Post-concussion syndrome (PCS) (aka persistent post-concussion symptoms) is a condition that often arises after a concussion, which is one type of traumatic brain injury (TBI). It is characterized by symptoms that persist long after the initial injury, leading to significant long-term effects that can impact both physical and mental health.
While most people recover from a concussion within a few weeks, some individuals experience lingering symptoms for months or even years, which can be debilitating and impact their quality of life. In some individuals, symptoms of PCS can persist for over a year, making it a critical area of concern for both patients and healthcare providers.
A 2003 study published in JAMA Neurology found that individuals with a concussion continue to experience symptoms for more than a year, indicating that PCS is more than just a temporary condition. (1)
The study demonstrated that the severity and duration of symptoms can vary widely among individuals, with some experiencing chronic headaches, dizziness, memory problems, and emotional disturbances for extended periods after the injury. This highlights the importance of understanding and managing PCS to prevent long-term complications.
Post-Concussion Syndrome and Its Impact on Overall Well-Being
PCS is a complex condition that can significantly affect an individual’s well-being. While a concussion may initially seem like a mild injury, PCS involves a wide range of physical, cognitive, and emotional symptoms that can last much longer than expected.
The recovery period for PCS can vary, with some individuals experiencing symptoms for several months and, in some cases, up to a year or more. During this period, individuals often report difficulties returning to their normal daily activities, including work, social interactions, and personal care.
The symptoms of PCS can be highly disruptive, leading to a decline in physical, emotional, and mental health. The condition can impact an individual’s ability to concentrate, think clearly, or perform tasks that require cognitive effort. In addion, physical symptoms like dizziness, imbalance, and headache can be disabling and generally interfere with normal activities or work. All of this can also lead to emotional challenges such as irritability, anxiety, and depression.
The persistent nature of these symptoms can cause frustration, stress, and feelings of isolation, significantly affecting the person’s quality of life and overall well-being.
Associated Long-Term Effects of Post-Concussion Syndrome
PCS can involve a range of symptoms extending beyond the injury’s immediate aftermath. These symptoms can vary in severity and may affect different areas of the body and mind.
Below is an overview of some common long-term effects associated with PCS:
Chronic Headaches
Chronic headaches are one of the most common and persistent symptoms of PCS. These headaches often occur frequently, can be intense, and are resistant to standard treatments. Many individuals experience migraines, tension-type headaches, or even post-traumatic headaches that can severely impact their daily activities. These headaches often originate from the neck in most PCS patients.
Neck Pain
Neck pain is another common symptom associated with PCS. The injury that causes a concussion often involves whiplash or other neck-related trauma. This can lead to neck stiffness, discomfort, or pain, further exacerbating other PCS symptoms. This neck injury often involves the upper cervical spine, which can cause headaches, dizziness, and imbalance.
Balance Issues
Balance problems are another hallmark of PCS, with individuals experiencing dizziness, lightheadedness, or a sense of unsteadiness. These issues can affect a person’s ability to walk or move freely, leading to an increased risk of falls and accidents. Imbalance is often worse when the patient moves their head or neck.
Sensitivity to Light and Noise
Many individuals with PCS report heightened sensitivity to light and noise. Bright lights or loud sounds can trigger headaches, nausea, or dizziness, making it difficult for individuals to engage in everyday activities like driving, work, or socializing in public spaces.
Dizziness
Dizziness or vertigo is often experienced as a spinning sensation or a feeling of being unbalanced. This symptom can be debilitating, as it affects a person’s ability to perform normal tasks and can lead to anxiety and fear of potential falls. An undiagnosed upper neck injury often causes this symptom.
Fatigue
Fatigue is a common and often debilitating symptom of PCS. Many individuals report feeling drained, even after getting adequate rest. This chronic exhaustion can interfere with physical and cognitive functioning and significantly affect quality of life. Fatigue can also be caused by constant headaches or neck pain and/or imbalance and dizziness. For example, sleep quality can often be made worse by pain.
Blurred or Double Vision
Visual disturbances, such as blurred or double vision, are common in PCS individuals. These symptoms can result from damage to the visual pathways in the brain and may impair a person’s ability to perform activities that require clear vision, such as reading or driving. They are also commonly caused by poor position sense input from the upper neck, which often interferes with normal eye tracking.
Late-Onset Sleep Issues
Sleep disturbances, including difficulty falling asleep, staying asleep, or experiencing restful sleep, are often reported by individuals with PCS. These sleep issues can contribute to further cognitive decline, mood disturbances, and general fatigue.
Gastrointestinal Symptoms
PCS can also affect the gastrointestinal system, leading to symptoms such as nausea, vomiting, constipation, or diarrhea. These symptoms can be a direct result of brain injury or may stem from the stress and anxiety caused by living with persistent concussion-related symptoms. They can also be part of an upper neck injury where irritation of the vagus nerve at C1 is not uncommon.
Challenges with Memory Retention
Many individuals with PCS experience memory problems, particularly difficulty remembering recent events or retaining new information. This cognitive impairment can significantly affect daily functioning and performance at work or school. While the brain injury itself can cause this, it can also be caused by poor eye tracking, as recall is directly linked to eye movements.
Difficulty Sustaining Attention
In addition to memory problems, individuals with PCS may struggle with sustaining attention or focus on tasks. This can make it difficult to complete projects or engage in activities that require concentration, such as reading, working, or even having conversations.
Impaired Mental Sharpness
Cognitive symptoms, such as brain fog, confusion, or difficulty processing information, are common in PCS. Individuals may feel mentally sluggish or experience episodes of disorientation, which can interfere with daily life. Also, realize that brain fog is a known problem of patients with upper neck injuries.
