A concussion is a mild traumatic brain injury that often results from a blow to the head. It can cause symptoms like headaches, dizziness, and confusion. Most people recover from a concussion within a couple of weeks. When these symptoms persist beyond the expected recovery period, it may indicate post-concussion syndrome (PCS). PCS can significantly impact daily life, leading to cognitive difficulties and emotional instability over time.
Often, the first port of call in managing PCS symptoms is medication. However, these don’t address the root cause of symptoms and may lead to severe side effects. The neck is connected to the head, so the upper neck is often injured in a concussion, but is really treated beyond physical therapy. At the Centeno-Schultz Clinic, we focus on understanding and diagnosing the underlying issues contributing to PCS, such as craniocervical instability or craniocervical syndrome. Our advanced diagnostic techniques, like Digital Motion X-ray and upright movement-based MRI, allow us to develop personalized treatment plans aimed at recovery and long-term well-being.
Clinical Overview Of The Conditions
Understanding the difference between a concussion and post-concussion syndrome (PCS) is essential for effective treatment and recovery. Both conditions stem from head trauma but manifest differently over time.
Concussion (Acute Phase)
A concussion is an immediate response to a head injury. Symptoms can include headaches, confusion, dizziness, and balance issues. These usually subside as the brain begins to heal, following rest and gradual return to activities. Research indicates that 90% of concussion symptoms resolve within 10-14 days.
Post-Concussion Syndrome (Persistent Phase)
Post-concussion syndrome occurs when concussion symptoms persist beyond the typical recovery period. This condition can lead to prolonged headaches, fatigue, difficulty concentrating, and emotional challenges.
Various causes and risk factors contribute to PCS, making it a common complication of concussions. Studies report that the prevalence of ongoing symptoms after a head trauma ranges from 10% to over 40%. While PCS can be difficult to diagnose, understanding what is contributing to ongoing symptoms is essential to promote long-term recovery.
The Difference In Mechanisms of Concussion and Post-Concussion Syndrome
Different mechanisms lead to concussions and post-concussion syndrome. A concussion occurs as a result of mechanical forces that cause the brain to shake or jolt inside the skull.
This initial impact leads to immediate tissue damage inside the brain. This disrupts brain function and can disrupt the normal release of brain chemicals, particularly neurotransmitters. PCS occurs when something prevents the brain from healing or when disruptions to brain functions are ongoing. More importantly, PCS is often diagnosed when there is an injury to the neck while the treatment is focused on the head.
Some of the changes in the brain that may lead to PCS include:
Neurochemical Imbalances and Metabolic Shifts
A sudden head trauma can affect the balance among neurotransmitters—chemicals responsible for transmitting signals in the brain. These chemicals, which include dopamine and serotonin, play a role in several body functions, including cognitive health and even hunger. Changes can lead to short-term symptoms like confusion and dizziness.
In PCS, the neurochemical imbalances carry on beyond the estimated recovery period, causing longer-term challenges in cognitive functioning and mood. Additionally, concussions influence how the brain metabolizes energy, which can deplete it of the energy needed for normal processes, causing mental fatigue and concentration problems.
Inflammatory Factors and Autonomic Disruptions
After a concussion, the body initiates an inflammatory response, crucial for healing damaged tissues. During this process, blood containing healing factors and oxygen builds up around the tissues, causing swelling. Normally, inflammation is acute, and it resolves itself once the damaged tissues have healed.
In PCS, this inflammation–and the accompanying swelling—can persist, disrupting normal brain function and worsening pain and discomfort. This could also lead to dysfunction in the autonomic nervous system, which controls essential functions like heart rate and digestion. For instance, you might experience irregular heartbeats or digestive issues, even long after the head injury. In addition, the upper neck controls these same autonomic functions, so an injury there can mimic PCS.
Cervical Spine and Vestibular Involvement
When head trauma happens, the neck—especially the upper cervical spine—often gets injured too. Problems in this area, like at the atlanto-occipital (C0–C1), atlantoaxial (C1–C2) joints, and C2-C3 facet joints can cause neck pain and chronic headaches.
Upper cervical instability can also lead to dizziness, which is also known as cervicogenic dizziness. This happens because injury or instability disrupts position sense signals from these joints. Also, since the upper cervical spine works closely with the vestibular system (which controls balance), injury here can make you feel off-balance or dizzy. This can make everyday activities, like walking or driving, more difficult or risky.
