Persistent Post-Concussive Symptoms (Post-Concussion Syndrome)

Diagnosis

There is no single test to confirm persistent post-concussive symptoms. Healthcare professionals typically start with a thorough medical history and may use the following assessments:

• Neurological exam to test memory, thinking, senses, strength, coordination, and reflexes
• Neurological testing to further evaluate concentration, memory, language, thinking, and planning skills
• Imaging such as CT or MRI scans to check for structural brain changes or other conditions, especially if symptoms include severe headache, memory loss, or vomiting. Imaging cannot directly detect persistent post-concussive symptoms
• Referral to other specialists based on symptoms, which may include:

• Physical therapy, occupational therapy, or speech therapy

• Psychologist for anxiety or memory concerns

• Ear, nose, and throat specialist for dizziness

• Ophthalmologist or neuro-optometrist for vision changes

Treatment

There is no specific treatment for persistent post-concussive symptoms. Management focuses on treating individual symptoms, which vary from person to person.

Headaches
• Medicines used for migraines or tension-type headaches, sometimes including medications for depression, high blood pressure, or seizures
• Avoid overuse of pain medicines to prevent medication overuse headaches

Memory and thinking problems
• Time may help; most cognitive symptoms improve over weeks to months
• Use notebooks, visual cues, or reminders to aid memory
• Cognitive therapy, occupational therapy, or speech therapy may be helpful
• Stress management and relaxation therapy can improve cognitive symptoms

Dizziness or vertigo
• Physical therapy trained in balance rehabilitation can help alleviate symptoms

Sleep symptoms
• Practice good sleep hygiene, including consistent sleep and wake times
• Medicines may be used if necessary to improve sleep

Vision
• Vision changes often improve over time
• Some patients may need a neuro-optometrist for persistent visual symptoms

Sensitivity to light and sound
• Symptoms usually improve with time
• Exposure therapy guided by a physical or occupational therapist may help

Irritability, depression, and anxiety
• Understanding the cause of symptoms can reduce distress
• Treatment options may include psychotherapy, medications for depression or anxiety, and early, gradual physical activity that avoids reinjury