Symptoms of Post-Concussion Syndrome
Post-Concussion Syndrome is defined as “a cluster of concussion symptoms", or "three or more new or worsening symptoms" which last beyond one month as defined by the International Classification of Diseases or at least three months as defined by The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-R.)
In terms of the percentage of people with concussions who then develop Post-Concussion Syndrome, the figures vary from "10 to 20 percent of individuals," to a 2018 study which estimated that between 11.4% and 38.7% of people with concussions will develop Post-Concussion Syndrome. "By the age of sixteen, one in five children will sustain a mild traumatic brain injury also known as concussion. Our research found that one in seven school children with mild traumatic brain injury suffer post-concussion syndrome symptoms for three months or longer."
‘Persistent symptoms’ or 'Post-Concussion Syndrome' is not a single, specific injury, but rather a group of post-traumatic symptoms that may be linked to other contributing factors (whiplash, for ex) which "do not necessarily reflect ongoing physiological injury to the brain."
"Recent literature suggests that the physiological time of recovery may outlast the time for clinical recovery", clinical recovery meaning that the patient appears well to the doctor overseeing her case. "The consequence of this is as yet unknown, but one possibility is that athletes may be exposed to additional risk by returning to play while there is ongoing brain dysfunction."
The symptoms of Post-Concussion Syndrome (PCS) fall into four categories:
Except for their persistence, the symptoms people experience with Post-Concussion Syndrome are the same as those experienced in the immediate/early stage of a concussion.
Each person with Post-Concussion Syndrome will have their own unique cluster of symptoms.
- Headache or "pressure" in the head (the most common symptom)
- Neck pain
- Sensitivity to Light
- Sensitivity to Sound
- Ringing in the Ears
- Balance problems, dizziness
- Fuzzy, double, or blurry vision, trouble with reading
- Rarely, decreases in taste and smell
- Reduced tolerance to stress, emotional excitement, or alcohol.
- Difficulty with memory, or remembering new information
- Difficulty with attention
- Difficulty with thinking clearly
- Difficulty with focus or concentrating
- Feeling slowed down mentally
- Sleeping more than usual (most common with a recent concussion)
- Sleeping less than usual, or trouble falling asleep (typically when more time has elapsed since the concussion)
- Irritability that didn't exist before the concussion
- Sadness or depression that didn't exist before the concussion
- Anxiety or nervousness that didn't exist before the concussion
- More emotional
- Apathy that didn't exist before the concussion
Some of these symptoms may appear immediately after the concussion, and others may not be noticed for days or months after the injury, or until the person resumes their everyday life. Centers for Disease Control and Prevention.
Our PCS symptom list references information from Centers for Disease Control & Prevention, Concussion Legacy Foundation, the Mayo Clinic, momsTeam, and Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.
Is Post-Concussion Syndrome related to how severe your concussion was?
"You don't have to lose consciousness to get a concussion or post-concussion syndrome." (Most of the people we know with PCS did not lose consciousness when they were concussed.) The Mayo Clinic says that "the risk of post-concussion syndrome doesn't appear to be associated with the severity of the initial injury."
However, numerous studies do show a relationship between the severity of early concussion symptoms (within 24 hours) and longer recovery times. For example, a study of high school and college athletes with concussions found that loss of consciousness, amnesia about events before and after the concussion, and greater symptom severity within the first 24 hours following injury were associated with longer recoveries (7 or more days). Another study showed that individuals who had four or more concussion symptoms were at double the risk of prolonged symptoms.
What makes a person more vulnerable to Post-Concussion Syndrome?
- Who you are:
- Children 8-12 years old
- Teenagers 13-18 years old There is some evidence that the teenage years, particularly the high-school years, might be the most vulnerable time period for having persistent symptoms—with greater risk for girls than boys.
- Elderly adults
- Your medical history:
- A history of previous concussion(s)
- Symptoms lasted longer than one week (previous concussion)
- A history of mood, anxiety, learning or seizure disorder
- A history of migraines
- A history of previous concussion(s)
- The nature of the concussion
- severe impact
- double impact (hit twice in a short timeframe)
- four or more concussion symptoms in the very early stage (or in the ER)
- answering questions slowly
- balance problems
- noise sensitivity
- duration of the initial concussion symptoms
- major visual symptoms soon after injury
Resources for this section: Concussion Legacy Foundation, momsTeam, Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED (see related chart at the bottom of this page) and Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.
Prognosis for Recovery From Post-Concussion Syndrome
"The prognosis for PCS is good. It’s believed that around 50% of people with a history of mTBI (mild traumatic brain injury) or concussion are still experiencing symptoms three months after their injury, and at a year that number has dropped to 10–15%, meaning that the majority of the symptoms go away within a year of the injury. (It should be noted that these numbers are debated and no number has the full consensus of experts.)" Elizabeth Sandel, M.D., author, speaker, researcher
"In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one. Some people may also find that it takes longer to recover if they have another concussion." Center for Disease Control & Prevention
Treatment for Post-Concussion Syndrome
"Treatment of PCS typically focuses on relieving the individual symptoms, as the underlying cause of PCS isn’t known and therefore can’t be addressed as a condition, like giving an antibiotic for pneumonia, for example. However, both medication and non-medication therapies are used to treat individual PCS symptoms."
Post-Concussion Syndrome and how it can affect your life
"Post-Concussion Syndrome can be extremely disruptive to a patient’s life. In addition to having to constantly manage concussion symptoms, which can intensify with normal activity, long-term PCS patients often have to restructure their lives to avoid activities and situations that cause symptoms to worsen. For children, this can mean extended absences from school and removal from sports and extra-curricular activities. In severe cases, it may be necessary for a child to repeat a grade. In adults, PCS can seriously impact a patients’ personal and professional life, interfere with family life, as well as the ability to focus, communicate, and be effective at work." Concussion Legacy Foundation
"PCS can result in significant physical, emotional, and cognitive stress, and be "significantly disabling, often resulting in an inability to attend school, complete academic work, participate in sporting and extracurricular activities and interact socially with peers." momsTeam
What are the physical causes of Post-Concussion Syndrome?
The medical community has a good understanding of what happens with the brain with the initial concussion, but it is not as clear what is the explanation for persistent post-concussion symptoms, or syndrome. Concussion involves "neuronal dysfunction, cell death and altered connectivity include: oxidative stress, metabolic dysfunction, neuroinflammation, axonal damage and alterations in cerebral blood flow." In terms of what is creating post-concussion syndrome, recent research points to "alterations in neuronal circuitry and neurotransmission."