Treatment of Post-Concussion Syndrome


When symptoms of concussion persist for more than a month or so, then the individual may be experiencing a Post-Concussion Syndrome (PCS). PCS can last for months or even years. We are not exactly sure why some individuals recover quickly and others experience continued symptoms. Research is showing that factors such as genetic predisposition, gender, age, number of previous concussions, pre-injury history of headache, migraine, learning disorder, attention disorder, or emotional disorder, presence of amnesia at the time of injury, or lack of rest immediately after the concussion can affect recovery time.


The treatment of PCS requires a comprehensive team approach. The team may include the neuropsychologist, primary care physician/pediatrician, athletic trainer, school nurse, neurologist, patient, and patient family members. If an individual has never engaged in a period of comprehensive cognitive and physical rest, then it may be appropriate to try such rest even during the PCS period, to give the brain a break from work and to allow it some healing time. Currently, rest is one treatment which has some scientific research support. Most other treatments are preliminary, experimental, and anecdotal.


A PCS treatment plan may include a neurological referral for possible medication management, biofeedback to help control the headaches, psychotherapy to address the stressors of PCS and its effects on quality of life, vestibular therapy to address balance issues, acupuncture and/or massage to help manage pain and stress, and vision therapy to correct visual difficulties. In addition, good nutrition and hydration are always important when healing. Basic vitamins, Omega 3 Fatty Acids, Fish Oil, and Magnesium Supplements have been suggested as possibly helpful, although strong research support is still not available.


When PCS continues even after a significant period of comprehensive rest, it may be best to provide the individual with a light exercise program that is carefully tailored so as not to increase symptoms, but to provide an avenue for re-conditioning and elevating self-esteem. A certified athletic trainer or physical therapist specifically trained in the specialty of concussion can help create the appropriate re-conditioning program.


An individual experiencing PCS may require significant academic or work accommodations or a medical leave due to symptoms such as fatigue, slowed mental processing, memory difficulties, periods of confusion, problems with multi-tasking, headaches, and emotional distress.


At RSM Psychology Center and the Sports Concussion Center of New Jersey, the neuropsychologist serves as the point person on the concussion team. The neuropsychologist 1) coordinates the concussion services and appropriate referrals for adjunct therapies, 2) arranges for onsite biofeedback services and cognitive rehabilitation services, 3) provides treatment with counseling, stress management, and post-concussion cognitive test monitoring, and 4) develops the personalized plan for return to learn and return to work accommodations.