Overview

Post-concussion syndrome (PCS) occurs when recovering from a concussion and symptoms last longer than expected. Normally, you should recover eventually, but sometimes symptoms like headaches, dizziness and concentration issues persist. However, with treatment, these effects can be minimised. 

Several risk factors can make PCS more likely to occur. These include past concussions, head injuries, behavioural, mental and brain-related conditions, age, gender and pronounced symptoms. If these are not treated, you may suffer from some complications including physical, cognitive, and psychological.¹

This article aims to explain all the risk factors that could increase your chance of having prolonged PCS, as well as any complications that could develop if they are not properly treated.

Understanding post-concussion syndrome (PCS)

Post-concussion syndrome is a combination of several signs and symptoms that occur as a consequence of a mild traumatic brain injury and which can persist past 3 months.^1,2 If you experience three or more of the following symptoms, you might have PCS and you should consult a medical expert:

• Headaches
• Dizziness
• Nausea
• Fatigue
• Irritability
• Anxiety
• Sleep disturbance
• Mental fogginess
• Vertigo
• Attention deficit 
• Memory impairment
• Slowed thinking (taking longer than usual to form thoughts)
• Sensitivity to noise and light
• Apathy or personality changes that last longer than 3 months
• Rapid changes in mood
• Depression^1,2,3 

The amount of time these symptoms persist will depend on the individual. Some patients recover in 7-10 days after the impact that caused the concussion and some recover after 1 month.^1,2 However, some individuals may present with symptoms up to months after the concussion.³ 

Risk factors for post-concussion syndrome

There are several risk factors that make you more likely to suffer from PCS. These include:

• History of head injury
• Pat concussion
• Concussion severity
• Symptoms
• Gender
• Age
• Presence of neurodevelopmental disorder
• Genetics
• Mental illness
• Healthcare service use

History of head injury

Suffering from more than one brain injury increases your chances of PCS

Past concussions

Multiple and/or previous concussions make you more likely to develop PCS 

Concussion severity

The severity of the initial concussion is also a determinant. Intracranial hematoma or depressed skull fracture puts you more at risk.

Symptoms

Experiencing symptoms for a long time after the impact, especially headaches, puts you at higher risk of PCS.

Gender

People who are assigned female at birth (AFAB) are more likely to have persistent PCS. Additionally, AFABs are more likely to suffer from headaches, concentration issues, fatigue and irritability.

Age

A study suggested that younger individuals are more likely to recover after a concussion (post-concussion) compared with older people over 61 years.³

Neurodevelopmental disorders

Having conditions like attention deficit hyperactivity disorder (ADHD) and learning disabilities.

Genetics

Certain genes can worsen your symptoms and make them last longer. 

Mental illness

if you are diagnosed with depression, anxiety, bipolar disorder, and personality disorders, you’re at risk of having prolonged PCS symptoms

Healthcare services use

Behaviours of not seeking medical help to deal with the concussion and symptoms properly can result in poor PCS outcomes. ^1,2,3

Complications of post-concussion syndrome

There are several complications of post-concussion syndrome that you could experience. They are related to the symptoms that linger longer than three months or that persist. Here are the possible complications that you could develop:

• Slow recovery of neurological functions
• Disrupted blood-brain barrier and reduced cerebral blood flow
• Problems thinking, concentrating and focusing
• Trouble finding words to use
• Sleep disturbances like insomnia
• Having headaches and migraines
• Developing depression and anxiety
• Feeling more aggression
• Poor equilibrium
• Malingering
• Being unable to work or perform daily activities
• Impulsive behaviour
• Having suicidal thoughts
• Overuse of analgesics^1,4

Prevention and management strategies

Unfortunately, post-concussion syndrome is unpredictable and this makes it difficult to prevent. However, there are some actions you can take for the best outcome possible. 

Precautionary measures

There are some actions you can take to reduce your risk of developing concussion and PCS:

• Helmets and protective gear

Wearing protective gear when playing sports or for certain jobs or activities can lower your risk of hitting your head and having a concussion.

• Awareness

Be aware of any situations that could cause you to head trauma and tread safely. For example, wear a seatbelt while driving, be observant of your surroundings, climb up and down the stairs carefully, etc

• Education

Learning about concussions and PCS is important so you know what to expect and understand what’s going on with you, to feel less scared, anxious and stressed.¹

Immediate post-injury management

• Rest and activity modification

Resting your brain and body is important to prevent symptoms from getting worse, especially in the first days after your concussion. Once you start feeling better, you should talk with your doctor about getting back to your daily activities progressively.

• Symptom management

Keep track of your symptoms, and if you believe they are getting worse, ask for medical advice. Moreover, while you’re recovering, you should avoid doing any activity that could result in a second concussion.

• Rehabilitation therapy

This can help you manage your symptoms, and your general practitioner (GP) might recommend cervical physical therapy, vision therapy, or vestibular rehabilitation.¹ 

• Psychological support and counselling

This may provide you with support and teach you how to cope with irritability and mood changes. 

FAQ’s

What is the treatment for post-concussion syndrome?

The treatment for PCS will vary depending on the individual. That is because there is no specific medicine or therapy to directly treat this condition. Your GP will provide you with the most optimal treatment designed for you. Normally, this combines a symptomatic approach (medical treatment that targets the symptoms you have), physical and mental rest and active forms of therapy (explained above).¹

When should you seek care?

You should get immediate help after receiving a hit to the head and losing consciousness. Moreover, if you notice any of the previously described symptoms after a head injury, it would be wise to consult your GP, and also if you notice your symptoms persisting after 10 days or so. 

How can you take care of yourself?

This will depend on what symptoms you’re experiencing. Your GP will give you suggestions but, it is advised that you avoid physical activity and mental effort, like reading, working or going through your phone and rest for a while. It’s also recommended that someone is available with you so they can check on you from time to time.

Can you fully recover from post-concussion syndrome?

If you receive the appropriate treatment for PCS you can definitely recover, and it may go away. However, be aware that a small number of people might still experience some symptoms even one year after the concussion. While this is not ideal, treatment can help you minimize their effect.¹

Summary

Post-concussion syndrome happens when you suffer from a concussion and your symptoms last longer than expected. As a result, you might experience headaches, dizziness, cognitive problems and mood changes for three months or longer. 

Furthermore, some risk factors can increase your chance of PCS, including the severity of concussion, multiple head injuries, age, gender, genetics, neurodevelopmental issues and mental conditions. Not only that, but you may also experience some complications like headaches, trouble concentrating and thinking, sudden and mood changes. 

Whilst PCS is quite difficult to prevent, there are some actions you can take to achieve a good quality of life, like using protective gear when required, resting and managing your symptoms. But in general, PCS has a good prognosis and it often goes away.