Post-concussion syndrome, also known as persistent post-concussion symptoms (PPCS), occurs when concussion symptoms persist for months or years after you sustain a mild traumatic brain injury (mTBI) or another type of brain trauma. 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 hundreds of post-concussion patients every year 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:
We also share stories from four patients who made successful post-concussion syndrome recoveries.
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, schedule a consultation.
Note: Any data relating to brain function mentioned in this post is from our first-generation fNCI scans. Gen 1 scans compared activation in various regions of the brain with a control database of healthy brains. Our clinic is now rolling out second-generation fNCI which looks both at the activation of individual brain regions and at the connections between brain regions. Results are interpreted and reported differently for Gen 2 than for Gen 1; reports will not look the same if you come into the clinic for treatment.
Post-concussion syndrome (PCS) occurs when a patient experiences persistent symptoms three months or more after a head injury. Those symptoms could include headaches, brain fog, fatigue, sleep problems, memory issues, vision problems, and more. PCS can develop after a concussive event (falls, car accidents, contact sports, etc) or another closed-head injury. 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.
Post-concussion syndrome can develop after a mild, moderate, or severe TBI. It can also come from brain traumas like carbon monoxide poisoning, transient ischemic attack (TIA), chemical exposure, certain viral or bacterial illnesses, surgery, and more.
Post-concussion symptoms stem primarily from dysfunctional neurovascular coupling (NVC), which is the dynamic relationship between neurons and the blood vessels that supply them. When you experience a concussion (or any TBI), your immune system causes inflammation near the site(s) of injury. The affected parts of your brain experience a temporary breakdown of tiny structures in and around those cells.
As a consequence, those cells don’t get the right amount of oxygen and at the right time to power the signaling your brain normally does. When you try to do something that those cells govern — like encoding a new memory or paying attention to a conversation — they won’t be able to accomplish the task. Other neural pathways will then attempt to complete the process, even though it’s a less efficient path for that information to take.
The result of NVC dysfunction is these hypoactive brain regions that can’t do their fair share of the work. Other brain regions will try to take on more work than they should, but they can’t do so efficiently. This tires your brain out, leading to post-traumatic headaches, feeling overwhelmed, irritability, and other symptoms.
For the majority of people who suffer from a concussion, symptoms usually resolve 3-6 weeks post head trauma. We assume that’s because the brain goes back to using the best pathways for any given process (although it may just be really good at compensating for the injury). But for post-concussion syndrome patients, the brain keeps using less efficient pathways to complete tasks even after the inflammation has resolved. That suboptimal signaling is what results in long-lasting concussion symptoms.
If suboptimal signaling seems confusing to you, think of it like road traffic. A healthy brain would distribute “traffic” — i.e., the signaling and blood flow dynamics needed for a task like reading — equally along existing pathways. Suboptimal signaling is like getting stuck in a traffic jam or taking a frontage road instead of the highway. It’s inefficient and requires more “gas” to get to the same destination.
The more your brain has to use suboptimal pathways, the more likely you are to experience symptoms.
A concussion may also result in...
These post-concussion complications can produce many of the long-lasting symptoms characteristic of post-concussion syndrome.
Post-concussion 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’s a good idea to explore 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," "postconcussional syndrome," and “postconcussive 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.
Post-concussion syndrome can be permanent if you do not receive treatment, but often resolves or improves with the right therapy. It can be more difficult to treat for some people due to other underlying factors, including cervical spine problems, that contribute to the symptoms of PCS 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.)
Patients who underwent four days of EPIC Treatment demonstrated significant improvement in both objective and subjective data. 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 of our patients continue to report decreased symptoms and increased quality of life over time.
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.
This research shows how the treatment program we offer is able to target and repair the dysregulations found in post-concussion syndrome thanks to neuroplasticity (our brain’s natural ability to adapt and recover).
Further reading: How neuroplasticity treatment can help you recover from a brain injury
Note: To read the research papers mentioned above, visit our publications archive.
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 each concussion.
That said, a previous concussion is not a reliable indictor of whether you will develop post-concussion syndrome. Some other indicators are more reliable. For example, women and those with pre-existing depression have a higher risk of developing PCS regardless of concussion history.
Up to 30% of all concussion patients develop lasting post-concussion symptoms and sequelae to some degree — a much higher incidence than you might expect given the current lack of awareness in the medical community.
