Post-Concussion Syndrome – What Happens When a Concussion Doesn’t Recover?
Widely known, but often dangerously dismissed, concussion is a term we have all become familiar with over the years. However, up until recently, ‘post-concussion syndrome’ was something rarely heard unless you were personally affected. With emerging research, this is now changing.
To understand the impact of post-concussion syndrome, it’s important to identify what it is and how it differs from concussion.
“A concussion is a traumatic brain injury that affects your brain function. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. Concussions are usually caused by a blow to the head. Violently shaking of the head and upper body also can cause concussions.
Some concussions cause you to lose consciousness, but most do not.
Falls are the most common cause of concussion. Concussions are also common if you play a contact sport, such as [American] football or [football]. Most people usually recover fully after a concussion.” – Mayo Clinc
By way of the simplest definition, post-concussion syndrome refers to a concussion which continues for weeks, months or longer after the initial injury. A complex disorder, research indicates that around 15% of people who have one concussion will go on to suffer persisting symptoms.
The side-effects, and their severity, will vary from person to person, however common symptoms include one or a combination of the following:
- Disturbed sleep;
- Psychological issues such as irritability, anxiety and depression;
- Cognitive difficulties such as memory loss, slow processing and reduction in concentration
There is no definitive test to diagnose post-concussion syndrome and most diagnoses are made through considering the patient’s medical and head-trauma history and neuro-radiology scans, although the condition often goes undetected in the latter.
Whilst it’s impossible to predict who will suffer from post-concussion syndrome, some research indicates that the condition may affect people with the following risk factors more severely:
- Those who suffered from early onset headaches, fatigue, memory loss or confusion after their injury;
- Those with a prior history of headaches or head traumas (including concussion);
There continues to be debate amongst professionals as to whether post-concussion syndrome is caused by physiological, organic injury or is, instead, psychological in nature. Some researchers believe that it is caused by a mixture of damage to structural parts of the brain and pre-existing psychological issues in a person’s history (such as a history of anxiety, depression or chronic pain). The relevance of psychological vulnerabilities is of note, when consideration is given to the fact that most researchers accept that there is no proven correlation between the severity of the original head injury and the development of post-concussion syndrome.
In addition to difficulties in identifying patients who may be more at risk, and obtaining a definitive diagnosis, prognosis also is tricky. Again, this varies greatly from person to person. A full recovery can be made within weeks or months, but it can also continue for years. Treatment will be tailored to deal with each patient’s individual symptoms and needs and may include a mixture of pain management, physiotherapy, anti-depressants and Cognitive Behavioural Therapy. As with most conditions, early intervention is considered key to both the patient’s ability to cope and in the reduction of symptoms.
From the brief overview of post-concussion syndrome above, it’s clear to see why this condition has been puzzling doctors and patients alike for decades. It’s difficult to anticipate, diagnose and predict.
It’s widely accepted that people with a history of head traumas are vulnerable to future neurological disorders – such as dementia. In addition to this, there’s now further research which suggests that, aside from longer-term neurodegenerative disease, a history of head injuries increases the risk of post-concussion syndrome too. For these reasons, it’s understandable why there is such a spotlight on athletes when considering these matters, especially those who are at risk of either significant traumatic brain injury (such as those in boxing, NFL or rugby) or repetitive blows to the head (such as in football).
Whilst you may not have necessary heard the term ‘post-concussion syndrome’ before, you are likely to have read about a number of sporting issues, past and present, where post-concussion syndrome and other longer-term neurological disorders are likely to have played a factor:
- For many years, concussion has not been taken seriously enough in football. It’s been dismissed as a sport where there isn’t sufficient threat of neurological damage. However, a number of research papers have identified the link between repetitive blows (such as from heading a football during training and in matches), cumulative concussions and degenerative brain disease. Most notably in the last few years, the University of Glasgow’s Brain Injury Research Group conducted research which found that ex-footballers had three and a half times the death rate due to neurodegenerative conditions than the general population. I have written further about the issues concerning the management of head injuries in football, rugby and cricket.
- Sports that are widely considered to be contact sports, such as boxing and American football, have garnered more attention historically for their impact on head injuries. However, the data is still shocking. In 2019 in the NFL (American football), 224 concussions were diagnosed in one season (including preseason, practices and games). Of this, 136 concussions were suffered in the 256 regular season games an average of 8 concussions per week throughout the season. This is a harrowing number of injuries which, statistically, is likely to give rise to longer-term neurological issues for a number of these athletes. I previously looked into issues regarding head injury management in the NFL and preventative measures which could assist.
- Further research has meant that many sports have now introduced new safety measures to protect children from head injuries. For example, guidelines are now in place limiting football headers in children during training. This is particularly so given that the frontal lobe of a young person’s brain can continue to develop up until the age of 25 years. Studies have shown that children can take longer to recover from a concussion than adults and may suffer more severe neurological disturbances.
I’m currently representing a number of clients who have suffer from post-concussion syndrome. Whilst post-concussion syndrome can happen after any concussion, my current clients all suffered their injuries after sustaining head injuries in road accidents. Unfortunately, years after their accidents, they continue to suffer symptoms of concussion – which have a disabling effect on their personal and professional lives. Through the legal process, they will receive compensation to account for the personal injuries and financial losses they have suffered as a result of the car crashes (which were not their fault).
Suffering from a head injury, no matter how relatively minor you may assume it to be, is frightening and the immediate priority for anyone is to focus on recovery and rehabilitation. If you or a loved one continue to suffer symptoms some months after your initial injury, you may wish to ask your neurologist to look into a potential diagnosis of post-concussion syndrome. A diagnosis, if made, may assist you in identifying the treatments and therapies to assist you.