II. Definitions

  1. Postconcussion Syndrome
    1. Persistent Concussion-related symptoms beyond 3 months and beyond resolution of initial Concussion
  2. Mild Traumatic Brain Injury (MTBI)
    1. Preferred term to Postconcussion Syndrome
    2. Postconcussion Syndrome is a subjective term with symptoms that may be altered by Secondary Gain and other external factors

III. Epidemiology

  1. Incidence 5-20% of Concussions (or MTBI)
    1. Some estimates are as high as postconcussive syndrome in 38-80% of Concussions

IV. Risk Factors

  1. Female gender
  2. Children and older age
  3. Inadequate social support
  4. Lower baseline functional status or socioeconomic status
  5. Pre-existing conditions
    1. Major Depression
    2. Anxiety Disorder
    3. Attention Deficit Disorder
    4. Migraine Headaches
    5. Post-Traumatic Stress Disorder (PTSD)
    6. Substance Abuse

V. Symptoms

  1. Common Symptoms
    1. Headache (most common)
    2. Dizziness
  2. Cognitive Symptoms
    1. Impaired attention and memory
    2. Difficult Executive Function (e.g. organization, planning, reasoning)
  3. Behavioral Symptoms
    1. Irritability
    2. Altered mood
    3. Insomnia
    4. Fatigue
  4. Other Symptoms
    1. Blurred Vision
    2. Photosensitivity
    3. Neck Pain
    4. Tinnitus
    5. Balance difficulty
    6. Hearing Loss
    7. Loss of Taste or smell sense
  5. Exacerbating Factors
    1. Physical Activity (most common)
    2. Cognitive activity

VI. Diagnostics

  1. Chronic Headaches after Concussion (esp. severe or progressive Headache without prior head imaging)
    1. Head CT or Head MRI
  2. Persistent Dizziness after Concussion
    1. Electronystagmography (ENG)
    2. Fistula Test
    3. Posturography
  3. Persistent neurologic or behavioral changes
    1. Neuropsychological Testing (including computerized Neuropsychological Testing)
  4. Activity provoked symptoms
    1. Graded aerobic treadmill test may reproduce Concussion symptoms

VII. Precautions: Red Flags

VIII. Prognosis

  1. See Cognitive Deficit following Concussion
  2. Prolonged course risk factors
    1. See Risk Factors above

IX. Management: Targeted symptom management

  1. Cognitive deficit
    1. See Cognitive Deficit following Concussion
    2. Consider Neuropsychological Testing
    3. Consider brain imaging
    4. Assess for comorbid conditions
      1. Major Depression
      2. Anxiety Disorder
      3. Insomnia
  2. Mood Disorder
    1. Major Depression Management
    2. Anxiety Management
    3. Consider Selective Serotonin Reuptake Inhibitor (SSRI)
  3. Headaches
    1. Consider Migraine Prophylaxis
  4. Vertigo
    1. See Vertigo Management
  5. Sleep Disturbance
    1. See Disorder of Initiating and Maintaining Sleep (Insomnia)
    2. See Sleep Hygiene
  6. Sports
    1. See Return to Play after Concussion
    2. No sports participation until initial Concussion symptoms resolve
    3. If Exercise-induced symptoms after initial Concussion symptoms have resolved
      1. Submaximal Exercise Prescription
      2. Example: 80% of maximal tolerated Heart Rate for 20 min/day, 5 days per week
  7. Other symptom management
    1. Fatigue management
    2. Insomnia management
  8. Consultations to consider
    1. Physical therapy
      1. Vestibular and balance therapy
      2. Neck rehabilitation
    2. Occupational Therapy
      1. Functional therapy on specific tasks
    3. Speech Therapy
    4. Neuropsychology
    5. Mental Health

XI. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  2. Bengtzen, Novak and Chesnutt (2016) Crit Dec Emerg Med 30(5): 3-10
  3. Jotwani (2010) Curr Sports Med Rep 9(1): 21-26 [PubMed]
  4. Kushner (2001) Am Fam Physician 64:1007-14 [PubMed]
  5. Mott (2012) Am Fam Physician 86(11): 1045-51 [PubMed]

