What is concussion?

Concussion is an injury to your brain that can occur after a blow to your head (a head injury). The blow to your head causes your brain to move slightly within your skull. This can momentarily disrupt the electrical activity within some of the cells in your brain so that your brain stops working properly for a short period of time. It is this disruption that leads to the symptoms of concussion. Concussion is also known as a minor traumatic brain injury by some doctors.

Classically, someone with concussion has a headache, appears confused, and has loss of memory around the time of their head injury. They may also have lost consciousness briefly after the head injury (but not always). Vomiting and some temporary disturbance of vision can also be symptoms of concussion.

Most people with concussion make a full and quick recovery and do not need any treatment. In most cases, concussion does not lead to any long-term problems. However, it is important to note that everyone who has had a head injury, however minor, does need close monitoring for a few days afterwards. This is because what may appear at first to be symptoms of concussion could also be symptoms of a more serious problem such as bleeding within the brain. A separate leaflet, 'Head Injury Instructions', gives more details. Specifically, these include important symptoms to look out for after a minor head injury and when to see a doctor.

What is post-concussion syndrome and what are the symptoms?

Post-concussion syndrome is a collection of symptoms that some people develop after they have had concussion. It is a complication of concussion. It is sometimes called post-concussive syndrome.

The symptoms of post-concussion syndrome can include:

• Physical symptoms:
  • Headache. This is the most common symptom.
  • Dizziness. This is the second most common symptom. This may be accompanied by vertigo (dizziness with a spinning sensation).
  • Nausea (feeling sick).
  • Double or blurred vision.
  • Hearing loss and/or a ringing noise in the ears (tinnitus).
  • Reduced sense of smell and taste.
  • Problems tolerating light and noise.
• Psychological symptoms:
  • Being easily irritable.
  • Feeling anxious easily.
  • Depression.
  • Having disturbed sleep and feeling tired.
  • Reduced sex drive.
  • Changes in your appetite.
  • Personality changes such as showing socially or sexually inappropriate behaviour.
  • Having a lack of energy and a lack of interest in things.
  • Having sudden outbursts of emotion - for example, sudden crying or laughing episodes.
• Problems with mental processes (called cognitive symptoms):
  • Forgetfulness.
  • Concentration and attention problems.
  • Slowed reaction times.
  • Problems processing information and problems reasoning.
  • Difficulty learning new things.

Not everyone with post-concussion syndrome will have all of the symptoms mentioned above. Also, doctors disagree about how long symptoms need to have been present in order to make a diagnosis of post-concussion syndrome. Some doctors say you need to have cognitive symptoms and then at least three of the other symptoms for at least three months to make a diagnosis. Others doctors diagnose the condition if symptoms are present within the first week or so after a minor head injury.

In general, for most people, symptoms of post-concussion syndrome only last for a few weeks. But for some people, the symptoms last longer and can last for three to six months or, rarely, a year or more.

What causes post-concussion syndrome?

The exact reason why some people develop post-concussion syndrome is not clear. There are a number of different theories. One theory is that it is caused by tiny areas of bruising or other damage to the nerve cells in the brain caused by the initial head injury. Some doctors believe that post-concussion syndrome develops because of a psychological or emotional reaction to the initial head injury.

How common is post-concussion syndrome?

It is difficult to be certain about how many people develop post-concussion syndrome after a head injury. This is because many people with a minor head injury do not see a doctor.

About 700,000 people visit Accident and Emergency departments each year in England and Wales because of a head injury. Some studies have shown that up to half of these people have symptoms of post-concussion syndrome one month after a head injury and around 15 in 100 of these people still have symptoms one year after a head injury.

For some reason, post-concussion syndrome seems to be more common in women than in men. This is despite the fact that men are more likely than women to have a head injury.

How is post-concussion syndrome diagnosed?

If you are worried that you may have symptoms of post-concussion syndrome, you should go and talk to your doctor.

Your doctor will usually diagnose post-concussion syndrome by your typical symptoms. They may also do a physical examination, paying particular attention to your nervous system to check that there are no signs of any problems. A physical examination of your nervous system includes simple tests of your muscle strength in your arms and legs as well as tests of your muscle reflexes, your co-ordination and your sensation. Your doctor may ask you to perform a number of movements of your arms, legs and face, etc. They may also ask you to do some of these movements against resistance from them. There should be no signs of problems with your nervous system on physical examination if you have post-concussion syndrome.

Your doctor may also suggest some tests to check your mental processes. For example, tests of your memory and perhaps maths and drawing. Sometimes, your doctor may suggest a scan of your brain, such as a CT scan or an MRI scan. This is mainly to make sure that there are no other reasons for your symptoms - for example, bleeding in the brain after a head injury.

What is the treatment for post-concussion syndrome?

The symptoms of post-concussion syndrome usually improve and go away within three months after the initial head injury for most people. In the meantime, at present, there is not any treatment that seems to speed up recovery. However, most people find that having a diagnosis and an explanation for their symptoms helps.

There are some other things that you may find helpful if you have been diagnosed with post-concussion syndrome:

• Don't rush back into things - it is generally advised that anyone who has had a head injury takes things slowly and doesn't rush straight back into things. If possible, try to return to your usual activities gradually after a head injury.
• Sleep hygiene - if you are having problems sleeping and are feeling very tired, try to stick to a regular schedule. The separate leaflet, 'Sleeping Problems - Self Help Guides' gives more details.
• Medication to help symptoms - your doctor may suggest some medication to help some of the symptoms of post-concussion syndrome that you may have. For example, painkillers for headache, medication to help with nausea symptoms or an antidepressant if you have symptoms of depression.
• Keep your stress levels down.
• Avoid alcohol.

If you still have symptoms three months after your initial head injury, or if your symptoms are particularly troublesome, your doctor may suggest that they refer you to a specialist used to dealing with problems related to head injury. This may be either a neurologist, who specialises in problems of the nervous system, or a psychiatrist or neuropsychologist, who specialises in problems relating to mental health.

Can post-concussion syndrome be prevented?

Things that can prevent or reduce head injury in the first place can also help to prevent post-concussion syndrome. Wearing a seatbelt in a car and wearing a helmet whilst cycling, riding a motorbike or doing high-risk sports such as skiing are important. Wearing a hard hat may also help to prevent head injury in certain jobs.

Further help and information

Headway - the brain injury association

Bradbury House, 190 Bagnall Road, Old Basford, Nottingham, Nottinghamshire NG6 8SF
Helpline: 0808 800 2244 Web: www.headway.org.uk
Aims to promote understanding of all aspects of brain injury and to provide information, support and services to people with a brain injury, their families and carers.

References

• Legome EL et al; Postconcussive Syndrome (Trauma and Orthopedic Perspective), eMedicine, Apr 2010
• Lubit RH; Postconcussive Syndrome (Psychiatric Perspective), eMedicine, Dec 2010
• Triage - assessment - investigation and early management of head injury in infants, children and adults, NICE Clinical Guideline (September 2007).
• Head injury, Clinical Knowledge Summaries (February 2009)