Post-concussion syndrome (PCS) results from injuries to the head. This can range from mild concussions (being struck on the head) to severe head injuries. Not always does the degree of head trauma correlate with the degree and symptoms of PCS. It is estimated that approximately 60-80% of patients suffering a moderate to severe concussion, traumatic brain injury (TBI), will develop PCS. In milder head injuries, PCS will develop up in up to 40-50% of injured individuals. Loss of consciousness is not a requirement for development of PCS. It is not even a requirement that there be a direct head injury. Patients who have sudden jerking movements of the head, particularly in car accidents, with out direct head trauma can suffer from PCS. Risk factors for development of PCS can include lower education level, drug or alcohol abuse, prior head injuries, or preexisting depression or anxiety. The recognition and diagnosis of the symptoms of PCS are important in helping affected patients to return to normal a quickly as possible.
The symptoms of PCS may develop immediately or make take days to several weeks to become apparent. Headaches and dizziness are the most common complaints in patients with PCS. These however are not the only symptoms that can be associated with PCS. Varying degrees of memory loss, concentration difficulty, anxiety, depression, irritability, emotional and behavioral disturbances, insomnia and personality changes. The headaches can vary from mild, dull, generalized headache to severe migraine like headaches. These headaches usually occur daily and can be quite debilitating. Dizziness can be anywhere from lightheadedness to a spinning type of dizziness known as vertigo. Patient can have irritability, anxiety and depression, partly due to the head injury but also from the persistence of their symptoms. Insomnia frequently accompanies these other psychological symptoms. In more severe case, behavioral changes can occur. Patients can become impulsive and irrational in their behavior. Psychological changes are more apparent later in the course of PCS. Decreased ability to concentrate and slowness in mental function can occur, particularly in higher functioning individuals.
Treatment for PCS is primarily time. Many of the symptoms of PCS will clear within days to a few weeks. A typical time for clearing of symptoms is usually 3 months and as much as 6 months. In 10-15% of the cases it can take a year or more for improvement. The earlier the diagnosis is made, generally the better the outcome. Headaches and dizziness complaints most commonly bring the patient to a doctor’s office. Patients may have tension headaches, migraine headaches or a condition known as occipital neuralgia. The latter is an injury to the occipital nerve at the base of the skull. The most effective treatment for this condition is an occipital nerve block. Other headache conditions are treated with the usual preventative migraine medications protocols. As anxiety, irritability and depression are common symptoms of PCS, the antidepressant medications are the most effective treatment for both the headaches and psychological symptoms. Antidepressant medications have been used for decades in controlling migraine and other headache disorders. Over-the-counter analgesics can be used to relieve headache and neck pains. Narcotics should be avoided as they are addictive and do not help the overall patient outcome. Mayo Clinic has an excellent, comprehensive summary of post-concussion syndrome.
In patients who have persistent complaints of memory loss, concentration difficulties, forgetfulness, anxiety and depression, neuropsychological testing followed by counseling can be helpful in patient management and improvement of symptoms. Testing is usually not done for at least 3-6 months following the head injury. This is because so many patients will spontaneously improve over this time period. Once testing is completed, the psychologist can help the patient through counseling to improve their overall well being. Other diagnostic tests may be performed and can include MRI brain studies, EEG or PET scan.
Prognosis for patients with PCS is excellent in the majority of the cases. Most patients are back to their normal baseline within a few weeks, with a few taking as long a 3 months. It is far less common for patients to continue having symptoms beyond this. It is estimated that only about 15% of patients with PCS will have symptoms a year or more. Early treatment by experienced neurologists or other physicians who have training in treatment of concussion, traumatic brain injuries and post-concussion syndrome are important in improving a patient’s quality of life in as short of period of time as possible.
{ 11 comments… read them below or add one }
This explains so much. I had a bad fall a month ago and didn’t see the doctor until a few days later. He said I might have headaches for up to 3 months, but didn’t say anything about the possibility of confusion. There are days I feel like a zombie. I just can’t see to get motivated. I’m confused and I don’t seem to really care, and I know this isn’t me. Reading your article really helped. I can see that eventually things will be normal again. I just need to give myself time.
ive had post concussion syndrom for over 4 years now it hasnt gone away
I had a concussion last week and this explains why I’m still experiencing headaches and neckaches. I’m also irritable and snapping at people, which isn’t like me. And while I haven’t acted impulsively, I’m having several impulsive thoughts and finding it very hard not to act on them. I thought I was going crazy!
I have had post concussion syndrom for 18 months, and the worst thing is the extrememly bad migraines and all my short term memory loss…..
I have also had post concussion syndrom for two years from playing ice hockey. and it is a living hell. Ive been to 22 doctors and no one has a clue. I would not wish this apon anyone
I’ve been suffering from PCS for over two years now. What type of doctor should I see for treatment?
