Ongoing concussion symptoms

Ongoing concussion symptoms

Due to the mild nature of the injury in concussion, we eventually expect a full recovery for virtually all people. However, some individuals may take longer than others to achieve a full return to their usual level of functioning. In a minority of cases (approximately 15 to 20%), concussive symptoms will persist for greater than one month – these are known as persisting post-concussive symptoms (PPCS). Approximately 5 to 10% of the population will continue to have symptoms until three months, and a very small number of people (1 to 5%) may experience symptoms up to 12 months.

Research shows that certain factors can increase the risk of post-concussive symptoms:

• History of psychological difficulties and/or diagnosed psychiatric conditions
  • Particularly, anxiety, depression, or post-traumatic stress disorder
• Multiple concussions within a short timeframe (i.e., within three months)
• Previous acquired brain injury
• Substance use
• Ongoing litigation / legal matters (particularly those relating to the concussion event)
• Neurodevelopmental conditions, such as ADHD and learning difficulties

Consensus concussion guidelines state that, along with the presence of the factors above, PPCS are most likely due to other, secondary, factors that occur alongside the concussion:

• Anxiety, and / or depressive symptoms
• Ongoing headache pain
• Sleep disturbance
• Fatigue/low energy
• Visual disturbance

The exact causes of PPCS are yet to be explained. However, leading researchers have implicated a complex interaction between initial, temporary neurobiological disruption (i.e., associated with the concussion) and these secondary factors. For instance:

• While there is limited structural damage in concussion, there might be changes to the way the brain functions (e.g., temporary changes in neurochemistry) that result directly from concussion may cause brain fog, fatigue, and disrupted sleep in the first few days or even weeks following injury
• Disrupted sleep can exacerbate mild cognitive issues, making them much more severe and making it difficult to work, study, be around other people, and socialise
• A lack of work, study, and social or leisure activities can lead to anxiety and/or depressive symptoms
• Increased irritability or emotional dysregulation can also cause relationship problems that, in turn, can cause further decline in mood
• Anxiety and depression symptoms can disrupt sleep even further, exacerbating disruption to cognition, lifestyle, and in turn, worsen mood, in an ongoing cycle