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Related Studies

Ontology: Post-Traumatic Headache (C0032816)

Definition (MSH) Secondary headache attributed to TRAUMA of the HEAD and/or the NECK.
Concepts Pathologic Function (T046)
MSH D051298 , D020773
ICD9 339.20, 339.2
ICD10 G44.3 , G44.30, G44.309
SnomedCT 210944005, 54012000, 230477005
Dutch hoofdpijn posttraumatisch, hoofdpijn; posttraumatisch, posttraumatisch; hoofdpijn, posttraumatische hoofdpijn, Posttraumatische hoofdpijn
German Kopfschmerz nach Trauma, posttraumatische Kopfschmerzen, Posttraumatischer Kopfschmerz
Swedish Posttraumatisk huvudvärk
English POSTTRAUMATIC HEADACHE, Post-traumatic headache, unspecified, post-traumatic headache, post-traumatic headache (diagnosis), Headache post-traumatic, Post-trauma headache NOS, Post-traumatic headache NOS, Post-Traumatic Headache [Disease/Finding], post-traumatic headaches, post traumatic headache, Headache;post traumatic, headaches post traumatic, posttraumatic headache, headaches posttraumatic, Headache - post traumatic, Posttraumatic headache, Post-traumatic headache, Posttraumatic headache (finding), headache; post-traumatic, post-traumatic; headache, Headache, Post-Traumatic, Headaches, Post-Traumatic, Post Traumatic Headache, Post-Traumatic Headaches, Post-Traumatic Headache
Japanese ガイショウゴズツウ, 頭痛-外傷後, 頸原性頭痛, 頭痛-頸原性, 外傷後頭痛
Czech poúrazová bolest hlavy, posttraumatická bolest hlavy, Posttraumatická bolest hlavy
Finnish Vammanjälkeinen päänsärky
Polish Ból głowy pourazowy
Hungarian Post-traumás fejfájás, Trauma utáni fejfájás
Norwegian Hodepine etter traume, Posttraumatisk hodepine
Portuguese Cefaleia Pós-Traumática, Cefalalgia Pós-Traumática, Cefalgia Pós-Traumática, Cefaleia pós-traumática
Spanish Cefalalgia Postraumática, cefalea postraumática (hallazgo), cefalea postraumática, Cefalea postraumática, Cefalea Postraumática
Italian Cefalea post-traumatica
French Céphalée post-traumatique

Ontology: Post-Concussion Syndrome (C0546983)

