Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosis
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Post-concussion syndrome (PCS) describes a collection of physical, emotional, cognitive (thinking-related), and behavioral symptoms that persist for several weeks to months after sustaining a mild traumatic brain injury (concussion).
Once diagnosed, treatment is focused on managing symptoms. This is done through various interventions like early education, rest, cognitive behavioral therapy, and/or taking one or more medications.
Post-Concussion Syndrome Symptoms
Symptoms associated with a concussion usually develop immediately or within hours to days after a brain injury. In most cases, these symptoms ease within a couple of weeks.
For those with PCS, however, concussion-related symptoms may persist for months, or even a year or more.While not an exhaustive list, symptoms associated with PCS include the following.
Verywell / Ellen Lindner
Headaches
The headache of PCS typically resembles that of atension-type headache,migraine, or some combination, and develops in over 60% of patients with a mild head injury.
Factors that may increase the risk for developing a headache after a concussion include:
Dizziness
Patients with PCS may report dizziness, lightheadedness, orvertigo. Some patients also exhibit symptoms ofvestibular migraine.
Anxiety, depression, orpost-traumatic stress disorder(which are also symptoms of PCS) may also contribute to a patient’s dizziness.
Interestingly, research suggests that the presence of dizziness at the time of a sports-related concussion may be a sign that the patient will take a longer time to recover.
Sleep Disturbances
Sleep disturbances associated with post-concussion syndrome include:
Cognitive and Emotional Changes
Impaired memory and concentration are seen in PCS and are most likely to occur right after the brain injury.Patients may also report fatigue, feeling groggy or foggy, and have trouble thinking clearly or paying attention.
Personality changes, irritability, intolerance to stress, emotional blunting (apathy, emotional numbness), disinhibition (not suppressing inappropriate or unwanted behavior), or mood swings may also occur.
Other
A variety of other somatic (physical) symptoms have been reported with PCS including blurry vision or double vision, restlessness, increased susceptibility to alcohol, light and noise sensitivity,tinnitus(ringing in the ears), nausea, and neck pain.
Concussions usually follow a direct blow to the head, like from a fall, assault, or sports impact injury (e.g., football, hockey, soccer, lacrosse).A direct blow or whiplash can cause the nerves to be stretched or strained, causing shear injury.
Concussions can also occur from rapid acceleration-deceleration movements of the head, such as from a blast-related injury or whiplash injury (e.g., motor vehicle accident).
It’s not clear why some people develop PCS after a concussion and others do not. Experts suspect the answer likely stems from a combination of physical and psychological factors.
Physical Factors
Some of the abnormal brain processes that result from a concussion and potentially contribute to PCS development include:
Psychological Factors
Psychological factors before, during, and after a brain injury may also contribute to PCS manifestation, duration, and/or severity.
As an example, research suggests that those with PCS are more likely to have various psychiatric ailments like depression, anxiety, and PTSD than people with head injuries who did not develop persistent PCS.
Being female and experiencingamnesiaor aloss of consciousnessfrom your brain injury may also make you more likely to have a higher number of PCS symptoms.
Finally, factors like malingering and/or poor effort on cognitive testing have been proposed as possible explanations for why a person’s PCS symptoms may be inconsistent with the severity of their brain injury.
Post-concussive syndrome is a clinical diagnosis. This means that there is no single blood or imaging test that can definitively say whether a patient has the condition.
Instead, to make the diagnosis, doctors rely on a patient’s medical history and criteria set forth in various professional society publications like theInternational Statistical Classification of Diseases and Related Health Problems(ICD-10) or theDiagnostic and Statistical Manual of Mental Disorders(DSM).
For example, using the ICD-10’s criteria, a patient may be diagnosed with PCS if they have a history of a traumatic brain injury and exhibit at least three of the following eight symptoms:
Some experts would argue that the criteria used to diagnose PCS are restraining and arbitrary.In order to ensure an accurate diagnosis, be sure to see aneurologistor neuropsychologist who has experience diagnosing and treating patients with PCS.
During the diagnostic process, your doctor may order one or more imaging tests like brainmagnetic resonance imaging (MRI)or an advanced MRI technique called diffusion tensor (DT) imaging. These tests can help rule out alternative diagnoses (e.g.,tumororstroke) and/or detect more serious brain pathologies (e.g.,brain bleed).
The treatment of PCS focuses on managing a patient’s symptoms.
PCS therapies that your doctor may suggest and tailor to your individual care include:
There is a lack of high-quality studies that might help predict who is more likely to take longer to recover.However, a history of previous concussions or other medical conditions may affect prognosis.