Variation in Short-Term or Prolonged Healing Timeframes
Typically, most concussion symptoms resolve within a couple of weeks. This is because, following head trauma, the body initiates processes to repair damaged tissues and restore brain functioning.
However, not every person experiencing a concussion heals at the same rate. The variability in healing times can depend on factors like the severity of the initial injury, genetics, and even pre-existing medical conditions.
Do These Conditions Share Similar Manifestations?
Concussions and post-concussion syndrome often share overlapping symptoms, but they are distinct conditions. However, identifying the signs of post-concussion is essential to inform treatment decisions. Here is how they differ:
Common Acute Phase Symptoms
In the immediate aftermath of a concussion, you’ll likely experience symptoms that are typical of the acute phase. These symptoms generally arise due to the sudden and undue forces experienced by the brain. Chemical balance and tissue integrity become disrupted, causing cognitive problems, including:
- Headache, nausea, or brief memory lapses: These occur due to changes in brain chemicals, such as GABA and serotonin, and in the pressure inside the skull, which affect normal brain function. The swelling associated with inflammation also aggravates pain and headaches.
- Sensitivity to light or loud noises: A head trauma disrupts the neural pathways. When this happens, your brain will process external stimuli differently, usually in a more intense way. This can lead to heightened sensitivity to sound or light, the second most common symptom of concussion.
- Irritability or mild confusion: The brain’s chemical imbalance impacts our ability to regulate emotions, leading to irritability, sleep issues, anxiety, and stress. Confusion can also occur as the brain’s signaling processes struggle to adapt to changes.
Indicators of Persistent Concussion Symptoms
The acute symptoms of concussion often resolve with adequate treatment and rest. However, when they continue beyond the expected timeframe, they suggest the onset of PCS. Common indicators include:
- Lingering headaches, blurred vision, or balance problems: These symptoms occur when the body is unable to restore balance after neurochemical and metabolic changes.
- Sleep disturbances, including insomnia or frequent waking: Head trauma can affect the production of neurotransmitters involved with the wake-sleep cycle, such as melatonin. This can lead to changes in natural sleep patterns and sleep disorders such as insomnia. Over time, these problems can affect daytime energy levels, mood, and stress levels, contributing to a negative cycle.
- Difficulty focusing on tasks or managing everyday responsibilities: Changes in chemical balance can affect the brain’s ability to produce, manage, and metabolize energy. This can result in fatigue, difficulty concentrating, and issues with managing energy levels throughout the day.
Factors That Contribute To Worsening Symptoms
Concussion symptoms usually resolve within one to two weeks with proper care and rest. Post-concussion syndrome is diagnosed when symptoms persist for longer than three months.
However, several factors can influence recovery, impacting both the severity and duration of symptoms. These include:
- Repeated Head Impacts. Sustaining additional injuries before a previous concussion has healed can prolong recovery. Each impact aggravates existing damage, leading to compounded chemical imbalances, tissue injuries, and inflammation.
- Inadequate Rest and Recovery. Rest is crucial in the initial stages following a concussion, as it allows the brain to repair itself. Without enough rest, the brain can be overwhelmed, trying to restore chemical balance, metabolize energy, and focus on daily activities. This can lead to incomplete or delayed healing.
- Psychological Stress. Stress hormones influence brain chemistry and can worsen existing imbalances. Additionally, psychological and emotional stress can amplify symptoms. This is because stress can heighten perceptions of pain, increase headaches, and contribute to emotional instability, making recovery more challenging.
- Poor Sleep or Nutrition. Quality sleep and good nutrition are vital for brain health. During sleep, the brain focuses on vital functions, such as managing energy and stored information. Sleep disturbances impede neuronal repair and functions like chemical homeostasis. Poor nutrition affects metabolic processes and makes it hard for the body to produce the energy required for healing.
Additionally, PCS is often misdiagnosed. This can lead to a delay in recognizing symptoms and getting the right treatment, which can extend recovery times.
When Do You Need Further Medical Evaluation?
After a head trauma, it is essential to seek medical care, no matter how mild it may seem. However, after the initial treatment, you may reach out for further medical evaluation if you notice these signs:
Headaches, Dizziness, Or Brain Fog Beyond 4–6 Weeks
Headaches, dizziness, or brain fog that last for more than 4-6 weeks could be a sign that the brain hasn’t fully healed after the initial trauma. These symptoms may require more targeted interventions to address lingering issues and prevent tissue damage from worsening.
