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A Complete Guide to Post-Concussion Syndrome

A Complete Guide to Post-Concussion Syndrome

Concussions  |  Traumatic Brain Injury  |  Post Concussion Treatment

Post-concussion syndrome occurs when concussion symptoms persist for 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:

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.

What Is Post-Concussion Syndrome?

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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, such as recall words or learn new things, they are not able to complete the task. 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 unable to properly signal for enough oxygenated blood to complete the procedures 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.

Note: To be honest, we don't like the term "post-concussion syndrome." The word "syndrome" implies that we don't understand what causes post-concussion symptoms, when in reality, we do. And not only do we know what causes it, we can treat it, too. We'd love to see the language shift from "post-concussion syndrome" to "post-concussion symptoms." But since many of our patients are familiar with the term "post-concussion syndrome," we've used it here as in years past.

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 symptoms of concussion they are experiencing. That said, PCS can be permanent if you never seek proper treatment for the condition.

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, 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 after those four treatment days. Many patients continue to report decreased symptoms and increased quality of life over time.

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SIS stands for "Severity Index Score," which describes the severity of brain dysfunction as identified via an fNCI scan. PCSS stands for "post-concussion symptom scale." It describes self-reported symptom severity.

In our most recent research publication, we explain the fNCI (functional neurocognitive imaging, a type of functional MRI) that we use to “see” the dysfunctional brain regions for each patient. Using that information, we can 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 and autonomic nervous system (ANS) dysregulation play 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 the research mentioned above, 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?

Multiple concussions will not necessarily cause post-concussion syndrome, but they are a risk factor for developing PCS.  We do not know why some individuals develop PCS symptoms and others do not, but we do know that you have a chance of developing PCS after every concussion. This topic is still being researched. To learn about how multiple concussions can affect the brain, you can read our post: Multiple Concussions: Long-Term Effects and Treatment Options.

Post-Concussion Syndrome Symptoms

Post-Concussion Syndrome (PCS) occurs when common symptoms of concussion — such as headaches, dizziness, poor concentration, irregular sleep patterns, or changes in mood — remain longer than three months after the initial concussion. We compiled a list of common symptoms of post-concussion syndrome reported by patients:

Post-Concussion Symptoms List with bullets

The symptoms from your initial injury may not be the same as the symptoms you experience over time.

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. 

Unfortunately, concussive symptoms are not limited to cognitive symptoms listed above; you may find you have sleep disturbances, balance problems (when you did not before your concussion), or psychological symptoms such as 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. As we work on patient education, we’ve developed resources to help patients understand specific post-concussion symptoms:

Post-concussion syndrome 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 problems. 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.

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.

Post-Concussion Syndrome Symptoms Years Later

If you have persistent symptoms beyond a year, it is safe to say the brain will not heal from that injury without treatment of post-concussion syndrome. When looking at the long-term effects of post-concussion syndrome, the symptoms you experience often get worse over time instead of getting better.

In adults, as the brain ages, there is a natural decline in mental function. When you add a complication such as post-concussion symptoms onto this natural decline in function, the two cause a decrease in mental capability.

In addition, post-concussion symptoms often feed into each other. For example, if you have headaches and trouble sleeping, the two will make each other worse over time. The concussion headaches can make it harder to sleep; the sleep problems (insomnia, waking up a lot at night, poor sleep quality, etc.) make you more likely to have headaches. And with those, other symptoms such as brain fog, fatigue, ability to focus, and so forth, can all get worse as well.

Patients often find themselves in a slow, downward spiral that they can’t get out of without help. Not only does it take a severe toll on their quality of life, but it can also worsen any existing psychiatric disorders or emotional symptoms they experience.

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 such as emotions, behavior, and motivation). It is very common for a concussion to affect your mental health.

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 also 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 and mental disorders 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 their feelings and express what they are feeling to others. To learn more about concussions and psychological factors, read our post on personality changes after a brain injury or concussion.

