Concussion and Post-Concussion Syndrome
A detailed resource on causes, symptoms, diagnosis, management, and recovery pathways for concussion (a mild traumatic brain injury) and post-concussion syndrome. Understand how to recognise symptoms early, treatment options, and when to seek specialist care.
Overview of Concussion and Mild Traumatic Brain Injury (mTBI)
What is a Concussion?
A concussion is a traumatically induced transient disturbance of brain function caused by a blow or force to the head or body. It is a type of mild traumatic brain injury (mTBI), a broader category describing brain injury with usually temporary symptoms. Although often used interchangeably, concussion is technically a subset of mTBI.
Causes and How It Happens
Concussions can result from:
- Direct impact to the head
- Indirect forces causing rapid acceleration or deceleration of the brain (e.g., whiplash in car accidents)
The injury disrupts brain function through changes in brain cell activity and metabolism rather than structural damage. Loss of consciousness is rare (about 10%) and not necessary for diagnosis.
How Common Are Concussions?
In the US, around 1.7 million traumatic brain injuries occur annually, many of which are concussions. Common causes include:
- Motor vehicle accidents
- Being struck by objects
- Assaults
- Contact sports (football, soccer)
Female athletes tend to sustain concussions twice as often as males in the same sports.
Clinical Presentation and Diagnosis
Common Symptoms
Symptoms usually develop within hours to days after injury and affect:
- Emotional: Irritability, mood swings
- Cognitive: Confusion, memory problems, difficulty concentrating
- Physical: Headache (most common), dizziness, nausea, sensitivity to light or sound
- Sleep: Trouble sleeping, sleeping too much or too little
Signs Warranting Immediate Medical Evaluation
- Loss of consciousness
- Confusion or disorientation
- Balance or coordination problems
- Seizures
How Is Concussion Diagnosed?
Diagnosis is clinical, based on history and physical examination. There is no single test or symptom that confirms concussion. Tools often used include:
- SCAT5 (Sports Concussion Assessment Tool) for ages 13+
- Child SCAT6 for ages 5-12
- Balance Error Scoring System (BESS) for balance assessment
- King-Devick test for eye movement and concentration
Role of Imaging
A CT scan is usually not needed unless there are signs of more serious injury (e.g., worsening headache, neurological deficits). MRI may be used for prolonged symptoms.
Management and Prognosis
Immediate Care
- Remove the patient from activities that risk another head injury
- Rest both physically and cognitively for 24-48 hours
- Monitor symptoms carefully
Gradual Return to Activity
After initial rest, patients follow a graduated return to play protocol, gradually increasing activity in stages, each lasting at least 24 hours, without symptom return. Full medical clearance is required before resuming sports.
Expected Recovery
Most people recover within 1 to 2 weeks, though some may take longer. The severity of initial symptoms best predicts recovery time.
Post-Concussion Syndrome (PCS)
What is PCS?
PCS refers to symptoms persisting beyond the expected recovery time—more than 10-14 days in adults or over 4 weeks in children. Symptoms include headache, dizziness, memory issues, irritability, and fatigue.
Risk Factors for PCS
- Female sex
- Older age (especially over 40)
- History of previous concussions
- Psychiatric history (depression, anxiety)
- Mechanism of injury (e.g., transportation accidents)
Treatment of PCS
- Individualised symptom management
- Physical therapies (vestibular rehabilitation, vision therapy)
- Medication for headaches or mood symptoms
- Gradual return to physical and cognitive activity
- Psychological support for mood disorders
Special Considerations
Children and Adolescents
Children may take longer to recover and benefit from school support and gradual academic reintegration.
Older Adults
Age over 40 is associated with slower recovery and higher risk of prolonged symptoms.
Sex Differences
Females are more susceptible to both sustaining concussions and developing prolonged symptoms.
Prevention Strategies
- Use helmets and safety equipment in sports and cycling
- Enforce rules to reduce contact and collisions in sports
- Educate players, coaches, and families about concussion recognition and response
- Use seatbelts and fall prevention measures in all age groups
Key Clinical Pearls
- A concussion is a functional brain injury, not typically visible on imaging
- Loss of consciousness is not required for diagnosis
- Early removal from play prevents serious complications
- PCS affects up to 20% of concussion patients
- A multidisciplinary team approach improves outcomes
Frequently Asked Questions (FAQs)
Q: Can a concussion happen without hitting your head?
A: Yes, sudden forces causing rapid brain movement inside the skull can cause concussion without direct head impact.
Q: When should I see a doctor after a head injury?
A: If you experience worsening headache, confusion, vomiting, weakness, or loss of consciousness, seek urgent medical care.
Q: How long before I can return to sports?
A: After 24-48 hours of rest, a stepwise return to activity begins, usually requiring at least one week and medical clearance.
Q: What if symptoms last more than a month?
A: Persistent symptoms may indicate post-concussion syndrome, which requires specialist evaluation and tailored management.
Evidence and Guidelines
This guide follows current recommendations from:
- NICE Clinical Guideline CG176 (2023) on head injury management
- Consensus statements from the Concussion in Sport Group (CISG)
- Pediatric Emergency Care Applied Research Network (PECARN) head injury rules
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025