Persistent post-concussive symptoms (Post-concussion syndrome)

Diagnosis

No single test can prove you have persistent post-concussive symptoms. A healthcare professional may start with taking your full medical history and may use these tests to help determine your diagnosis:

• A neurological exam. This includes testing your thinking and memory, senses, strength, coordination, and reflexes.
• Neurological testing. These tests further check your concentration, memory, language, thinking and planning skills.
• Imaging. You may need brain imaging such as a CT scan or an MRI scan. Healthcare professionals may recommend brain imaging if you have concerning symptoms, such as a very bad headache, memory loss or vomiting. Imaging also can check for structural brain changes, such as damage to brain tissue, and other conditions that may be affecting the brain. But images cannot see persistent post-concussive symptoms.
• Other specialists. You may see other healthcare professionals based on your symptoms. This may include physical therapy, occupational therapy, speech therapy, or a psychologist for anxiety or memory problems. For dizziness, you may see an ear, nose and throat specialist. For vision changes, you might go to an eye specialist, known as an ophthalmologist. Or you might see a specialist in visual symptoms related to traumatic brain injuries or neurological conditions, known as a neuro-optometrist.

Treatment

There's no specific treatment for persistent post-concussive symptoms. Your healthcare professional treats your symptoms. The types of symptoms and how often they occur varies from person to person.

Headaches

Medicines that are often used for migraines or tension-type headaches may help. These may include medicines for treating depression, high blood pressure and seizures. Medicines are usually specific to the individual, so talk to your healthcare professional about which are best for you.

Keep in mind that the overuse of pain medicine may contribute to persistent post-concussive headaches. This is known as medication overuse headache. This can happen with pain medicine you get by prescription or that you buy at the store without a prescription.

Memory and thinking problems

Time may be the best therapy for memory and thinking problems after mild traumatic brain injury. Most of these symptoms go away on their own in the weeks to months after the injury, but using a notebook or visual cues may help you manage these symptoms as your brain heals.

Certain forms of cognitive therapy may be helpful, including focused rehabilitation in the areas that you need to strengthen. Some people may need occupational or speech therapy. Stress can make cognitive symptoms worse, so learning how to manage stress can be helpful. Relaxation therapy also may help.

Dizziness or vertigo

Dizziness is feeling faint, woozy or not steady. Vertigo is a false sense that your surroundings are moving. Dizziness and vertigo symptoms can be treated by a physical therapist specifically trained to treat balance symptoms.

Sleep symptoms

Trouble sleeping and other sleep symptoms are common after a concussion. Learning about good sleep habits, known as sleep hygiene, can help. This includes going to bed and waking up on a regular schedule. Sometimes medicines may be needed to improve sleep.

Vision

Vision changes also are common after concussion. These include blurry vision and sometimes double vision. Often vision changes get better on their own. Some people with persistent post-concussive symptoms may need to see a specialist who treats visual symptoms related to traumatic brain injuries, known as a neuro-optometrist.

Sensitivity to light and sound

For some people with persistent post-concussive symptoms, light and sound are bothersome. These symptoms tend to get better with time. But exposure therapy with a physical or occupational therapist may help these symptoms.

Irritability, depression and anxiety

Symptoms often improve once you understand the cause of your symptoms and that symptoms are likely to get better with time. Learning about persistent post-concussive symptoms can help ease fears and offer some peace of mind. If you have new or increasing depression or anxiety after a concussion, some treatment options may include:

• Psychotherapy. Talking with a psychologist, psychiatrist or social worker who works with people who have had a brain injury may help.
• Medicine. Medicines can treat depression and anxiety.
• Physical activity. Early, gradual exercise that avoids reinjury may help you feel better.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Preparing for your appointment

You first may see a member of your healthcare team, who makes the initial diagnosis of a concussion. Or the diagnosis might be made by a healthcare professional in the emergency room.

You may be referred to a brain and nervous system disorder specialist, known as a neurologist, or a brain rehabilitation specialist, known as a physiatrist.

Here's some information to help you get ready for your appointment and know what to expect.

What you can do

Take these steps to help you prepare for your appointment.

• Write down any symptoms you're experiencing, including any that may not seem related to the reason for the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements that you're taking and the doses.
• Ask a family member or friend to go with you, if possible. Sometimes it can be hard to remember all of the information given during an appointment. A friend or family member may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Prepare a list of questions to make the most of your appointment. List your questions from most important to least important in case time runs out.

For persistent post-concussive symptoms, some basic questions to ask your healthcare professional include:

• Why are these symptoms still occurring?
• How long will these symptoms continue?
• Do I need any other tests? Do I need to do anything to prepare for the tests?
• Are there any treatments available, and which do you recommend?
• Are there any activity restrictions that I need to follow?
• Are there any brochures or other printed material that I can take home? What websites do you recommend visiting?
• When can I return to work?
• When can I drive again?
• Is it safe to drink alcohol?
• Is it OK to take medicines that were prescribed before the injury?

Don't hesitate to ask any other questions you have during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions. Being ready to answer them may give you more time go over any other points you want to cover. Your healthcare professional may ask:

• How did the initial injury occur?
• Have your symptoms been constant, or do they come and go?
• What symptoms are you currently experiencing?
• How often do the symptoms occur?
• Does anything improve your symptoms?
• What, if anything, makes your symptoms worse?
• Are your symptoms getting worse, staying the same or getting better?