Traumatic brain injury (TBI) might lead to severely debilitating long-term sequelae in the absence of an early diagnosis and adequate treatment, one of the most important forms being a concussion, defined as a traumatic event during which various pathophysiological processes (primarily mechanical forces exerted on brain tissue) lead to brain injury, but without evidence on imaging studies [1]. Various symptoms appear shortly after the initial injury, including headaches, amnesia, and loss of consciousness, whereas emotional instability, sleep disturbances, and cognitive impairment (reduced reaction time is a key finding) can be present as well [1]. Postconcussive syndrome (PCS) is still an incompletely defined disorder that several authors describe as prolongation of symptoms after a concussion [2] [3]. The majority of patients recover from a concussion within a period of days to weeks, but PCS is estimated to occur in approximately 10% of cases [4]. Notable findings in PCS include persistent emotional instability, difficulty sleeping, anxiety, dizziness, irritability, visual disturbances, sensitivity to noise, and inability to maintain concentration, in addition to complaints mentioned previously [2] [3] [5] [6]. Depression may also be a long-term adverse effect of concussion and is an important constituent of PCS [1] [7].

• Fatigue

  RESULTS: Headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, whereas sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up [pediatrics.aappublications.org]

  Eye tracking abnormalities can often cause headaches, dizziness, eye fatigue, sensitivity to busy environments or bright light. [sdwpt.com]

  The most commonly reported post concussion symptoms are headache, dizziness, decreased concentration, memory problems, irritability, fatigue, visual disturbances, sensitivity to noise, judgment problems, depression, and anxiety. [ncbi.nlm.nih.gov]

  These include dizziness, fatigue, and headaches. Post-concussion syndrome can begin to occur within days of the head injury. It can sometimes take weeks for the symptoms to appear. [healthline.com]

• Inflammation

  The autoimmune reaction results in inflammation, which damages the myelin sheath and the nerve fiber under it. This rare type of inflammation leads to demyelination of nerves in the brain and spinal cord. [merck.com]

  Steroids are effective on PCS flare ups- best one is a tapered approach Dexamethazone and it resets the brains hormones and helps inflammation linked to these symptoms. [healthunlocked.com]

  Inflammation and CBD Inflammation in my neck caused a lot of headache, pain, and stress throughout my entire body. Using CBD as both an oral treatment and topical treatment greatly reduced these symptoms. [jontoivoproject.com]

  Nesfatin-1 is a peptide secreted from hypothalamic centers in response to inflammation ( Bonnet et al., 2009 ). [doi.org]

  Our final goal was to break the pattern of excessive nerve firing, vascular insufficiency, autonomic responses, anxiety related to these stressors, sleeplessness, inflammation, and muscle tensions. [cyberpt.com]

• Malaise

  Symptoms In general, the most commonly accepted definition is that postconcussive syndrome consists of someone having suffered from mild TBI and then goes on to suffer from the following: Headache, dizziness, malaise, fatigue, or decreased tolerance to [verywell.com]

  Post-Concussion Syndrome according to The International Classification of Diseases, 10th Revision (ICD-10) 2 History of head trauma with loss of consciousness precedes symptom onset by a maximum of 4 weeks Three or more symptom categories: Headache, dizziness, malaise [momsteam.com]

  Symptoms in 3 or more of the following symptom categories: Headache, dizziness, malaise, fatigue, altered noise tolerance Irritability, depression, anxiety, emotional lability Subjective concentration, memory, or intellectual difficulties without neuropsychological [physio-pedia.com]

• Chronic Fatigue Syndrome

  Keywords Traumatic Brain Injury Chronic Fatigue Syndrome Mild Traumatic Brain Injury Mild Head Injury Minor Head Trauma These keywords were added by machine and not by the authors. [doi.org]

  PCS also shares symptoms with chronic fatigue syndrome, fibromyalgia, and exposure to certain toxins. [en.wikipedia.org]

• Nausea

  Your Doctor may prescribe certain medications to help ease your symptoms, such as painkillers (for headaches), anti-depressants or anti-nausea medication. [sportsinjuryclinic.net]

  Repeated vomiting or nausea. Slurred speech. The people checking on you should take you to an emergency department right away if you: Look very drowsy or cannot be awakened. [braininjspecialists.com]

  Immediate symptoms of a concussion can include confusion, amnesia, nausea, vomiting, headache or dizziness. Post-concussion syndrome (PCS) is a condition in which the symptoms of a concussion persist for weeks, months or years. [livestrong.com]

  Three days later, she presented to the athletic training room clinic with complaints of frontotemporal headache, nausea, dizziness, photosensitivity, and phonosensitivity. She also endorsed feeling slowed down, irritability, and drowsiness. [amssm.org]

