What Is Post-Concussion Syndrome?

In people with a concussion, most symptoms go away within the first few weeks after injury. But about 15% to 20% of these individuals experience symptoms that last beyond the expected recovery period. This is called post-concussion syndrome or post-concussive syndrome.

“Persistent symptoms can really impact well-being. They can affect multiple parts of an individual’s life,” says Priyanca Shah, DO, MBA, a Mass General Brigham brain injury specialist.

“If you’re younger and in school, it could affect you educationally. It could affect you socially, making you not want to, or not be able to, go out with friends as much. It could affect you psychologically, causing frustration and anxiety. It could affect you vocationally, making it difficult to go to work or do your job well,” she explains.

Dr. Shah focuses on physical medicine and rehabilitation, particularly concussions. She sees patients at multiple locations throughout the system, including Spaulding Rehabilitation, Mass General Brigham Healthcare Center in Waltham, and Mass General Brigham Healthcare Center in Foxborough.

She encourages people to seek care as soon as possible after a concussion. A qualified professional can monitor your symptoms and your progress to make sure you’re recovering well.

Long-lasting concussion symptoms

What causes post-concussion syndrome?

Post-concussive syndrome isn’t well understood, and researchers don’t know why it affects some people but not others. However, persistent concussion symptoms seem more common in people who have a history of:

• Anxiety or depression

• Migraine headaches

• Learning disability, such as attention-deficit/hyperactivity disorder (known as ADD or ADHD)

People who play certain contact sports are at a higher risk of concussions. These sports include:

• American-style football

• Hockey

• Soccer

However, there’s no evidence that post-concussion syndrome is more common in athletes.

Diagnosing post-concussive syndrome

No single test can definitively diagnose post-concussion syndrome. Doctors make a diagnosis based on symptoms, how long they’ve lasted, and clinical examination.

Dr. Shah monitors symptoms over time with the Post-Concussion Symptom Scale (PCSS). The tool is a questionnaire that asks you to rate the severity of your symptoms. At each follow-up visit, Dr. Shah administers the PCSS to monitor progress.

She also conducts repeat examinations to assess:

• Cognitive (brain) function

• Function of cranial nerves (nerves in the brain that help you taste, smell, hear, and feel sensations, as well as help you make facial expressions and movements)

• Eye movement

• Muscle strength, sensation, and reflexes

• Balance

Treating post-concussion symptoms

A doctor or concussion specialist can help you determine what to do if concussion symptoms persist. Treatment varies widely depending on the results of your examination and your individual needs.

“First, I make sure I’m managing your most bothersome symptoms. We may do this with lifestyle strategies, physical therapy, and possibly medications,” Dr. Shah says. “Lifestyle strategies can be particularly effective at reducing symptoms and improving well-being.”

Dr. Shah recommends a short period of relative rest, physical therapy, and aerobic activity.

She emphasizes the importance of getting daily exercise that raises your heart rate. Keep the intensity level below the point when it triggers symptoms, she advises, but remember to stay physically and socially active. The goal is to help you live your life as normally as possible.

When can I return to sports after post-concussion syndrome?

Your doctor will work with you to create a rehabilitation plan for safe return to sport or other activities.

Depending on your symptoms, their intensity, and how long they last, your doctors may refer you to other specialists, such as:

• Physical therapy or occupational therapy, which can help with balance, pain, and daily functioning

• Speech therapy

• Psychology or neuropsychology to address cognitive or mood difficulties

• Neurology, if headaches persist

• Neuro-optometry or ENT (ear, nose, and throat) for prolonged trouble with vision, dizziness, or balance

“People do recover. Concussions aren’t a permanent brain injury, and they do resolve over time,” Dr. Shah says. “It's important for your safety and well-being to see a concussion specialist to create a plan for safe return to sports or other activities.”