A Primer on Post-Concussion Syndrome
Post-concussion syndrome is multifactorial, complex, and highly individualized.
If you’ve experienced a concussion, and are still experiencing symptoms outside of the window of time in which most concussions resolve spontaneously, then you are not alone. Post-concussion syndrome (PCS), or persistent post-concussion symptoms can manifest in a variety of symptoms that make daily life and athletic pursuits very challenging for many people just like you.
What exactly is post-concussion syndrome?
Post-concussion syndrome can be thought of as a collection or group of symptoms that have over-extended their welcome after someone has sustained a concussion. PCS is the equivalent of that one person at a party who know one knows, but everyone is sure that someone invited them over, so they just let them chill over in the corner without anyone talking to them.
It’s important to note that post-concussion symptoms are different and unique to each person experiencing PCS. In order to better understand how PCS impacts people, we tend to classify symptoms into four major groups.
PHYSICAL: Think of this group of symptoms as ones that result in some sort of unwanted physiologic change or alteration (aka our “status quo”). Common examples include:
headache (by far the most common symptom reported in concussion & PCS cases)
neck pain
exercise intolerance
stress intolerance
visual changes (blurry vision, diplopia, etc)
light and noise sensitivity
balance problems & dizziness
autonomic dysfunction (dysautonomia)
COGNITIVE: Think of this group of symptoms as ones that impact the way our brain normally thinks and functions. Common examples include:
difficulty remembering new information
difficulty paying attention
decreased ability to focus & concentrate
“feeling in a fog” or confusion
EMOTIONAL/BEHAVIORAL: Think of this group of symptoms as ones that impact our overall mental health status. You may notice that some of these symptoms could exist prior to a concussion. PCS may heighten, alter, or worsen these symptoms. Common examples include:
Anxiety
Apathy
Irritability
Depression
More emotional
SLEEP: Think of this group of symptoms as ones that impact our normal sleep routine. Common examples include:
difficulty falling asleep
difficulty staying asleep
sleeping more than usual
sleeping less than usual
Anyone dealing with post-concussion syndrome may experience any combination of these symptoms. It’s important to note that while many of these symptoms flat out suck, they are treatable. Post-concussion syndrome is treatable, no matter the amount of time since the initial injury or persistence of symptoms.
There are a few ways that a healthcare provider can come to an official post-concussion syndrome diagnosis, which I have listed below.
ICD-10 clinical diagnostic criteria for post-concussion syndrome requires a history of mTBI (mild traumatic brain injury) and the presence of three or more of the following eight symptoms: 1) headache, 2) dizziness, 3) fatigue, 4) irritability, 5) insomnia, 6) concentration or 7) memory difficulty, and 8) intolerance of stress, emotion, or alcohol.
DSM-IV diagnostic criteria for post-concussion syndrome are: A) history of mTBI causing “significant cerebral concussion;” B) cognitive deficit in attention and/or memory; C) presence of at least three of eight symptoms (e.g., fatigue, sleep disturbance, headache, dizziness, irritability, affective disturbance, personality change, apathy) that appear after injury and persist for ≥3 months; D) symptoms that begin or worsen after injury; E) interference with social role functioning; and F) exclusion of dementia due to head trauma and other disorders that better account for the symptoms.
WHAT CAUSES POST-CONCUSSION SYNDROME?
Long story short, the medical community isn’t sure of exactly what causes post-concussion syndrome. While we have a pretty good understanding of what happens to the brain immediately following an acute concussion (basically a brain energy crisis secondary to neurochemical changes and altered blood flow), we don’t have the means to pinpoint PCS to a singular “source.” This is likely due to the multifactorial and complex nature of post-concussion syndrome.
The likelihood of developing post-concussion syndrome does seem to be correlated with factors such as:
severity/persistence of symptoms following a concussion
multiple concussions within a short time frame
significant visual changes following a concussion
history of migraines
pre-existing learning conditions such as ADHD
pre-existing mood/behavioral conditions such as depression and anxiety
seizure disorders
being 8-18 years old
being female
being elderly
life with post-concussion syndrome
If you or someone you know is dealing with post-concussion syndrome, then you likely understand the immense frustration that stems from dealing with an “invisible” injury. For many, post-concussion syndrome can cause significant, undesired changes in daily life. It can impact school, work, sports, and relationships. For many, the stress associated with the feeling of missing out, not contributing, unable to function “normally,” or putting life on hold becomes part of a negative feedback loop that contributes to ongoing symptoms. Many feel as if they can’t improve, maybe because they haven’t found the appropriate help or guidance. Maybe they’ve received some ill-informed advice from a provider unversed in management of post-concussion syndrome. The good news is that post-concussion syndrome doesn’t have to be permanent, and that improvement is possible.
Please stay tuned for our next post, where we’ll provide an overview of post-concussion syndrome management and treatment.
In strength,