Motor vehicle crashes, sports injuries, occupational accidents, assaults, and falls may result in concussions, a type of head injury that causes bruising of the brain. Concussions are also known as mild traumatic brain injuries (TBI). While most concussions resolve on their own within a couple of weeks, approximately 15% of patients with a mild TBI go on to experience persistent headaches and are later diagnosed with post-concussion syndrome (PCS).
Ongoing pain and headaches are two of the most common symptoms used to diagnose post-concussion syndrome. PCS can have long-term effects on cognition, memory, learning, and executive functioning skills. Symptoms of PCS impact a patient’s ability to function in their daily life and to earn a living.
What Is Post-Concussion Syndrome?
In the United States, 1.5 million people suffer a concussion each year, at an estimated economic cost of $17 billion annually. Ninety percent of concussion patients can expect to fully recover within 10 to 14 days of their accident, but others will continue to have concussion symptoms for months afterward. In very rare cases, mild traumatic brain injury symptoms cause permanent disability.
Chronic, persistent daily headaches that continue after the expected recovery period may be a sign of post-concussion syndrome. You don’t have to lose consciousness to suffer from a concussion or to experience post-concussion syndrome.
What Are the Symptoms Associated With Post-Concussion Syndrome?
The signs of PCS typically appear seven to 10 days following a head injury and resolve themselves within three months but may go on for a year or more in some patients. Symptoms can be physical, cognitive, behavioral, or emotional in nature. In addition to debilitating headaches, PCS patients report the following long-term symptoms:
- Tension headaches
- Sudden onset migraines
- Dizziness
- Loss of balance and coordination
- Clumsiness
- Fatigue
- Confusion
- Impaired memory and concentration
- Brain fog
- Delayed thoughts
- Irritability or agitation
- Mood swings
- Restlessness
- Anxiety
- Depression
- Emotional disturbances
- Apathy or personality changes since the accident
- Insomnia or hypersomnia (sleeping too much)
- Ringing in the ears
- Double or blurred vision
- Trouble seeing at night
- Difficulty tracking with the eyes
- Difficulty seeing things up close
- Sensitivity to light and sounds
- Decreased taste or smell
- Seizures
Who Is Most at Risk for Developing Post-Concussion Syndrome?
Experts haven’t pinpointed the exact cause of PCS or why some patients go on to develop it while others do not. Anyone who suffers from a concussion can develop PCS, but the risk increases with age. Women and patients with a previous history of concussions are also more likely to be diagnosed with PCS, as well as individuals with a history of psychiatric disorders, ADHD, or chronic pain syndrome. These and other factors make some patients more likely to have persistent concussion symptoms, including chronic headaches:
- Past history of head injuries
- A concussion with complications
- Having another brain-related condition or learning difficulty
- A history of anxiety, depression, or bipolar disorder
- A large number of concussion symptoms immediately following injury
- More severe concussion symptoms
How Is Post-Concussion Syndrome Diagnosed?
PCS can be difficult to diagnose. Uncomplicated mild traumatic brain injuries show up as normal brains on CT scans. When there are complications, such as bleeding or bruising of the brain or a skull fracture, doctors are better able to visualize the injury via CT or MRI. Uncomplicated, mild TBIs are more likely to resolve within three months than those involving complications.
Your health care provider will want to examine you and take a comprehensive medical history before providing a PCS diagnosis. Some information you can expect to provide includes:
- The date of your injury
- How the injury occurred
- Whether there was a loss of consciousness
- The number of previous concussions you’ve had
- Current symptoms
You may also undergo a full neurological exam testing your cranial nerves, vision, reflexes, strength, and ability to feel sensations. A PCS diagnosis requires the presence of a cognitive deficit in the areas of attention or memory, along with at least three other symptoms that last longer than three months.
What Is the Treatment for Persistent Headaches?
In caring for patients with persistent headaches, the focus is on treating symptoms. Complete physical and brain rest is recommended for the first 24 to 48 hours following a TBI. Allowing the brain to rest is thought to lessen symptoms and speed up concussion recovery time.
There is no direct treatment or cure for PCS beyond time and rest. However, your doctor will track the symptoms you’re experiencing to measure their improvement over time. The following are used to control head pain and manage symptoms while your brain heals:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen or acetaminophen
- Nerve block to the occipital nerve at the back of the head
- Anti-nausea medication
- Melatonin to improve sleep
- The use of hats, sunglasses, and earplugs to block out light and noise
- Physical therapy
- Speech and language therapy
- Psychiatric care to address behavioral symptoms
Light exercise, such as slow walking or riding a stationary bike, has been shown to jump-start the recovery process following a concussion. Consult your doctor before beginning any exercise program.
What Are the Long-Term Risks of Persistent Headache?
Long-term chronic head pain causes patients considerable stress and may lead to depression and other psychological disorders. Emotional symptoms are the most commonly reported persistent symptoms of TBI lasting beyond one year.
There are also risks associated with becoming dependent on narcotic medications used to treat head pain, leading to substance use disorders. Other risks of persistent headaches are:
- Cognitive impairment
- Problems thinking or focusing
- Memory loss
- Executive dysfunction
- Inability to perform daily tasks or work
- Personality changes
- Impulsive behavior
- Aggression
- Thoughts of self-harm and suicide
If you’ve been involved in an accident or assault that resulted in injury to the head or neck, caused you to black out, or led to whiplash, you should seek medical treatment immediately. Early intervention and rest may shorten the length of time you experience persistent headaches and other symptoms. If your symptoms continue past the expected recovery period, you may be eligible to receive compensation for your pain and suffering, medical expenses, and lost wages.
SOURCES:
National Institutes of Health- Chronic Pain Syndrome
Centers for Disease Control and Prevention- ADHD