Definition (MSH) The organic and psychogenic disturbances observed after closed head injuries (HEAD INJURIES, CLOSED). Post-concussion syndrome includes subjective physical complaints (i.e. headache, dizziness), cognitive, emotional, and behavioral changes. These disturbances can be chronic, permanent, or late emerging.
Concepts Disease or Syndrome (T047)
MSH D038223
ICD9 310.2
ICD10 F07.2 , F07.81
SnomedCT 268793008, 154962006, 192201000, 192075000, 40425004, 230282000, 51996004
English Nonpsychot post-trau brain syn, Postcontusional encephalopathy, POSTCONCUSSION SYNDROME, POSTCONCUSSIVE SYNDROME, postconcussion syndrome (diagnosis), postconcussion syndrome, Post-Concussion Syndrome, Post Concussive Syndrome, Post-Concussive Syndrome, Post-Concussive Syndromes, Syndrome, Post-Concussive, Syndromes, Post-Concussive, Post-Concussion Syndrome [Disease/Finding], post syndrome concussion, postconcussive syndrome, post-concussional syndrome, post concussion syndrome, post-concussion syndrome, concussion post syndrome, concussions post syndrome, post concussion symptoms, post concussive syndrome, post-concussive syndrome, post concussional syndrome, Post-traumatic brain syndrome, nonpsychotic, Post concussional syndrome, Concussional syndrome, Post-concussional syndrome (disorder), Post-head injury syndrome, Post Concussion Symptoms, Post Concussive Symptoms, Post-Concussion Symptom, Post-Concussion Symptoms, Post-Concussive Symptom, Post-Concussive Symptoms, Symptom, Post-Concussive, Post Concussion Syndrome, Postconcussion syndrome, Nonpsychotic post-traumatic brain syndrome, Post-concussional syndrome, Post-traumatic brain syndrome, Post-concussion syndrome, Post-contusional encephalopathy, Post-contusional syndrome, Postconcussion syndrome (disorder), Post concussion syndrome, brain syndrome; post-traumatic, brain; syndrome, post-traumatic, nonpsychotic, disorder; postconcussional, post-traumatic; brain syndrome, postconcussional syndrome, postconcussional; disorder, postconcussional; syndrome, postcontusional syndrome, postcontusional; syndrome, syndrome; brain, post-traumatic, nonpsychotic, syndrome; postconcussional, syndrome; postcontusional, Postconcussion syndrome, NOS, Postconcussional syndrome
Italian Sindrome post-commotiva, Sindrome cerebrale post-traumatica, Sindrome post-commozione cerebrale
Dutch posttraumatisch hersensyndroom, hersenen; syndroom, posttraumatisch, niet-psychotisch, hersensyndroom; posttraumatisch, postcommotioneel; aandoening, postcommotioneel; syndroom, postcontusioneel; syndroom, posttraumatisch; hersensyndroom, stoornis; postcommotioneel, syndroom; hersenen, posttraumatisch, niet-psychotisch, syndroom; postcommotioneel, syndroom; postcontusioneel, postconcussie-syndroom, Commotioneel syndroom, post-, Postcommotioneel syndroom
French Syndrome cérébral post-traumatique, Syndrome commotionnel, SPC (Syndrome Post-Commotionnel), Syndrome subjectif des traumatisés crâniens, Symptômes postcommotionnels, Syndrome postcommotionnel, Symptômes post-commotionnels, Syndrome subjectif post-traumatique, Syndrome lié à une concussion, Syndrome post-commotionnel
German HWS-Schleudertrauma, posttraumatisches zerebrales Allgemeinsyndrom, Organisches Psychosyndrom nach Schaedelhirntrauma, Post concussion syndrome, Post-kommotionelles Syndrom, Posttraumatische Hirnleistungsschwäche, Syndrom nach Gehirnerschütterung
Portuguese Síndrome cerebral pós-traumática, Síndrome pós-concussão, Síndrome Pós-Concussão, Síndrome Pós-Concussiva
Spanish Síndrome cerebral postraumático, Síndrome posconcusional, Síndrome de postconmoción cerebral, síndrome postcontusión, síndrome poscontusional, Síndrome Postconcusión, síndrome cerebral postraumático, síndrome posconmocional (trastorno), síndrome posconmocional, síndrome poscontusión, síndrome postconmocional, síndrome postcontusional, síndrome postcontusión (trastorno), Síndrome postconcusión, Síndrome Postconcusional, Síndrome Postconmoción
Japanese 外傷後脳症候群, ガイショウゴノウショウコウグン, ノウシントウゴショウコウグン, 振とう症候群, 脳震とう後症候群, 脳震盪症候群, 震とう症候群, 脳振盪後遺症, 振盪症候群, 脳振盪後症候群, ホメン症候群, 震盪症候群, 脳震盪後症候群, 脳振とう症候群, 脳震とう症候群, フリードマン血管運動神経症候群, 脳振とう後遺症, Homen症候群, 脳振盪症候群, 脳振とう後症候群, Friedmann血管運動神経症候群
Swedish Postkommotionella syndrom
Czech postkomoční syndrom, Posttraumatický mozkový syndrom, Postkomoční syndrom, postkontuzní syndrom
Finnish Aivotärähdyksen jälkeinen oireyhtymä
Korean 뇌진탕후 증후군
Polish Zespół powstrząsowy
Hungarian Poszttraumás cerebralis szindróma, Postcommotiós szindróma
Norwegian Post-commotio-syndrom, Postkommosjonelt syndrom