In post-concussion syndrome (PCS), a patient with a mild traumatic brain injury (mTBI) experiences persistent symptoms from the injury. The symptoms might last months, years, or even decades after the event if left untreated.
For most patients, having PCS (or wondering if you have PCS) can mean confusion, questions, and anxiety. So in this post, we wanted to ease some of the uncertainty by compiling answers to commonly asked questions regarding post-concussion syndrome, including:
Some patients are incorrectly told they don’t have PCS or that it’s a permanent condition that can’t be improved with anything but time. The truth is that most patients can make significant progress in the care of experienced physicians and therapists.
As we discuss below, the key to recovery is active rehabilitation, rather than just treating the symptoms with medication (a common scenario that doesn’t address the underlying issue). At our post-concussion syndrome treatment clinic, the patients we treat average a 60% recovery on self-reported symptoms in just one week.
Note: If you think you’re a candidate for post-concussion syndrome treatment, request a consultation with our team. 90% of our patients experience improvement in their symptoms during treatment week.
Post-Concussion Syndrome Signs and Symptoms
All of the following are symptoms of post-concussion syndrome:
As you can see, symptoms of PCS range from cognitive symptoms, such as difficulty making decisions, to physical symptoms, such as balance problems and blood pressure dysregulation. Many patients also suffer from emotional symptoms such as anxiety, depression, and sleep disturbances.
Symptom severity depends on several risk factors. You’re more likely to have lasting symptoms if you’ve had multiple head injuries, but that doesn’t mean your symptoms will be more severe than for someone who only has had one.
Contrary to popular belief, loss of consciousness doesn’t increase your likelihood of having persistent symptoms. And a sport-related concussion isn’t necessarily less severe than a vehicle-related injury. What seemed like a minor head injury at the time can still cause lasting symptoms.
What if You Experience Post-Concussion Syndrome Symptoms Years Later?
It is not unusual for the symptoms of concussions to come and go, worsen over time, or last for years after the original brain injury. For example, you might have some symptoms that worsen with exercise or stress. Many patients find that carefully controlling their routines (things like avoiding situations known to aggravate symptoms, getting enough sleep, and eating well) results in a reduction of symptoms. But if they deviate from that routine, the symptoms “come back.”
The good news is that you can still see positive results even if the injury occurred years in the past: If it was treatable then, it’s treatable now. Your cognitive function can improve with treatment. While it’s better to get treatment within a year of the injury, we’ve seen patients whose injuries were 30+ years in the past make remarkable progress during and after treatment.
A regular MRI (magnetic resonance imaging) scan cannot detect post-concussion syndrome; it can only detect structural damage to the brain. The damage caused by concussions is not shown with a standard structural MRI. But there are tests that can detect post-concussion syndrome. At Cognitive FX, we use fNCI, which is short for functional neurocognitive imaging.
fNCI is a kind of functional MRI that looks at oxygenated and deoxygenated hemoglobin in the brain as it is accomplishing different cognitive tasks. By comparing blood flow in regions of your brain to a database of brains of people who haven’t had any injury and are functioning normally, we can pinpoint which areas of your brain are affected and develop a customized treatment protocol.
Neurovascular coupling (NVC) is behind many post-concussion symptoms. Here’s a quick breakdown of what happens to your brain during and after a concussion and why some people don’t recover as expected.
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 oxygen they need to power the signaling your brain normally does. When you try to do something that those cells govern — like remembering where you put your keys — 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.
For the majority of people who suffer from a concussion, the brain will go back to using the best pathways for any given process after 3-6 weeks post head trauma. But for post-concussion syndrome patients, that brain damage never heals on its own. In those cases, 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 needed for a task like reading — equally along existing pathways. Suboptimal signaling is like getting stuck in a traffic jam or having to route around an accident. It’s harder, it takes longer, and it’s frustrating. Cells impacted by post-concussion syndrome either can’t call for enough blood flow or they call for far too much, making it harder for the brain to do its job well. Other cells in nearby regions have to do the job for them, but it’s easy for them to become overloaded.