  Treatment plans often include prescriptions for pain medications, anti-nausea medications and anti-depressants. [starjournalnow.com]

• Vomiting

  Repeated vomiting or nausea. Slurred speech. The people checking on you should take you to an emergency department right away if you: Look very drowsy or cannot be awakened. [braininjspecialists.com]

  Immediate symptoms of a concussion can include confusion, amnesia, nausea, vomiting, headache or dizziness. Post-concussion syndrome (PCS) is a condition in which the symptoms of a concussion persist for weeks, months or years. [livestrong.com]

  In relatively mild cases, potential symptoms of this form of brain injury include headaches, muddled thinking or confusion, nausea, vomiting, short-term memory loss, short-term loss of consciousness and unusual sleepiness or difficulty waking up after [recoveryranch.com]

  No nausea, vomiting, speech, or vision changes. She rested at home last night, but didn’t feel up to reading, or watching TV. She drove herself to your office today. [thecurbsiders.com]

  She had a brief convulsion immediately after the fall, was unresponsive for less than 1 minute, and awakened with a severe generalized headache and nausea but no vomiting. [doi.org]

• Tinnitus

  Symptoms A symptom of post-concussion syndrome sometime after the initial head injury or concussion and can include headaches, dizziness, blurred vision, ringing in the ears (tinnitus), nausea, loss of taste or smell and difficulty sleeping. [sportsinjuryclinic.net]

  The symptoms most often associated with postconcussion syndrome are headache, dizziness, vertigo, anxiety, fatigue, difficulty in concentrating, depression, heart palpitations, tinnitus, and apathy. [aapc.com]

  Physical symptoms of PCS are headaches, dizziness, sensitivity to light or noise, double vision, tinnitus, decreased sense of smell, insomnia and nausea. For some people diagnosed with PCS the symptoms can be psychological. [careyandleisure.com]

  Symptoms of hearing problems can include a ringing or buzzing sensations within the ears (tinnitus) or hearing loss. Hearing impairment may be temporary but can persist for more than a year in certain people with PCS. [livestrong.com]

  Hearing loss and/or a ringing noise in the ears (tinnitus). Reduced sense of smell and taste. Problems tolerating bright light and loud noise. Emotional and behavioural symptoms: Being easily irritable and sometimes aggressive. [patient.info]

• Benign Paroxysmal Positional Vertigo

  In patients with Visual Motion Sensitivity (VMS), BNO can improve both subjective visual perception and objective performance with sensorimotor tasks. [19] Considerations: [11] It is important to clear patients of Benign Paroxysmal Positional Vertigo [physio-pedia.com]

  BPPV (Benign Paroxysmal Positional Vertigo) is always screened for and promptly treated when found. If gaze stability is impaired, a peripheral source such as labyrinthine concussion without fracture may be to blame. [jlgh.org]

• Fear

  The prevalence of headache, irritability, fears, sleep disorders, learning difficulties, as well as concentration and memory problems did not differ significantly between children with mild traumatic brain injury and the control group when the results [ncbi.nlm.nih.gov]

  Intensified by fear and uncertainty, this syndrome can interfere with daily life and lead to frustration and despair, especially when its cause remains unknown. [drdiane.com]

  Mayo Clinic also recommends education on the disorder to ease a person’s fears for depression and anxiety, along with medications and standard talk therapy. [integrativepractitioner.com]

  Just spending an hour there was so overwhelming, I was constantly in fear of being hurt. Remember to me, a pat on the back was like a blow to the skull; my fear of being hit again was taking over my life. What did I have to look forward to... [jontoivoproject.com]

  Irritability, depression, anxiety, emotional lability Subjective concentration, memory, or intellectual difficulties without neuropsychological evidence of marked impairment Insomnia Reduced alcohol intolerance Preoccupation with above symptoms and fear [momsteam.com]

• Mood Swings

  Cognitive and psychological symptoms of the post-concussion syndrome can include forgetfulness, lack of concentration, slowed reaction times, difficulty taking on new information as well as anxiety, depression and mood swings. [sportsinjuryclinic.net]

  You may also have mental health problems like anxiety, depression, and mood swings. [cancercarewny.com]

  Personality changes are common, and rapid mood swings alternate with waxing and waning energy levels. Taken individually, such impairments might not amount to much. However, such impairments usually appear in groups or clusters. [headinjury.com]

  Some patients will describe a feeling of restlessness, mood swings, aggression, decreased libido, anger, lack of ability to tolerate stress, impulsiveness, and loss of social judgment. [autoaccident.com]

