother discovered Cognitive FX in one of the many Facebook groups she was a part of and shared the information with Sam. Read more here about Sam’s soccer concussion recovery journey.
If you are experiencing post-concussion symptoms that have not resolved on their own, you are not alone. Other patients have gone before you and found real relief from their suffering. We won’t promise you a miraculous one-week recovery that obliterates all your symptoms, but we can give you a fighting chance. Most of our patients go on to live the lives they left behind after their concussions. With perseverance, hard work, and good medical treatment, they’re able to overcome their brain damage.
On average, we help our patients improve by 75% in brain function after completing EPIC Treatment at our clinic. Our patients self-report an average improvement of 62% on their post-concussion symptoms, and most continue to improve after going home.
Want to know if EPIC Treatment is right for you? Sign up for a free consultation. We would be happy to discuss what options are available to you as a PCS patient.
About Dr. Alina Fong PhD
Alina K. Fong received her PhD in Clinical Neuropsychology with an emphasis in neuroradiology from Brigham Young University. She received the national American Psychological Association Clinical Neuropsychology Division 40 Graduate Student Research Award in 2004 for her research on "Cortical Sources of the N400 and 'The N400 Effect." Dr. Fong's interest in brain mapping soon turned to functional MRI, and since then, her research efforts have been focused on the clinical applications of fMRI.