Apathy
Apathy, or a lack of interest or motivation, is another symptom often reported by individuals with PCS. This can manifest as a diminished interest in previously enjoyable or meaningful activities, negatively impacting mental and social well-being.
Personality Changes
Personality changes can occur after a concussion, with individuals becoming more irritable, anxious, or withdrawn. These changes can strain personal relationships and make it difficult for individuals to maintain social connections.
Depression
Depression is a significant psychological effect of PCS. The persistent nature of the symptoms, combined with the frustration of not being able to recover fully, can lead to feelings of hopelessness and sadness. This can profoundly impact an individual’s overall mental health and quality of life.
Why Persistent Symptoms Might Signal Something More
While PCS is typically linked to concussions, persistent symptoms can sometimes signal an underlying condition that requires further evaluation. Ongoing symptoms that do not improve with time or standard treatments may indicate the presence of additional injuries or complications, such as undiagnosed neck injuries or more severe brain trauma.
Persistent symptoms should be taken seriously, as they could reflect a more complex issue that requires specialized care.
For instance, if symptoms such as headaches, dizziness, or neck pain continue for months, it may indicate an underlying musculoskeletal or neurological injury. Further evaluation and imaging tests are necessary to identify the root cause and guide treatment in such cases.
How Post-Concussion Symptoms Can Mask Underlying Upper Neck Injuries
One key factor that can contribute to prolonged PCS symptoms is an undiagnosed upper neck injury. The neck and head are intricately connected, and a whiplash-type injury that occurs during the concussion could lead to neck misalignments due to ligament, facet joint, or occipital nerve injuries. These injuries can mimic or exacerbate the symptoms of PCS, making it difficult to differentiate between the two conditions.
In some cases, individuals with PCS symptoms may have an underlying neck injury that is causing or prolonging their symptoms. For example, unresolved neck injuries can contribute to chronic headaches, dizziness, neck pain, and fatigue, making it harder to differentiate between PCS and other conditions.
Therefore, it is crucial to consider the possibility of an undiagnosed neck injury when evaluating PCS symptoms.
What To Do if You Suspect an Upper Neck Injury
If you suspect that an upper neck injury might be contributing to your PCS symptoms, it is essential to seek a comprehensive evaluation. Regrettably, few physicians specialize in the upper neck due to the complexity of these injuries. Hence, just seeking out your local neurologist, orthopedist, spine surgeon, or interventional spine clinic may not get you very far.
At Centeno-Schultz, we have been treating upper neck injuries for 30-years and understand how they are diagnosed and how to treat them quickly and effectively.
In some cases, imaging tests such as X-rays, MRIs, or more specialized imaging techniques may be required to diagnose a neck injury.
Diagnosing the Root Cause of Your Symptoms
Accurate diagnosis is critical in determining the root cause of persistent PCS symptoms. This process typically involves a detailed medical history, physical examination, and very specialized diagnostic imaging. A comprehensive approach ensures that all potential causes, including neck injuries, are considered.
DMX Technology Helps Diagnose Upper Neck Injuries
One of the most effective ways to identify upper neck injuries is through DMX (dynamic motion X-ray) technology. This advanced imaging technique allows doctors to visualize the movement of the cervical spine in real-time, helping to identify misalignments, joint instability, and other issues contributing to PCS-like symptoms.
DMX technology provides highly detailed images that can aid in the accurate diagnosis of neck injuries that may otherwise go undetected.
Upright MRI:
Upright MRI with flexion-extension views can also diagnose an upper neck injury. In this test, the patient sits rather than stands and can flex their neck and head forward and backward. This test looks for abnormal motion between the skull and upper neck or in the upper neck vertebrae.
Centeno-Schultz Clinic Can Help You Receive Proper Diagnosis
The Centeno-Schultz Clinic (CSC) is a leader in diagnosing and treating complex conditions related to upper neck injuries and PCS. The clinic specializes in advanced diagnostic techniques, including DMX and upright MRI, to help identify the underlying causes of persistent symptoms.
CSC offers a range of treatment options tailored to each patient’s unique needs, ensuring that individuals receive effective care for neck injuries and other conditions.
The Parts of the Upper Neck that Can Be Injured and Cause PCS Symptoms
Many parts of the upper neck can be injured in a concussion, and these include:
- C0-C3 facet joint injuries can refer pain to the head and cause imbalance/dizziness, and brain fog
- The alar and transverse ligaments help to stabilize your head on your neck and when injured can cause cracking, popping, and a “bobble head” feeling.
- The occipital nerves can cause headaches and a “bruised skull” feeling
- The vagus nerve can be irritated by upper neck instability or craniocervical instability which can lead to autonomic symptoms like gastroparesis, tachycardia, POTS, and other things.
Targeting the Injured Parts with Specific Injections to Prompt Healing is Often the Solution
Once the patient has a specific upper neck diagnosis, that injured part can be targeted for precise image-guided injection of orthobiologics which can prompt repair and healing. These injections, like platelet-rich plasma and bone marrow concentrate which contains stem cells, can precisely place these substances where they are needed.
Target the Source of Your Symptoms for Better Recovery
Recovery from an upper neck condition usually involves treating the root cause of the symptoms. If you are experiencing persistent symptoms of PCS, it is important to seek professional evaluation and comprehensive testing to determine whether an underlying condition, such as a neck injury, may be contributing to your ongoing struggles.
By targeting the source of your symptoms, you can receive more effective treatment and ultimately achieve a better recovery.
Still dealing with PCS symptoms? Contact us today to learn how we can help you get a proper diagnosis for your condition.
Reference
- McCrea M, Guskiewicz KM, Marshall SW, et al. Acute Effects and Recovery Time Following Concussion in Collegiate Football Players: The NCAA Concussion Study. JAMA. 2003;290(19):2556–2563. doi:10.1001/jama.290.19.2556