Further reading: The long-term effects of multiple concussions
We compiled a list of the most common emotional, physical, and cognitive symptoms of post-concussion syndrome reported by patients:
| Emotional | Cognitive | Physical |
| Anxiety | Brain fog | Blood pressure changes |
| Depression | Difficulty concentrating | Change in (or loss of) taste or smell |
| Feeling overwhelmed | Difficulty finding things | Difficulty balancing |
| Impulsiveness | Difficulty reading | Dizziness or vertigo |
| Irritability | Getting lost | Exaggerated startle response |
| Mood swings | Long-term memory problems | Exercise intolerance |
| PTSD | Short-term memory problems | Fatigue |
| Social anxiety | Slowness to decide, think, speak, or act | Feeling anxious without anxious thoughts |
| Teariness | GI issues | |
| Headache | ||
| Heart rate issues | ||
| Intolerance of caffeine or alcohol | ||
| Light sensitivity | ||
| Nausea | ||
| Sexual dysfunction, low libido | ||
| Shaking or shivering | ||
| Sleep disruption | ||
| Temperature irregularities | ||
| Tension in the neck, jaw, and/or shoulders | ||
| Tinnitus | ||
| Vision problems (double vision, blurry vision, tired eyes, etc.) |
The symptoms from your initial injury may not be the same as the symptoms you experience over time. For example, you may find that initial confusion goes away, but exercise becomes increasingly difficult.
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:
Concussions lead to emotional symptoms, too. 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). Changes in mental health are some of the most common symptoms of PCS.
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. Even a mild head injury can lead to mental disorders like post traumatic stress disorder (PTSD).
Making matters worse, an injury affects how the brain interprets the information it receives and how it processes this information. This can make it difficult for someone to understand and express what they are feeling to others. Psychological factors can also increase the severity of other, non-emotional symptoms like sleep problems and headaches.
By the way, we created an online course that covers which types of headaches you can get after a concussion, as well as specific techniques for coping with those types of headaches. If you want to learn how to manage your headaches at home, visit our course.
We have written several guides for people struggling with mental health changes after injury:
Often, patients with emotional symptoms are given prescriptions for antidepressants, mood stabilizers, or other psychoactive drugs. A brain injury makes you more susceptible to negative side effects, so monitor your symptoms carefully. It is best to treat the brain injury with active therapy (something we’ll discuss below) and resolve any persisting mental health issues at a psychiatry practice. Your doctor can determine whether additional pharmaceutical intervention is necessary.
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, schedule a consultation.
Post-concussion symptoms can persist or recur years after the original injury. In general, PCS symptoms tend to stay the same or get worse over time until they are properly treated. Some patients also develop new symptoms due to complications from their condition.
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. History of concussion is also linked to structural and functional alterations in aging individuals, even in those that may present with “normal” neuropsychological performance.
In addition, post-concussion symptoms often feed into each other. For example, if you have migraines and trouble sleeping, the two will make each other worse over time. The concussion headaches can make it harder to sleep; the sleep disturbances (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 escape 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. This is why it is so important to get the right diagnosis and treatment, especially if your concussion symptoms are worsening.
The good news is that we’ve detected no difference in recovery rates whether you’ve had post-concussion syndrome for just a year or over a decade. The brain is still capable of healing all those years later!
Further reading: Former figure skater finds relief after fourteen years of post-concussion syndrome and Businessman recovers from persistent symptoms 33 years after his brain injury
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 serious damage. A computerized tomography scan (CT scan) or magnetic resonance imaging (MRI) may be performed to detect structural brain abnormalities or damage to the bone. That said, these scans will not identify the presence of PCS. If you're experiencing dizziness, you could be referred to a medical professional who specializes in ear, nose, and throat complaints.
Your doctor may recommend a psychologist or licensed counselor 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 physical and neuropsychological testing, and symptom reporting can all be used in diagnosis.
Further reading: Post-concussion syndrome tests
In most cases, an MRI cannot detect post-concussion syndrome. An MRI uses magnets to look at protons (positively charged particles) in water. In regards to a brain scan, that means the image is of the soft tissue in your head.
An MRI 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 such as 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?
At this point, you may be wondering why fNCI is effective, since it’s a type of MRI. fNCI is a type of functional MRI rather than a structural MRI. Functional MRI is designed specifically to show blood flow in an organ rather than the structural integrity of that organ. So, if you get a functional MRI of the brain, you can see which regions of the brain are calling for increased blood flow (generally indicative of increased activity).
By having patients complete the same set of tasks in the MRI machine, we can tell the difference between patients who have a healthy response to those tasks and those who don’t (post-concussion syndrome patients).
That information not only helps us diagnose PCS but also tailor treatment to the specific needs of each patient.
Typically, healthcare professionals will diagnose someone 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.
At Cognitive FX, we look at a number of indicators, including...
With the second generation of fNCI, we’re able to assess 56 brain regions for neurovascular coupling dysfunction as mapped to 27 functional descriptions:
An example of second-generation fNCI results for a healthy patient.