If you have any physical factors or life circumstances that may negatively impact your ability to heal from PCS, please reach out to your healthcare team. You may need extra strategies or assistance (e.g., guidance from a social worker) to ensure that you don’t get behind in your recovery process.
Summary
Post-concussion syndrome can develop after recovery from a concussion and last for weeks, months, or years after the initial injury. Symptoms may be physical (headache, dizziness, sleep problems), cognitive (difficulty with memory or concentration), or behavioral (irritability, intolerance). They are highly variable and affect daily life.
Treatment is focused on managing the symptoms through education, psychological therapy, or medications.
A Word From Verywell
If you or a loved one is suffering from post-concussion syndrome, remain patient and hopeful as your brain heals. Recovery from PCS is a gradual, stepwise process—symptoms may ebb and flow, and you can still have bad days, even when you are feeling and functioning like yourself again.
During this trying time, reach out to loved ones, compassionate friends, or a support group for comfort, guidance, and/or assistance. Remember to be gentle to yourself and listen to your intuition. Rest when needed, take steps to reduce stress in your life, and stick to your treatment plan, which may require frequent tweaks along the way.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Symptoms of mild TBI and concussion.Tator CH, Davis HS, Dufort PA, et al.Postconcussion syndrome: demographics and predictors in 221 patients.J Neurosurg.2016;125(5):1206-1216. doi:10.3171/2015.6.JNS15664Lieba-Samal D, Platzer P, Seidel S, Klaschterka P, Knopf A, Wöber C.Characteristics of acute posttraumatic headache following mild head injury.Cephalalgia.2011;31(16):1618-1626. doi: 10.1177/0333102411428954International Headache Society.Headache attributed to trauma or injury to the head and/or neck.Fife TD, Kalra D.Persistent vertigo and dizziness after mild traumatic brain injury.Ann N Y Acad Sci.2015 Apr;1343:97-105. doi:10.1111/nyas.12678Lau BC. Kontos AP, Collins MW, Mucha A, Lovell MR.Which on-field signs/symptoms predict protracted recovery from sports-related concussion among high school football players.Am J Sports Med.2011;39(11):2311-2318. doi:10.1177/0363546511410655Lim MM, Bauman CR.Sleep-wake disorders in patients with traumatic brain injury. UpToDate.Evans RW.Postconcussion syndrome. UpToDate.Polinder S, Cnossen MC, Real RGL.A multidimensional approach to post-concussion symptoms in mild traumatic brain injury.Front Neurol. 2018;9:1113. doi:10.3389/fneur.2018.01113Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhap L-R.Traumatic brain injury.Cell Transplant.2017;26(7):1118–1130. doi:10.1177/0963689717714102American Association of Neurological Surgeons.Concussion.Giza C, Greco T, Prins ML.Concussion: pathophysiology and clinical translation.Handb Clin Neurol.2018;158:51-61. doi:10.1016/B978-0-444-63954-7.00006-9Silver JM.Effort, exaggeration, and malingering after concussion.J Neurol Neurosurg Psychiatry.2012;83:836–841. doi:10.1136/jnnp-2011-302078Boake C, McCauley SR, Levin HS.Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury.J Neuropsychiatry Clin Neurosci.2005;17(3):350-356. doi:10.1176/jnp.17.3.350Makdissi M, Cantu RC, Johnston KM, McCrory P, Meeuwisse WH.The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms?Br J Sports Med.2013;47(5):308-313. doi:10.1136/bjsports-2013-092255Baker JG, Freitas MS, Leddy JJ, Kozlowski KF, Willer BS.Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome.Rehabil Res Pract. 2012;2012:705309. doi:10.1155/2012/705309Lee MJ, Zhou Y, Greenwald BD.Update on non-pharmacological interventions for treatment of post-traumatic headache.Brain Sciences. 2022;12(10):1357. doi:10.3390/brainsci12101357Karr JE, Areshenkoff CN, Garcia-Barrera MA.The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.Neuropsychology. 2014;28(3):321-336. doi:10.1037/neu0000037Eme R.Neurobehavioral outcomes of mild traumatic brain injury: a mini review.Brain Sci. 2017;7(5):46. doi:10.3390/brainsci7050046
