Persistent Post-Concussion Symptoms

What is a Concussion?

A concussion, also called a mild traumatic brain injury (mTBI), is caused by a blow or sudden jolt to the head. It is generally defined by a loss of consciousness lasting 30 minutes or less, or no loss of consciousness at all, and CT or MRI scans typically show no visible damage to the brain. Common symptoms include:

• Headaches
• Dizziness
• Nausea
• Fatigue
• Blurred vision
• Sensitivity to light or noise
• Sleep disturbance
• Emotional changes (irritability, low mood, worry)

Concussions may also temporarily impact cognitive functions, including memory, attention, concentration, and processing speed.

What are Persistent Post-Concussion Symptoms?

Most people are expected to fully recover from a concussion within two to four weeks, though recovery can sometimes take up to three months. When concussion symptoms persist beyond the expected recovery period, it may indicate the development of Persistent Post-Concussion Symptoms (PPCS), also called Post-Concussion Syndrome. PPCS can impact daily life, making it harder to participate in activities like work, school, or social interactions.

Research on PPCS

In many cases of PPCS, brain scans (CT or MRI) do not show any visible damage, which is why doctors can not always identify a clear physical cause for ongoing symptoms. The same symptoms seen in people with PPCS are also found in other groups, such as healthy individuals, those with chronic pain, spinal or orthopaedic injuries, people who have experienced trauma, and those dealing with psychological stress. Since these symptoms are not exclusive to PPCS, it can sometimes be misdiagnosed.

The exact causes of PPCS is not fully known, however, it is understood to represent a complex interplay of biological, psychological, and social factors. Some of the factors that can increase the risk of developing PPCS or make symptoms worse include:

• A history of mental health difficulties or current struggles with anxiety, depression, or stress
• Pre-existing difficulties with learning or attention
• Problems with vision, eye movement, balance, or neck issues
• History of headaches or migraines
• Sleep problems
• Ongoing pain
• Having experienced multiple concussions or a “complicated” mild TBI (i.e., concussion with some mild contusions or other abnormalities on brain scans).

What is Still Unknown?

Despite advancements, some aspects of PPCS remain unclear:

• The exact causes of PPCS and the influence of the brain on persisting symptoms
• Individual differences in recovery trajectories and why some people experience prolonged symptoms while others recover quickly are not fully understood.
• While some treatments like psychological therapy and rehabilitation are helpful, researchers are still investigating effective treatments for PPCS

What Maintains Symptoms?

Cognitive-Behavioural Therapy (CBT) provides a framework for understanding how certain cognitive and behavioural patterns contribute to the persistence of symptoms:

• Hypervigilance: Excessive monitoring of symptoms can heighten awareness and make them feel more severe.
• Catastrophic Thinking: Beliefs that symptoms mean permanent damage can increase anxiety, and lead to further distress and increased symptoms.
• Misattribution of Symptoms: Sometimes every-day cognitive issues such as forgetfulness and fatigue may be misinterpreted as evidence of a brain dysfunction, which can make symptoms feel worse.
• Avoidance of Activities: Fear of worsening symptoms can lead people to avoid daily tasks, work, exercise, and social activities. This can increase anxiety and reinforce negative thoughts about the severity of the symptoms and the ability to recover. It also makes it harder to return to activities due to lack of practice, which can lower confidence in improving. It can also lead to physical deconditioning.

Is It All In My Head?

No, post concussion symptoms are not “all in your head.” The symptoms you’re experiencing are very real, and the underlying causes can be complex, often involving a combination of biological, psychological, and social factors. Because of the multifaceted nature of PPCS, effective treatment typically requires a collaborative approach, with input from a range of professionals. This may include medical doctors, psychologists, physiotherapists, occupational therapists, and other allied health professionals, all working together to address different aspects of the condition and support your recovery.

What Helps with PPCS Symptoms?

Evidence suggests several strategies can support recovery:

• Psychological Support: Support from a psychologist with experience in PPCS to target the psychological and behavioural factors maintaining the condition. Cognitive behaviour therapy (CBT) has been shown to be beneficial for individuals experiencing PPCS.
• Challenging Unhelpful Thoughts: Learning to identify and change unhelpful thoughts about symptoms (e.g., catastrophising and misattribution of symptoms) can reduce distress and help improve coping.
• Gradual Return to Activities: As long as you have been medically cleared to do so, it is important to slowly reintroduce daily tasks, work, and physical movement. This helps reduce avoidance and rebuild tolerance and confidence.
• Lifestyle Factors: Learning ways to improve sleep, engage in more healthy eating, reduce alcohol and substance use and manage stress can help improve overall wellbeing and the physical, cognitive, and psychological symptoms associated with PPCS.

Hardwick Psychology Services has Neuropsychologists and Clinical Psychologists who are experienced in providing support with PPCS. Individuals can self-refer for intervention or they could be referred through their insurance provider or can be referred by their treating team. Please feel free to contact our admin team on (07) 3515 0172 for further information.