Mood Changes Or Difficulty Handling Daily Tasks
Significant mood changes or difficulty managing everyday responsibilities might be linked to ongoing neurological imbalances. While this is a common sign after a concussion, you should be able to regain emotional stability and cognitive function as your brain heals. If this doesn’t happen, it is important to understand what’s causing persistent symptoms.
Specialist Referrals For Additional Treatable Factors
Sometimes, addressing PCS requires assistance from specialists who can identify and treat specific factors contributing to prolonged symptoms.
- Imbalance in chemicals like GABA, serotonin, and dopamine.
- Pre-existing conditions, such as anxiety or migraines.
- Psychological or post-traumatic stress.
- Musculoskeletal issues, such as neck or spine injuries.
- Poor sleep patterns or sleep disorders
- Nutritional deficiencies, such as low levels of omega-3 fatty acids, B vitamins (especially B6, B9, B12), Vitamin D, and Magnesium.
You may benefit from seeing experts in neurology, physical therapy, psychology, and nutrition.
What if I think I have an upper neck injury? That requires specialized evaluation from an expert in upper neck injury. [place CTA here for a CSC consult]
Worsening Neurological Symptoms
Any worsening of neurological symptoms, such as increased confusion, slurred speech, or numbness, requires immediate evaluation. These changes can indicate complications, including severe brain damage and inflammation, that need urgent medical attention.
Possible Undiagnosed Cervical Conditions
Neck injuries often happen along with head injuries, since the cervical spine is usually affected in accidents. Sometimes, pre-existing neck or posture problems can make symptoms last longer.
Additionally, undiagnosed cervical issues, like craniocervical instability, may actually be the reason for ongoing PCS symptoms. Certain types of headaches, called cervicogenic headaches, can stem from the neck if there’s injury or dysfunction in the upper cervical spine. For example, irritation of the greater occipital nerve or stress at the atlantoaxial joint (C1–C2) can cause migraine-like pain, especially when you turn your head or sit with poor posture.
The Importance Of Accurate Diagnostics and Imaging
Diagnosing concussion and post-concussion syndrome isn’t always straightforward. Traditional imaging methods like CT or MRI often return normal results because they focus on detecting structural damage, such as bleeding or fractures.
However, PCS often involves significant functional impairments that are not visible with these techniques. In turn, concussions are often diagnosed based on symptoms and history, but this approach isn’t always accurate.
Additionally, some symptoms linked to PCS—like dizziness, visual problems, and headaches—can actually come from mechanical instability in the cervical spine, especially at the cranio-cervical junction (where the skull meets the upper neck), rather than from the brain itself.
At the Centeno-Schultz Clinic, we understand the importance of determining the cause of ongoing symptoms and avoiding medications that fail to address the root problem. That is why we emphasize the necessity of thorough evaluations that go beyond standard imaging, allowing our physicians to truly understand the factors contributing to your symptoms.
Accurate Cervical Diagnosis with DMX Technology
Understanding neck injuries is crucial, as symptoms stemming from the cervical spine can mimic or complicate post-concussion syndrome.
That is why, at Centeno-Schultz Clinic, we leverage Digital Motion X-ray (DMX), which offers an innovative approach to diagnosis by capturing real-time images of neck movements. This dynamic imaging allows our physicians to visualize how your joints and ligaments are functioning in motion, and how they influence the spine and skull. This is essential to detect conditions like craniocervical instability (CCI), which may not appear on static images.
Being aware of how factors like CCI can aggravate PCS symptoms or lead to more severe complications is critical when choosing treatment strategies that tackle the root cause of the problem.
Get the Right Diagnosis With A Second Opinion From Centeno-Schultz
If you’re dealing with persistent PCS symptoms, resorting to medications may fail to address the root cause and can lead to side effects. This is why it’s crucial to evaluate potential neck issues that can simulate PCS symptoms and complicate your recovery journey.
At Centeno-Schultz Clinic, we leveraged advanced techniques to address the issues that may be at the root of ongoing concussion symptoms, improving long-term cervical spine health. By accurately identifying the root cause, we provide you with a tailored plan to improve your health and recovery.
Want to make sure what condition you have? Schedule a second consultation for the right diagnosis of your pain.