• Aggressive Behavior

  Of the 30patients with major depression, 17 patients (56.7%) demonstrated significantaggressive behavior (Overt Aggression Scale scores >3 or a score of 3 withphysically aggressive behavior against self or others) compared with 10 of44 patients who showed [doi.org]

• Headache

  Headaches that occur after a concussion may feel like migraine headaches or tension-type headaches. Most headaches are tension-type headaches, which may be associated with a neck injury that occurred at the same time of the head injury. [en.wikipedia.org]

  headache” for a second, simply categorize these headaches, just like we do other headaches, and treat accordingly. (7) And that’s what we do in our practice, and we find success with many cases. [brain-bodyhealth.com]

  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. [relieve-migraine-headache.com]

  If you have PCS, you can experience recurrent or constant headache pain that mimics migraine, cluster headaches or tension-type headache symptoms, explain doctors at The Mayo Clinic. [livestrong.com]

  Headache is one of the most common complaints in patients with traumatic brain injury. By definition, headache that develops within 1 wk after head trauma (or within 1 wk after regaining consciousness) is referred to as posttraumatic headache (PTH). [doi.org]

• Dizziness

  The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. [doi.org]

  (DHI) [12] 25 item questionnaire measuring self-perceived disability due to unsteadiness and dizziness. [physio-pedia.com]

  Headaches, dizziness, fatigue, emotional instability, anxiety, sleep disturbances and an overall decreased quality of life are described as the most important complaints. [symptoma.com]

  Eye tracking abnormalities can often cause headaches, dizziness, eye fatigue, sensitivity to busy environments or bright light. [sdwpt.com]

  The most commonly reported post concussion symptoms are headache, dizziness, decreased concentration, memory problems, irritability, fatigue, visual disturbances, sensitivity to noise, judgment problems, depression, and anxiety. [ncbi.nlm.nih.gov]

• Irritability

  The prevalence of headache, irritability, fears, sleep disorders, learning difficulties, as well as concentration and memory problems did not differ significantly between children with mild traumatic brain injury and the control group when the results [ncbi.nlm.nih.gov]

  The most commonly reported post concussion symptoms are headache, dizziness, decreased concentration, memory problems, irritability, fatigue, visual disturbances, sensitivity to noise, judgment problems, depression, and anxiety. [doi.org]

  These symptoms include such things as a heightened state of anxiousness, a heightened state of irritability and unusual noise sensitivity. [recoveryranch.com]

• Insomnia

  The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. [ncbi.nlm.nih.gov]

  There are many different ways of defining PCS, but it is usually considered present if three or more symptoms (such as insomnia, headache, and dizziness) are present for at least three months. [healthofchildren.com]

  Common symptoms seen in patients with this condition include: Dizziness Headache Slurred speech Nausea Other symptoms may include: Anxiety Sound and light sensitivity Insomnia In order to confirm the diagnosis, a physician will often perform a brain scan [tsrinjurylaw.com]

  Physical symptoms of PCS are headaches, dizziness, sensitivity to light or noise, double vision, tinnitus, decreased sense of smell, insomnia and nausea. For some people diagnosed with PCS the symptoms can be psychological. [careyandleisure.com]

  Treatment Wait and see approach should be employed in the first few weeks after injury except for conservative symptomatic treatments for pain and insomnia. [drkant.com]

• Seizure

  […] occurs days to months after concussion Does require seizure management and precautions Usually requires anticonvulsant therapy Occurs within minutes of concussion in athlete still symptomatic from prior brain injury, which can be earlier in same event [cdc.gov]

  […] accidents Sports Falls, especially in younger children and older adults Physical abuse Military combat People with a history of any of the following may be more likely to experience post-concussion syndrome: Migraine headaches Mood, anxiety, learning, or seizure [barrowneuro.org]

  Rare sequelae include hematomas, seizures, transient global amnesia, tremor, and dystonia. [ncbi.nlm.nih.gov]

  […] undiagnosed seizure disorder. [doi.org]

  […] memory, repeats self, repeatedly asks questions, unable to recall words or objects Loss of consciousness Call the doctor or EMT immediately if any of following symptoms appear: A headache that will not go away and is severe Not waking up; very sleepy Seizure [brainline.org]

Physicians must bear in mind the importance of an early diagnosis of concussion and proper initiation of therapy, particularly in younger athletes. For this reason, a meticulous clinical workup is recommended. Firstly, a detailed patient history must cover all the details regarding the event that led to brain injury (time, description of the mechanism of injury, and severity of impact) and evaluate the presence of associated symptoms [1]. The Sport Concussion Assessment Tool 2 (SCAT2), comprising of a series of self-evaluating questions, a Glasgow coma scale grading (GCS), cognitive assessment, as well as examination of balance and coordination, is a comprehensive tool that can be of significant benefit in assessing individuals in whom a concussion is suspected [1]. The subjective nature of this test, however, is a major limitation [2]. In addition to findings obtained during the interview with the patient, a complete physical and neurological examination is also important. Clinical criteria should be supported by various tests, the most important being the treadmill test that determines whether symptoms appear or become exacerbated with exercise [2] [8]. If patients are unable to perform strenuous activities after TBI due to the reappearance of symptoms, the diagnosis of PCS is highly likely [2] [8]. The role of imaging studies in identifying additional injuries to other structures (eg. the cranium) is quite important but is of little benefit for PCS due to the absence of macroscopic changes in the brain after a concussion.

