Post Concussion Syndrome - causes and treatment

A concussion is usually a mild injury to the brain.  But when Post Concussion Syndrome (or postconcussive syndrome) looks like it's come to stay, there's nothing "mild" about it!

But what is this strange syndrome?  What causes it, and why do some people seem to get it, and not others?  Most importantly, what's the treatment - how can you make this unwelcome visitor go away?

What is Post Concussion Syndrome?

To answer that question, we need to start with the concussion itself.  A concussion is a mild traumatic brain injury (actually, it's often now called by that name - MTBI).  It's caused by a trauma to the head, most often from a fall, vehicle accident, or sports injury.

As with many brain-related issues, there's really a lot we don't know about concussion itself, and exactly what it does to the brain.  But we do know that very soon afterwards there are symptoms - usually headache, dizziness, nausea, confusion, irritability and lethargy.  Sometimes there's amnesia, though it usually only lasts for a few hours.

As a matter of fact, usually the symptoms all go away, without much or any treatment.  A little rest, maybe over-the-counter painkillers for the headache, and the symptoms resolve.

But when there are lingering symptoms - for weeks, months or even longer - that indicates postconcussive syndrome.

Read this article for a full discussion of Post Concussion Syndrome Symptoms.

Since we know so little about concussion, it shouldn't be surprising that there's a lot we don't know about post-concussion syndrome.  We can see the symptoms, and have known about the problem for hundreds of years.  But what is the cause?

Why did I get PCS?

o one knows for sure why some people get Postconcussive Syndrome and others don't.  Most research to date seems to indicate that there are a variety of factors - before, during, and after the concussion, that make one person more likely than another to develop these symptoms.  However, it doesn't look like it has to do with the severity of the injury (at least, not that alone).

There seem to be a combination of damage to the brain, physiological factors, and psychological factors.  The British Journal of Psychiatry published an interesting list of some of the research on Post Concussion Syndrome, and how that research points to a variety of causes.

Note:  "Psychological" does not mean that the symptoms are imagined, or that they will go away if you have enough will power.  For one thing, remember that there are probably a variety of causes, and that psychological factors are only one part of the puzzle.  Also, this is most important when it comes to treatment - if you need treatment, a combination of treatments may be beneficial.  Psychological counselling has been a tool that has helped some patients, if not to completely overcome the symptoms, at least to improve quality of life over time.

With that said, let's look at treatment...

Post Concussion Syndrome Headache treatment

Let's start first with post concussion syndrome headache treatment, because this can be one of the biggest and most severe symptoms. As with any headache, you should always (1) check with your doctor and (2) be very cautious about using over-the-counter painkillers. Our hope is that the headaches will lessen and disappear over time - but the consistent use of painkillers may actually make your headaches increase over time.

Since the headaches may actually look like tension type headaches or migraine, the same medications are often used in post concussion syndrome headache treatment. Take a look at some medication migraine information here. Also, check out this article on post-traumatic migraine.

Other treatments

PCS is difficult to treat.  Generally, the symptoms are treated one by one.  But many of the symptoms are tricky.  For example, most doctors let the memory/thinking problems go away with time.  However, it does help to learn to use tools to cope.  For example, don't be afraid to ask people to clarify what they're saying, learn to write things down, carry a notebook and calendar, etc.

Like headache, depression may be treated like depression would normally be treated.  Actually, for many people it helps just to know that this is a real documented problem - it's not just something imagined.  People may just start to think they can't cope or are bad parents/spouses/friends/employees, until they realize there's a valid reason why they're having trouble.

As mentioned above, psychological treatment has helped a number of patients.  Various types of therapy may help you become more active little by little, and speed your recovery.

Rest and exercise

There is some disagreement on how rest and exercise figure in post concussion syndrome recovery. After a head injury, it's usually best to get plenty of rest for a while. But how much, and for how long?

A study in 2002 was done with patients who had mild head injury. One group had bed rest, the other did not. The result 3 months later was - no difference at all. The researchers did feel that the rest may have helped to alleviate some symptoms early on, but the rest didn't seem to help long term.

Though rest is important, it's probably wise to try to gradually increase your activity. As a matter of fact, sports specialists are now looking at a treatment that specifically gradually increases exercise over time, while monitoring how the patient is doing. This is called "regulated exercise". So far, results have been promising - here's hoping the research will filter into something that will help more patients. (Read more: New Treatment For Post-Concussion Syndrome Pioneered At UB)

Will I recover?

Most people with PCS seem to make a recovery within 6 months, usually in less time - a few weeks.  Sometimes patients see very little improvement, and then the symptoms quickly go away, so don't give up!

In a small number of cases, the symptoms may persist.  But even these patients are able to find good coping strategies that allow them to get back "into life" in most cases.

It may seem like it's taking forever, especially when you expect a quick recovery from a "mild" head injury.  But there is plenty of hope that the symptoms will go away.

Talk to your doctor, and make sure she has a full medical history and understands what symptoms you've been dealing with and for how long.  She can help direct you to treatment that will help.