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Post Concussive Syndrome: When Concussion Symptoms Linger

Nov 14, 2018
Complex Concussion

What is Post Concussive Syndrome (PCS)?

It is expected that most children will return to typical functioning within 3-4 weeks following a concussion. A small portion of children can experience symptoms that continue for a longer duration. This is called Post-Concussion Syndrome (PCS). PCS symptoms are variable and can involve headaches, dizziness, sleep problems, difficulties with concentration and memory, mood or anxiety problems, and difficulty tolerating school or exercise.

Why do some children have longer-lasting concussion symptoms?

There is no single cause of PCS. In fact, for most children with PCS, several factors contribute to difficulties. For example, experiencing a concussion can lead to changes in normal exercise, sleep and behavior patterns. Concussions can also be stressful and difficult to cope with, particularly when symptoms cause children to miss school, sports or other enjoyable activities.

We do not always know which children will experience a longer recovery, though children may be at higher risk for PCS if they have a history of anxiety or emotional conditions, attention or learning disabilities or have experienced frequent headaches prior to their injury.

What impact does PCS have on children and teens?

Most children who get a concussion do not develop PCS; however, for the small portion of children who do develop PCS, the symptoms can be difficult to manage. Symptoms can impact school attendance and make it hard for children to complete school work. Symptoms can also lead to depression, anxiety or other social and behavioral conditions. Many children with PCS have difficulty with exercise and may withdraw from enjoyable activities. Without proper medical care, PCS can sometimes persist for months or even years.

What treatments are available for PCS?

Each child’s experience with PCS is different. There are usually multiple factors contributing to prolonged symptoms, so treatment varies. There is no specific treatment, but doctors can treat the individual symptoms that make up PCS. 

Examples of treatment may include:

  • exercise
  • vestibular (inner ear) therapy
  • neck therapy
  • adjusting daily routines and sleep schedules
  • modifications to the school day
  • medications for headaches or pain
  • counseling for anxiety and other mood disorders

What should I do if I think my child is having persistent problems after a concussion?

Children who are experiencing concussion symptoms lasting more than a month may benefit from seeing a doctor who specializes in concussion or traumatic brain injury (TBI). It may also be helpful to see providers who specialize in the specific problems you are experiencing. Often, several providers can work together to develop a plan of care, including a neurologist, neuropsychologist, physical therapist and athletic trainer.

Could post-concussion syndrome or multiple concussions prevent my child from playing sports in the future?

This is a complicated question and should not be answered without significant thought and discussion with a doctor. Sometimes, if symptoms are too troublesome and persistent after a concussion, it may be best to avoid situations that could result in another concussion, such as contact sports. However, there is no set number of concussions or set duration of symptoms after a concussion that stipulates retirement from sports. 

After a concussion, most children are able to return to sports and other activities that they enjoy doing.  If you are concerned about multiple concussions or lingering symptoms after a concussion, your child should see a doctor experienced in the management of concussion and sports participation.

For more information about the Complex Concussion Clinic at Nationwide Children's Hospital, click here.

Featured Expert

Kelly McNally, PhD
Neurosciences

Kelly A. McNally, PhD, is a pediatric neuropsychologist at Nationwide Children's Hospital and a clinical assistant professor of pediatrics at The Ohio State University. 

Sean Rose
Sean Rose, MD
Neurology

Sean Rose, MD, is a pediatric sports neurologist and co-director of the Complex Concussion Clinic at Nationwide Children’s Hospital, and assistant professor of Pediatrics at The Ohio State University. His clinical practice focuses on concussion and other neurological conditions in athletes.

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