The more your brain has to use suboptimal pathways, the more likely you are to experience symptoms. Fortunately, that’s not the end of the story: Your brain can relearn better signaling pathways during a combination of physical and cognitive therapy. In the next section, we’ll discuss what good treatment for post-concussion syndrome looks like.
Treatment of Post-Concussion Syndrome
There are two treatment options for post-concussion syndrome, generally speaking: active rehabilitation and medication. Active rehabilitation is currently the best treatment protocol for restoring concussion damage. Because of the multidisciplinary nature of active rehabilitation, most doctors cannot offer a comprehensive active rehabilitation program (it is cost-prohibitive to have so many therapists on staff). Your alternative, medication, should be a last resort: While it doesn’t address the underlying problems, it can make the symptoms more bearable.
Active Rehabilitation: The Best Post-Concussion Syndrome Treatment
The brain’s ability to recover via neuroplasticity is remarkable. Patients suffering from post-concussion syndrome can and do experience notably improved symptoms after active rehabilitation, assuming it is done correctly.
At Cognitive FX, we employ a combination of physical and cognitive therapy designed to stress the brain enough that the brain will return to more optimal neural pathways. Doing so takes a multidisciplinary approach; we have a clinical neuropsychologist, a neuroradiologist, a neurosurgeon, a clinical psychologist, several neuromuscular therapists, several neurocognitive therapists, several occupational therapists, and two DynaVision specialists on our team.
If you’re interested in reading what kinds of therapy are available to you and how they work together during treatment, you can read our post on active rehabilitation and types of therapy for post-concussion syndrome. It explains physical therapy, vestibular therapy, speech therapy, occupational therapy, vision therapy, music therapy, and massage therapy, along with how those therapies are, or are not, employed at Cognitive FX. It also discusses how aerobic exercise plays into treatment.
Finally, we take some steps—including neuromuscular therapy, cardio exercise, and scheduled rest—to help the autonomic nervous system calm down, since it can be impacted by head injuries as well.
Medications for Post-Concussion Syndrome: What Are Your Options?
As you’ve likely experienced, many doctors prescribe medication to help manage the symptoms of post-concussive syndrome without addressing their cause. While some medications are necessary to keep you functioning, others only serve to mask the root issue.
Most patients arrive at our clinic on a number of medications designed to control their symptoms. We’ve detailed the most common medications we see used for treatment in our post on medications for post-concussion syndrome. We discuss everything from chronic headache medication to bioidentical hormone replacement.
When you consider medications, it’s extremely important to consider what the long-term effects could be and what effect taking multiple medicines will have on your liver… not to mention the side effects. Medicines for chronic pain, nausea, emotional symptoms, and other issues can really take a toll on your body when combined.
How to Find a Good Treatment Clinic
If you’ve decided to pursue active rehabilitation for post-concussion syndrome, then the next step is to decide where you will go for treatment. Obviously, you have to consider things like location, cost, and time.
But there are other factors surrounding the quality of the health care you receive that you can use to make a good decision. For example, the best clinics have the characteristics listed in our post-concussion treatment center checklist:
For a full discussion of this topic, see our post on the best concussion clinics. It’s important to make sure ahead of time that the clinic has the resources, staff, and program needed for neurorehabilitation.
But no matter how long it’s been since your injury, there’s still hope for recovery. With the right treatment regimen, a post-concussion syndrome diagnosis is not a life sentence. We’ve had patients from all over the United States and Europe visit our clinic because they knew we would take good care of them.
If you want to take the next steps toward recovery, schedule a consultation with our team. We’ll equip you with the resources you need to move forward.
About Dr. Mark Allen PhD
Mark D. Allen earned a PhD in Cognitive Science at Johns Hopkins University with post-doctoral training in Cognitive Neuroscience and Functional Neuroimaging at the University of Washington. He has 15 years of research and clinical experience in fMRI, with 22 publications in tier-1 peer-reviewed scientific journals, 3 book chapters, and dozens of presentations at scientific and professional conferences in neuroscience, neuroimaging, and neuropsychology. Having collected and analyzed fMRI data from over 1,000 experimental subjects and over 300 clinically-referred patients, Dr. Allen is a pioneer and expert in the development of fMRI for use in clinical settings.