Understanding Post-Concussion Syndrome

For the average person discussing the effects of head injuries, the term “post-concussion syndrome” gets thrown around a lot. And it’s an extremely popular search engine query, suggesting that many people believe post-concussion syndrome simply describes the symptoms someone has after a concussion.

But is that really the case? We discuss the clinical meaning of post-concussion syndrome, as well as why experts at the UPMC Sports Medicine Concussion Program do not focus on the term in their evaluation and treatment of concussions.

What Is Post-Concussion Syndrome?

Neuropsychologist Vanessa Fazio Sumrok, PhD, discusses what post-concussion syndrome really means in the clinical world. Like all injuries and conditions, there are different diagnostic manuals that medical professionals reference in researching and diagnosing concussions.

According to Dr. Sumrok, “There are conflicting sets of criteria for ‘post-concussion syndrome’ across the ICD-10 and DSM-IV [two of the manuals].” Essentially, one requires a history of head trauma with at least three specific symptoms, while the other is much more specific requiring the previously mentioned criteria, plus testing evidence of memory problems, possible personality changes, and other symptoms that must have lasted three months or more. She also mentions the newer DSM-5 manual, which has criteria of loss of consciousness, amnesia, or disorientation, which happen in a small percentage of concussion cases.

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What Is a Concussion?

In a clinical sense and according to the CDC, “a diagnosis of concussion (not post-concussion syndrome) is defined as caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.”

Evidence of concussion is typically seen in symptoms someone has after the injury, which may include headaches, dizziness, nausea, cognitive issues, sleep disruption, and mood changes. Only a small percentage of cases involve loss of consciousness, and even fewer involve findings on a CT scan or MRI (such as brain bleed or fracture, which typically indicate a moderate or severe traumatic brain injury).

For those who adhere to the ICD-10 definition of post-concussion syndrome, the term is often used interchangeably with concussion because it requires a head injury and at least three symptoms. But the DMS-IV criteria refers to more chronic symptoms, which only applies to a small percentage of those who have sustained a concussion.

Ultimately, “post-concussion syndrome” refers to a set of clinical criteria, which can vary from one diagnostic manual to another. It is a label that does not inform treatment of concussion, which can cause some confusion and is a significant reason the UPMC Sports Medicine Concussion Program uses a different approach altogether — the clinical trajectory model of concussion.

What Is the Clinical Trajectory Model?

“Using the clinical trajectory model of concussion helps in targeting treatments based on symptoms or profiles,” says Dr. Sumrok. “The clinical trajectory model examines the types of symptoms and identifies patterns consistent with one or more of the six profiles: vestibular, ocular, cognitive fatigue, post-traumatic migraine, cervical, and mood/anxiety. Each profile has specific treatments associated with it.”

Concussion treatment gets tailored to the specific patient and what they are experiencing after their injury. Dr. Sumrok provides examples of the vestibular and ocular clinical trajectories or “paths” of concussion. For example, this model would use symptom reports and findings from the vestibular ocular motor screening (VOMS) to determine if vestibular therapy is necessary to treat dizziness or other symptoms of vestibular dysfunction following concussion.

What You Should Know About Post-Concussion Syndrome

“It seems when many people hear ‘post-concussion syndrome,’ they assume the symptoms are chronic and will not resolve, which is quite demoralizing and leaves people feeling helpless,” says Dr. Sumrok. “There are a lot of internet sources that may not be providing the most accurate information. It’s important to note that most people with concussion recover and that most symptoms are treatable.”

Research shows that the earlier a patient sees a specialist for treatment, the better their outcomes and the faster their recovery. The clinical trajectory and profile model of concussion allows a clinician to assess risk factors and symptoms that fit with specific profiles to target treatments for faster recovery.

Also, many concussions improve with time and behavioral management (maintaining a regular daily routine and moderated activity) and do not always require therapies or medication to achieve full recovery. That said, it’s important to see an expert as soon as possible after a suspected concussion.

What to Do if You’re Diagnosed With Post-Concussion Syndrome

So, if you see your primary care doctor or another provider who diagnoses you with post-concussion syndrome, what should you do? Dr. Sumrok suggests following up with a concussion specialist for a full assessment of symptoms, cognitive function, and vestibular functions as soon as possible.

“A specialist can also provide treatment recommendations and referrals depending on symptoms and findings from assessments — which can include referrals to vestibular therapy, neurology, ophthalmology, psychiatry, psychotherapy, cognitive rehabilitation therapy, exertion therapy, or physiatry,” she says. “They may also help guide activity such as return to school, work, or physical activity. Generally, regulation and reasonable engagement in activity helps promote recovery from concussion, but a specialist can help guide a patient on where to start and when to increase activity.”

According to research and clinical evidence at the UPMC Sports Medicine Concussion Program, most people recover from concussion with a combination of natural recovery over time, behavioral management, and targeted treatment. Early evaluation and treatment are also key to promoting recovery.

Visit our website to learn more about our diagnosis, management, and treatment of concussions.

Call 412-432-3681 to schedule an appointment with the UPMC Sports Medicine Concussion Program.

Editor's Note: This article was originally published on , and was last reviewed on .

About Sports Medicine

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