Post-concussion syndrome

What are concussion aftereffects?

For most people, symptoms after a concussion begin to subside gradually over the first few weeks. However, for some, symptoms last longer and continue to affect daily life.

This is often called concussion aftereffects.

In healthcare and research, terms such as persistent post-concussion symptoms, prolonged symptoms after concussion, and post-concussion syndrome (PCS) are also used. These terms essentially describe the same situation: symptoms continuing longer than expected after a concussion.

There is no fixed time limit, but many international guidelines recommend that individuals with persistent symptoms after about four weeks receive a more thorough assessment.

If you have not yet read about the common symptoms of a concussion, we recommend that you start here.

Read also: Symptoms of a concussion → (internal link)

Why do symptoms persist for some?

This is one of the questions researchers have focused on most over the last many years. Previously, it was believed that aftereffects were primarily due to the brain still being affected by the injury itself. Today, we know the explanation is often more complex. For the vast majority, the acute biological changes in the brain have subsided after the first few weeks. Yet, symptoms can persist. This does not mean the symptoms are imagined or "just psychological." On the contrary, research shows that aftereffects are often caused by an interplay between several different factors.

Why are aftereffects about more than just the concussion itself?

A concussion does not only affect the brain.

It also affects the body, the nervous system, and the daily life one must function in.

Therefore, it is rarely a single factor that explains why symptoms persist. It is often the interplay between several conditions.

This way of understanding prolonged symptoms is called the biopsychosocial model and currently forms the basis for many international recommendations on treatment and rehabilitation.

Biological factors

The concussion itself can lead to symptoms such as headaches, dizziness, fatigue, sensitivity to light and sound, or neck pain.

Some people also have migraines, tension headaches, or other health conditions that can affect the recovery process.

Psychological factors

When symptoms persist, it is completely natural to feel uncertain.

Many people start asking themselves questions like:

Am I allowed to go for a walk?

Am I allowed to exercise?

Am I doing something wrong?

Will I ever be myself again?

This uncertainty is a natural reaction to a situation that can be difficult to understand and predict. At the same time, worry, stress, and lack of sleep can contribute to increasing the burden on the nervous system.

Social factors

A concussion rarely affects only the individual.

Work, studies, family, finances, and expectations from those around you can all influence how symptoms are experienced.

When the demands of everyday life exceed what the body can handle, symptoms will often intensify.

This does not necessarily mean that the brain is being damaged. It is often a sign that the load exceeds what the body can manage right now.

What happens in the nervous system?

One of the most important things to know is that long-term symptoms do not necessarily mean that the brain is still damaged.

For some people, the nervous system becomes more sensitive after a concussion.

You can compare it to a smoke alarm.

Normally, it only reacts when there is danger.

But if it becomes too sensitive, it can also go off when you are making toast or frying bacon.

The alarm is still working – but it is reacting more strongly than the situation requires.

In the same way, a sensitive nervous system can begin to react to activities that were previously completely unproblematic. This could be screen work, a trip to the supermarket, exercise, or many sensory impressions at once.

The symptoms are real.

But they do not necessarily mean that new damage is occurring to the brain.

This is also why the treatment of long-term symptoms is often about gradually helping the nervous system to once again experience ordinary activities as safe and manageable.

Why do symptoms fluctuate?

One of the most frustrating things about long-term symptoms after a concussion is that the symptoms rarely develop in a straight line.

Many people experience days where they feel almost recovered, followed by days where the headache, dizziness, or fatigue suddenly return.

This can create uncertainty.

Have I gotten worse again?

Have I done something wrong?

In most cases, the answer is no.

It is completely normal for symptoms to vary along the way.

Often, these fluctuations are linked to the total load the body has been exposed to. This load can be physical, mental, or social, and it builds up over several hours or days.

This also means that symptoms do not always appear immediately. You might have a good day, but only feel the consequences later that day or the following day.

What can contribute to maintaining the symptoms?

When symptoms persist, it is rarely due to a single thing.

Often, there are several factors that influence each other.

This can, for example, be:

• headaches or migraines
• neck pain
• dizziness or balance problems
• sleep problems
• stress and worries
• uncertainty regarding activity
• an everyday life with many demands and a fast pace

For some, it becomes difficult to find the balance between activity and rest.

Some end up pushing themselves too hard on good days and have to pay the price afterwards.

Others become so worried about getting more symptoms that they gradually start avoiding more and more activities.

Both reactions are understandable.

But both can make it harder to return to a daily life with fewer symptoms.

Therefore, treatment is often about finding a balance where the load can be gradually increased without causing unnecessary setbacks.

Is it possible to recover?

Yes.

Most people with post-concussion syndrome experience gradual improvement over time.

How long it takes varies from person to person and depends, among other things, on which symptoms you have, how long they have lasted, and which factors affect them.

Unfortunately, there is no treatment that helps everyone.

On the other hand, research shows that many benefit from an individual and targeted effort, where the treatment is based on their specific symptoms and daily life.

The most important thing, therefore, is not to find one single solution, but to understand what is maintaining the symptoms for the individual.

How are post-concussion symptoms treated?

There is no single standard treatment that suits everyone.

Treatment should be based on the symptoms and challenges that are most prominent.

For some, headaches are the biggest limitation.

For others, it is dizziness, mental fatigue, sleep problems, or uncertainty regarding activity.

At Hemi, we work in an interdisciplinary manner when it makes sense.

Depending on your symptoms, treatment may include, among other things:

• neurological assessment and medical treatment
• specialized physiotherapy
• pain management
• neuropsychological treatment
• work-related social support
• counseling on gradual return to work or studies

The goal is not just to reduce symptoms.

The goal is to help you gradually regain function, confidence, and a daily life with fewer limitations.

Read more about our treatment for post-concussion syndrome → (internal link to treatment page)

When should you seek help?

If symptoms persist beyond four weeks or significantly impact your daily life, it may be a good idea to get an assessment from a practitioner with experience in long-term post-concussion symptoms.

This is especially true if:

• symptoms are getting worse instead of gradually improving
• you are struggling to manage work or studies
• you experience persistent headaches or dizziness
• you find it difficult to be physically active
• symptoms are limiting your family or social life
• you are unsure about the best way to move forward

The better you understand your symptoms, the easier it often becomes to create a plan that suits your individual needs.

Frequently asked questions

Is post-concussion syndrome the same as persistent post-concussion symptoms?

Yes.

Both terms are used to describe symptoms that last longer than expected after a concussion. Today, terms like persistent symptoms or long-term symptoms after a concussion are also commonly used.

Is it normal for symptoms to fluctuate?

Yes.

That is actually one of the most characteristic features of post-concussion syndrome.

Symptoms can vary from day to day and are influenced by factors such as total load, sleep, stress, and activity level.

Do persistent symptoms mean the brain is still damaged?

Not necessarily.

For the vast majority, the acute biological changes in the brain have subsided. Persistent symptoms are often due to a complex interplay of several factors, which is why an individual assessment is important.

Is a full recovery possible?

Yes.

Many people with persistent symptoms experience gradual improvement, even if the symptoms have lasted for a long time.

Every recovery journey is unique, and your treatment should be too.