Note: While the fNCI is a key diagnostic tool, we also obtain a structural MRI of the brain and cervical spine for each patient. If we find any structural issues, we will refer you to a neurosurgery practice so you can get the help you need.
We use all of the data we collect to inform a personalized treatment plan that targets the specific physical and cognitive deficits you’re suffering from.
Are you seeking a post-concussion syndrome diagnosis? We can help. Schedule a consultation to learn what steps you can take next.
If you are diagnosed with post-concussion syndrome, what should you do next? The best treatment for post-concussion syndrome involves physical exercise and therapy from multiple disciplines. Some doctors try to manage PCS symptoms with medication, but this approach has serious downsides. There are also some natural remedies that can help, although they can’t fully treat the condition by themselves. We’ll share some resources regarding each in this section, along with where to find doctors who treat post-concussion syndrome.
Further reading: Post-concussion syndrome treatment options
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. One example is brain-derived neurotrophic factor, BDNF, which has been shown to increase post-exercise and help PCS patients in their recovery. 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.
At our clinic, we combine the PECB with a range of multidisciplinary therapies, including neuromuscular therapy, occupational therapy, cognitive therapy, neurointegration therapy, sensorimotor therapy, vestibular therapy, dynavision, and more. Patients also have scheduled rest with Brainwaves and at least two sessions with a psychologist.
To learn more about our approach to neurorehabilitation for post-concussion symptoms, you can also visit our EPIC (Enhanced Performance in Cognition) Treatment page.
Medications often come with side effects and/or long-term consequences, especially for brain-injured patients. And unfortunately, many patients find that their medications are minimally effective — if at all. Plus, if you’re taking multiple medications to manage post-concussional symptoms, that puts extra strain on your liver. Sadly, they are also the main solution many doctors turn to for PCS patients.
Adolescents face unique challenges with medications because they can have more serious side effects (such as suicidal feelings while using antidepressants) and we don’t know the long-term effect of these medications on the developing brain.
Anything you can do to relieve or minimize symptoms without medication is usually better for your overall health.
Further reading: Medications for post-concussion syndrome symptoms
There are a few natural remedies we have seen our patients taking that you may find helpful as well:
Do not start or stop taking supplements without consulting your doctor.
We have another post that takes a comprehensive look at natural remedies for post-concussion syndrome, including approaches like acupuncture, physical activity, diet, tea, and more.
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?”
Further reading: How to Find the Best Concussion Clinics Near You
There are many types of doctors you could visit for post-concussion medical care, including family physicians/pediatricians, sports medicine practitioners, emergency department doctors, neurologists, neuroradiologists, neuropsychologists, physical medicine and rehabilitation (PM&R) physicians (physiatrists), endocrinologists, and more.
Further reading: Types of head injury doctors
Keep in mind that not all health care providers are capable of treating PCS well:
Do your research and don’t be afraid to ask questions or find a new doctor if the one you’re seeing isn’t getting results.
If you haven’t yet had testing for hormone imbalances, you can ask your primary care doctor, OB/GYN, or endocrinologist to run some tests based on your symptoms. For more information, including questions to ask your doctor, read our article: How to talk to your doctor about hormone imbalance.
Sometimes, clinicians 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 one specific treatment protocol. Post-concussion syndrome is not one-size-fits-all. The brain regions affected by your brain injury are likely not the same as the regions that were damaged in 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 brain regions were affected, and in what way, which in turn lets us know exactly what kind of treatment to provide. 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, schedule a consultation.
Many studies have found that PCS recovery time varies drastically. Some patients recover after a couple of weeks without any long-term side effects; others struggle with symptoms for the rest of their lives. Some studies even go as far to state that “PCS may be permanent if recovery has not occurred by 3 years” (DOI: 10.1089/neu.2016.4677).
A recent study found that only 27% of post-concussion syndrome patients meeting diagnostic criteria at three months post-injury made a full recovery. The article "Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury" 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. Their findings indicate that concussion symptom prevalence is likely to increase over time, rather than resolve. This can leave PCS sufferers with little or no hope of recovery.
What we’ve found is that it doesn’t matter how old your injury was: The key to recovery is getting the right treatment.
On average, our patients report a 60% improvement in their symptoms in one week. We also performed follow-up research using fNCI scans 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.
Further reading: Recovering from post-concussion syndrome and How to tell the difference between post-concussion syndrome, chronic traumatic encephalopathy (CTE) and sudden impact syndrome (SIS)
It’s one thing to learn about the neuroscience 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:
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 fully restores your pre-injury self, 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 the brain damage they suffered.
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? Schedule a 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.
