From the Guidelines
Post-concussive syndrome occurs in approximately 34% to 44% of patients with concussion or mild traumatic brain injury at 3 to 6 months after injury, and between 5% and 20% experience symptoms at 12 months after injury. The rate of post-concussive syndrome is a significant concern, as it can lead to long-term symptoms and impact an individual's quality of life. According to the study published in JAMA Network Open in 2021 1, the true incidence of concussion or mild traumatic brain injury is estimated to be around 600 per 100 000 inhabitants, with most people recovering quickly, but a significant proportion experiencing long-term symptoms.
The symptoms of post-concussive syndrome comprise a combination of physical, cognitive, and emotional or behavioral symptoms, and might be associated with changes in personality and difficulties regarding personal and professional identity. The study highlights the uncertainty regarding the effectiveness of commonly applied nonpharmacological interventions to treat persistent postconcussion symptoms (PPCS) and the scarcity of meta-analyses dedicated to this topic.
Key factors to consider in the management of post-concussive syndrome include:
- Early identification and multidisciplinary management
- Gradual return to activities
- Cognitive rest followed by progressive cognitive exertion
- Targeted symptom management
- Nonpharmacological interventions such as graded physical exercise, vestibular rehabilitation, and psychological treatment.
As noted in the study published in JAMA Network Open in 2021 1, the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach has only been used sporadically, and there is a need for more systematic approaches to evaluate the effectiveness of nonpharmacological interventions in adults experiencing PPCS. The current evidence suggests that a comprehensive and multidisciplinary approach to management is essential to improve outcomes and reduce the duration of post-concussive symptoms.
From the Research
Post Concussive Syndrome Rate
- The rate of post concussive syndrome is not explicitly stated in the provided studies, however, it is mentioned that most patients recover within 2-4 weeks, but a significant minority experiences persistent post-concussive symptoms (PPCS) 2.
- The studies focus on the management and rehabilitation of concussion and PPCS, highlighting the importance of identifying underlying symptom generators and individualized treatment plans 3, 4.
- Treatment options for PPCS include sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, pharmacological management, or a combination of treatments 3, 4, 5.
- Medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds, but are not routinely used in most concussions that recover within days to weeks 5.
- A study investigating the association between acute administration of ibuprofen, acetaminophen, or both and headache presence at 7 days post-concussion in children found no association between treatment and presence of headache at 7 days 6.