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Symptoms of mild TBI and concussion.Tator CH, Davis HS, Dufort PA, et al.Postconcussion syndrome: demographics and predictors in 221 patients.J Neurosurg.2016;125(5):1206-1216. doi:10.3171/2015.6.JNS15664Lieba-Samal D, Platzer P, Seidel S, Klaschterka P, Knopf A, Wöber C.Characteristics of acute posttraumatic headache following mild head injury.Cephalalgia.2011;31(16):1618-1626. doi: 10.1177/0333102411428954International Headache Society.Headache attributed to trauma or injury to the head and/or neck.Fife TD, Kalra D.Persistent vertigo and dizziness after mild traumatic brain injury.Ann N Y Acad Sci.2015 Apr;1343:97-105. doi:10.1111/nyas.12678Lau BC. Kontos AP, Collins MW, Mucha A, Lovell MR.Which on-field signs/symptoms predict protracted recovery from sports-related concussion among high school football players.Am J Sports Med.2011;39(11):2311-2318. doi:10.1177/0363546511410655Lim MM, Bauman CR.Sleep-wake disorders in patients with traumatic brain injury. UpToDate.Evans RW.Postconcussion syndrome. UpToDate.Polinder S, Cnossen MC, Real RGL.A multidimensional approach to post-concussion symptoms in mild traumatic brain injury.Front Neurol. 2018;9:1113. doi:10.3389/fneur.2018.01113Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhap L-R.Traumatic brain injury.Cell Transplant.2017;26(7):1118–1130. doi:10.1177/0963689717714102American Association of Neurological Surgeons.Concussion.Giza C, Greco T, Prins ML.Concussion: pathophysiology and clinical translation.Handb Clin Neurol.2018;158:51-61. doi:10.1016/B978-0-444-63954-7.00006-9Silver JM.Effort, exaggeration, and malingering after concussion.J Neurol Neurosurg Psychiatry.2012;83:836–841. doi:10.1136/jnnp-2011-302078Boake C, McCauley SR, Levin HS.Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury.J Neuropsychiatry Clin Neurosci.2005;17(3):350-356. doi:10.1176/jnp.17.3.350Makdissi M, Cantu RC, Johnston KM, McCrory P, Meeuwisse WH.The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms?Br J Sports Med.2013;47(5):308-313. doi:10.1136/bjsports-2013-092255Baker JG, Freitas MS, Leddy JJ, Kozlowski KF, Willer BS.Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome.Rehabil Res Pract. 2012;2012:705309. doi:10.1155/2012/705309Lee MJ, Zhou Y, Greenwald BD.Update on non-pharmacological interventions for treatment of post-traumatic headache.Brain Sciences. 2022;12(10):1357. doi:10.3390/brainsci12101357Karr JE, Areshenkoff CN, Garcia-Barrera MA.The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.Neuropsychology. 2014;28(3):321-336. doi:10.1037/neu0000037Eme R.Neurobehavioral outcomes of mild traumatic brain injury: a mini review.Brain Sci. 2017;7(5):46. doi:10.3390/brainsci7050046
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Symptoms of mild TBI and concussion.Tator CH, Davis HS, Dufort PA, et al.Postconcussion syndrome: demographics and predictors in 221 patients.J Neurosurg.2016;125(5):1206-1216. doi:10.3171/2015.6.JNS15664Lieba-Samal D, Platzer P, Seidel S, Klaschterka P, Knopf A, Wöber C.Characteristics of acute posttraumatic headache following mild head injury.Cephalalgia.2011;31(16):1618-1626. doi: 10.1177/0333102411428954International Headache Society.Headache attributed to trauma or injury to the head and/or neck.Fife TD, Kalra D.Persistent vertigo and dizziness after mild traumatic brain injury.Ann N Y Acad Sci.2015 Apr;1343:97-105. doi:10.1111/nyas.12678Lau BC. Kontos AP, Collins MW, Mucha A, Lovell MR.Which on-field signs/symptoms predict protracted recovery from sports-related concussion among high school football players.Am J Sports Med.2011;39(11):2311-2318. doi:10.1177/0363546511410655Lim MM, Bauman CR.Sleep-wake disorders in patients with traumatic brain injury. UpToDate.Evans RW.Postconcussion syndrome. UpToDate.Polinder S, Cnossen MC, Real RGL.A multidimensional approach to post-concussion symptoms in mild traumatic brain injury.Front Neurol. 