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

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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:

  1. Attentional
  2. Subcortical
  3. Visual
  4. Language
  5. Executive

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

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If you are diagnosed with post-concussion syndrome, what should you do next? We’ll share some resources in this section.

Active Rehabilitation of Concussion and Post-Concussion Syndrome

At our post-concussion treatment clinic, we use a combination of exercise and multidisciplinary therapy. Our patients benefit from a phenomenon called the 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 to neurorehabilitation for post-concussion symptoms and how it compares to other clinics, 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-concussional symptoms, that puts extra strain 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 (when combined with black pepper) has been 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 such as “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.

Keep in mind that not all health care providers are capable of treating PCS well. A primary care doctor will not be able to help you much. Neurologists are often able to provide medication, but may or may not have a system in place to connect you with specialists in neuropsychology, physical therapy, and cognitive therapy. Sports medicine doctors can have good programs in place, but their education may not have been geared toward treating mild traumatic brain injury.

Do your research and don’t be afraid to ask questions or leave for a new doctor if the one you’re seeing isn’t getting results.

Persistent Post-Concussion Syndrome: What If Your Symptoms Haven’t Responded to Treatment?

Sometimes, doctors and researchers use the phrase “persistent post-concussion syndrome” to describe what patients experience when their post-concussion symptoms aren’t going away. But since most post-concussion syndrome cases don’t go away without treatment, we treat the terms as synonymous.

That being said, we’ve spoken with plenty of patients who were frustrated because they didn’t get better after treatment by other doctors or at other clinics. In that sense, their PCS really is persistent — symptoms remained even after treatment.

One of our patients, Sam Pembleton, tried all of the concussion clinics she could get to in Ontario with no luck. She even flew to a clinic in Boston, and they sent her home because she wasn’t responding to treatment. She suffered through five years of persistent post-concussion symptoms before she came to Cognitive FX. After treatment at our clinic, she was able to work and finish school, go out with friends, and simply enjoy life again.

One of our other patients, Myrthe van Boon, was told by her doctors that she would never recover from her skiing head injury. After treatment, her quality of life improved rapidly; she felt like she could finally be present in her daughters’ lives the way she’d dreamed.

So how can you go through treatment at multiple facilities and still not recover from PCS? As it turns out, most cases of post-concussion syndrome are treatable, but not all patients respond well to the exact same treatment. Post-concussion syndrome is not one-size-fits-all. The brain regions affected by your brain injury are not necessarily the same as the regions that were damaged for someone else.

But most treatment programs don’t take these differences into account, in part because they often don’t have the ability to determine precisely how and where the patient experienced neurotrauma. Making matters worse, not all doctors have the same familiarity with traumatic brain injuries and how best to treat them.

As a result, some patients are only given medication or maybe some occupational therapy to help them adjust to life with symptoms. Others are given therapy — some of which can be truly excellent — but not at the right pace or intensity for neuroplasticity to kick in. Others may provide perfectly good regimens that simply aren’t tailored enough to the needs of the patient.

That’s why providing each patient with an fNCI scan is so important to our work. It tells us which regions were affected, which in turn lets us know exactly what kind of treatment you should respond well to. And that’s why patients like Sam and Myrthe, who tried many different doctors, were able to make progress under our care but not elsewhere.

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.

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 years-old injuries make significant progress after treatment. Just because you’re having symptoms of a concussion years after the 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 to PCS recovery here.

Post-Concussion Syndrome Recovery Time

A recent study found that only 27% of PCS 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,” 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 states that 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 cases resolve 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

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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:

  • One of our patients, Olivia, was a figure skater who suffered from post-concussion syndrome for years without knowing what it was. Once she learned about PCS, she visited our clinic for treatment, then wrote about her many symptoms, her fNCI scan, and her experience with therapy at Cognitive FX
  • We interviewed Myrthe van Boon, who came to Cognitive FX from the Netherlands in October 2018. Her persistent post-concussive 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. 

Conclusion

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.

 

Editor's Note: This post was originally published in August 2019 and has since been updated with additional information.

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.