When a writer cannot write: Someone smashed into the back of the car in which I was a passenger about two & half years ago. I ended up with severe PCS, including confussion, short term memory loss, depression. My brains were like scrambled eggs. I also noted some weirded out attention deficit going on among other things. Anyway it was a nightmare because I am a writer. I had to drop my clients. Everytime I attempted to write a few sentances I had to keep rereading what I had just written because I kept forgetting everything I had just written in the sentance before. Also it was torture because I found myself unable to do more than one simple task at the same time. I went from multi-tasker to basket case tasker. I compare my PCS to being trapped in some hellish claustrophobic that suffocates my creativity. Things seemed to clear up after four months but unfortunately later on down the recovery road I collapsed into a terrible depression along with slowed thinking / memory issues and the whole nine yard cognitive cragmire funk. To make a long story short, it seems like I recover for periods of time only to collapse again into this troubling PCS / depression funky hell. This last summer I was great. Me tons of energy. Me swimming—ME LOOK GREAT! Brain not too bad! New boyfriend! I happy! Writing again! Ooops – the short winter november days came and wouldn’t ya know it— Crash! Boom! I weirded out into this sudden horrific PCS depression. Boyfriend gone! He was nuts about me now he no want me because he think I nuts. Me no happy! For the past four weeks I have been fighting my way back with fish oils, high protein diet, B vitamins. I also take vitamin D (I always seem deficient in D) and I shine vitamin D medical light at home for few minutes daily. I also have great Northern Light SAD. I swim & walk, even when I feel more like jumping from the window! I think I may be beating it– maybe when I wake up tomorrow I can tackle that half- finished screenplay I crashed out on five weeks ago! I want to try hyperbaric oxygen chamber as I have heard good things about it. I actually have been taking some oxygen from my friend’s simple O2 tanks- twenty to forty minutes per day when I am in funk. Sometimes it seems to help a bit. I am not sure how good this is. Anyway I think the hyperbaric o2 treatments are probably better but cost too much! Me broke with PCS!!!
I was diagnosed with post concussion syndrome a few days after rolling a car and now 4 1/2 years later still heave it. Doc originally insisted I was depressed needed prozac despite hospital diagnosis (I refused)/ just had tension headaches – everybody gets them/ refused a referral to a neurologist for 3 years ( I filed a complaint to get one!) etc
Just been told my headaches are post concussion migraines and can be treated with a digdrogortamine drip for a few days then a migraine preventative daily after this. After all this time a migraine preventative is not going to work on its own. (Dr Goadsby London). Cost 5000uk.
A neurologist with a specaility in headaches is a good place to start . Check them out on the internet for papers printed and their speciality.
Smile at yourself 20 times a day in a mirror – it stimulates good neurotransmitters like serotonin and keeps depression away. Look on the bright side – memory loss means that i cannot remember too many details of how #### I feel!
I have had PCS since dec 06 from an industrial accident. I have a hard time retaining information, i need to use lists for my memory, i have expressive language problems, anxiety, depression, you name it. I have been to doctors, specialists, they try to pill push. anti depressants, anxiety meds, sleeping pills.. nothing helps. those are all just bandaids. i am really frustrated.
I have been suffering from PCS for almost two years now. My family and I were involved in a very bad MVA. I suffered a closed head injuyy and severe concussion along with other severe bodily injurues. I have indentions and sunk in spots on my skull and one area that is extremely tender to the touch. My medical doctor referred me to a neurologist 9 months ago. I have been on a broad range of medications since the accident. Nothing has really helped. My neurologist is now sending me to a pain management doctor for some type of block for my head. I’m praying that this will work, I don’t know how much more I can take of the pain. Is there anybody out there that can tell me that this will go away? That this can’t get any worse?
I have written on this site about my PCS/Jan 2010. I am the writer who has battled PCS for the past 4 years since August 2007/ car accident. I want to share with others that I do go through wonderful periods of recovery where I am sharp again and writing well. I am sure that I am healed. Unfortunately the PCS seems to periodically creep up on me and crashes me out with many horrific reocurring symptoms such as strange ADHD issues, memory issues, slowed thinking, confusion, depression, loss of self to some degree–you name it (I almost feel bi-polar). It’s as though the concussion has made my nervous system/brain very fragile. I “break” when I overdo a little too much dieting and exercise or don’t eat enough healthy fats or have too much stress such as boyfriend loss, money issues, too much brain work at computer, etc. It frightens me. It’s the most heartbreaking and difficult challenge for those of us who suffer with PCS. We must all have faith. I am trying to combat CPS by sticking to things that seem to help such as high protein diet- healthy fats from nuts, avocados, etc- fruits and veggies- exercising my brain with work– sunlight helps! (I wish I could move South!) I go under vitamin D medical light almost every day for mood booster. I have been taking soft hyperbaric oxygen treatments (it does help but I can barely afford this!) The one I use is 1.3 atmospheric pressure/soft chamber with lower o2 content – would like to try the higher O2 concentration soon. I think it is super important for those of us with PCS to surround ourselves with friends. Get out even if you feel like a zombie. There are times when I am with my friends and I feel like someone with Alzheimers. Then again there are times when I feel great. Know that things will get better for all of us! Everyday is a new day — try and be good to yourself — healing is a life long journey for us and there is no race! Love to all Ellen