2018;9:1113. doi:10.3389/fneur.2018.01113Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhap L-R.Traumatic brain injury.Cell Transplant.2017;26(7):1118–1130. doi:10.1177/0963689717714102American Association of Neurological Surgeons.Concussion.Giza C, Greco T, Prins ML.Concussion: pathophysiology and clinical translation.Handb Clin Neurol.2018;158:51-61. doi:10.1016/B978-0-444-63954-7.00006-9Silver JM.Effort, exaggeration, and malingering after concussion.J Neurol Neurosurg Psychiatry.2012;83:836–841. doi:10.1136/jnnp-2011-302078Boake C, McCauley SR, Levin HS.Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury.J Neuropsychiatry Clin Neurosci.2005;17(3):350-356. doi:10.1176/jnp.17.3.350Makdissi M, Cantu RC, Johnston KM, McCrory P, Meeuwisse WH.The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms?Br J Sports Med.2013;47(5):308-313. doi:10.1136/bjsports-2013-092255Baker JG, Freitas MS, Leddy JJ, Kozlowski KF, Willer BS.Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome.Rehabil Res Pract. 2012;2012:705309. doi:10.1155/2012/705309Lee MJ, Zhou Y, Greenwald BD.Update on non-pharmacological interventions for treatment of post-traumatic headache.Brain Sciences. 2022;12(10):1357. doi:10.3390/brainsci12101357Karr JE, Areshenkoff CN, Garcia-Barrera MA.The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.Neuropsychology. 2014;28(3):321-336. doi:10.1037/neu0000037Eme R.Neurobehavioral outcomes of mild traumatic brain injury: a mini review.Brain Sci. 2017;7(5):46. doi:10.3390/brainsci7050046
Centers for Disease Control and Prevention.Symptoms of mild TBI and concussion.
Tator CH, Davis HS, Dufort PA, et al.Postconcussion syndrome: demographics and predictors in 221 patients.J Neurosurg.2016;125(5):1206-1216. doi:10.3171/2015.6.JNS15664
Lieba-Samal D, Platzer P, Seidel S, Klaschterka P, Knopf A, Wöber C.Characteristics of acute posttraumatic headache following mild head injury.Cephalalgia.2011;31(16):1618-1626. doi: 10.1177/0333102411428954
International Headache Society.Headache attributed to trauma or injury to the head and/or neck.
Fife TD, Kalra D.Persistent vertigo and dizziness after mild traumatic brain injury.Ann N Y Acad Sci.2015 Apr;1343:97-105. doi:10.1111/nyas.12678
Lau BC. Kontos AP, Collins MW, Mucha A, Lovell MR.Which on-field signs/symptoms predict protracted recovery from sports-related concussion among high school football players.Am J Sports Med.2011;39(11):2311-2318. doi:10.1177/0363546511410655
Lim MM, Bauman CR.Sleep-wake disorders in patients with traumatic brain injury. UpToDate.
Evans RW.Postconcussion syndrome. UpToDate.
Polinder S, Cnossen MC, Real RGL.A multidimensional approach to post-concussion symptoms in mild traumatic brain injury.Front Neurol. 2018;9:1113. doi:10.3389/fneur.2018.01113
Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhap L-R.Traumatic brain injury.Cell Transplant.2017;26(7):1118–1130. doi:10.1177/0963689717714102
American Association of Neurological Surgeons.Concussion.
Giza C, Greco T, Prins ML.Concussion: pathophysiology and clinical translation.Handb Clin Neurol.2018;158:51-61. doi:10.1016/B978-0-444-63954-7.00006-9
Silver JM.Effort, exaggeration, and malingering after concussion.J Neurol Neurosurg Psychiatry.2012;83:836–841. doi:10.1136/jnnp-2011-302078
Boake C, McCauley SR, Levin HS.Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury.J Neuropsychiatry Clin Neurosci.2005;17(3):350-356. doi:10.1176/jnp.17.3.350
Makdissi M, Cantu RC, Johnston KM, McCrory P, Meeuwisse WH.The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms?Br J Sports Med.2013;47(5):308-313. doi:10.1136/bjsports-2013-092255
Baker JG, Freitas MS, Leddy JJ, Kozlowski KF, Willer BS.Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome.Rehabil Res Pract. 2012;2012:705309. doi:10.1155/2012/705309
Lee MJ, Zhou Y, Greenwald BD.Update on non-pharmacological interventions for treatment of post-traumatic headache.Brain Sciences. 2022;12(10):1357. doi:10.3390/brainsci12101357
Karr JE, Areshenkoff CN, Garcia-Barrera MA.The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.Neuropsychology. 2014;28(3):321-336. doi:10.1037/neu0000037
Eme R.Neurobehavioral outcomes of mild traumatic brain injury: a mini review.Brain Sci. 2017;7(5):46. doi:10.3390/brainsci7050046
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