Several standardized, empirically supported treatment manuals are available. [ncbi.nlm.nih.gov]

Also, this is most important when it comes to treatment - if you need treatment, a combination of treatments may be beneficial. [relieve-migraine-headache.com]

The prognosis of mild CET is still uncertain and not all who have suffered a mild CET are going to develop a post-concussional syndrome. [elsevier.es]

Written by over 100 acknowledged leaders in the field, and containing hundreds of tables, graphs, and photographic images, the text deals with issues of neuroimaging and neurodiagnostic testing, prognosis and outcome, acute care, rehabilitative care, [books.google.com]

Prognosis The overall outcome is difficult to assess. Most individuals who have PCS recover fully, although if recovery has not occurred in one year it is less likely that it will ever occur. [healthofchildren.com]

The prognosis for minor cranial traumas is benign at vital level but a number of patients will develop long-term complaints, which contrast with the negativity of the clinical examination and complementary explorations. [noninvasiveicp.com]

Since stress exacerbates post concussion symptoms, and vice versa, an important part of treatment is letting the patient know that symptoms are normal and helping the patient deal with impairments. [11] Prognosis Edit For most patients, post concussion [psychology.wikia.com]

Both physiological and psychological etiologies have been suggested as causes for persistent post concussion symptoms and this has led to much controversy and debate in the literature. [ncbi.nlm.nih.gov]

Mood disorders occurring after TBI are clearly an area of neuropsychiatry in which further research in etiology as well as treatment is needed. [informahealthcare.com]

Epidemiology/Pathophysiology First published: 26 October 2011 Cited by: 1 Abstract Abstract Concussion is defined as a biomechanically induced brain injury characterized by the absence of gross anatomic lesions. [doi.org]

[…] features include: Emphasis on a disease state management approach to patient assessment and treatment Promotion of a holistic, biopsychosocial model of patient assessment and care Review of current expert consensus on practice guidelines Exploration of epidemiologic [books.google.com]

EPIDEMIOLOGY AND NATURAL RECOVERY The number of people who sustain a mild head injury and experience subsequent post-concussion symptoms is very high. [web.archive.org]

Recent literature relating to pathophysiology, neuropsychological outcome, and the persistent postconcussion syndrome will be integrated into the existing literature. [doi.org]

The basic pathophysiology of concussion is presented, followed by a recommended approach to the clinical evaluation of concussion in the emergency department and the physician's office. [ncbi.nlm.nih.gov]

Prevention The only way to prevent post-concussion syndrome is to prevent the original concussion. Wearing a helmet while riding a bike, rollerblading, or skateboarding can reduce the risk of head injury. [healthofchildren.com]

The only way to prevent PCS is by preventing the head injury itself. Here are some ways to help prevent head injuries: Wear your seatbelt while in a car. Ensure that children in your care are in the proper car seats. [healthline.com]

Prevention The only known way to prevent post-concussion syndrome is to avoid the head injury in the first place. [mayoclinic.org]

A review of controlled treatment outcome studies conducted over the past 2 decades in Scandinavia, Great Britain, Canada, and the United States suggests that early single session treatment can prevent the syndrome as effectively as traditional outpatient [ncbi.nlm.nih.gov]

1. McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med 2009;19(3):185-200.
2. Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012;4(2):147-154.
3. WHO (World Health Organization) International Statistical Classification of Diseases and Related Health Problems. 2010. [October 3, 2013]. (10th Revision. [Online version.]). http://apps.who.int/classifications/icd10/browse/2010/en.
4. Willer B, Leddy JJ. Management of concussion and post-concussion syndrome. Curr Treat Options Neurol. 2006;8(5):415-426.
5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Arlington, VA: American Psychiatric Publishing; 2013.
6. Dischinger PC, Ryb GE, Kufera JA, Auman KM. Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury. J Trauma. 2009;66(2):289-96;296-297.
7. Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol. 2006;21(4):303-310.
8. Leddy JJ, Kozlowski K, Donnelly JP, Pendergast DR, Epstein LH, Willer B. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010;20(1):21-27.