Many people suffering from persistent concussion symptoms are sent from doctor to doctor without a clear explanation. They can feel like it’s “all in their head,” but it might not be.

A new study suggests that reporting unexpected symptoms following a concussion may be associated with Functional Neurological Disorder / Somatic Symptom Disorder or exaggeration.

Neuropsychological Testing

Neuropsychological testing helps to determine if changes in your thinking and understanding are caused by an injury or illness, such as Alzheimer’s disease, depression or even your TBI. Your test results are often compared to the patterns of strength and weakness in people with no illness or those with different diseases to help your doctor arrive at the best possible diagnosis.

To do the testing, your neuropsychologist will interview you or someone who knows you well and will review your medical history. They will ask questions about the symptoms you have and your daily activities.

The tests you will be given are standardized (meaning that everyone is tested under the same conditions) and norm-referenced, which means your performance on the tests is compared to those of people with no brain injuries or illnesses. This helps to prevent malingering, where a person acts abnormally on an examination because of financial, emotional or social advantages.

Medications

People who have suffered from a concussion or multiple concussions have a higher risk of developing persistent symptoms. Many of these patients have been treated by primary care providers who tell them to “rest.” Those patients go from doctor to doctor with no resolution of their symptoms.

Medications can help with some of the symptoms that persist after a concussion. Headache, depression/anxiety, sleep disturbances, and vertigo/disequilibrium may respond to pharmacological management. A patient with a daily headache can often benefit from physical and cognitive behavioral therapy (CBT).

The doctor may perform a computerized tomography scan or magnetic resonance imaging of the brain for other symptoms that do not respond to medication. These tests are not routinely performed because they have no proven role in determining whether or not someone has post concussion syndrome symptoms and are more expensive than other diagnostic measures. These tests also expose the patient to radiation. A neurologist specializing in sports neurology will be more familiar with sports concussion problems and can make testing recommendations.

Physical Therapy

Many people find that their concussion symptoms persist beyond the expected recovery timeframe. This can be referred to as post-concussion syndrome (PCS). PCS is considered a disorder in the DSM-5 and ICD-10, although there is disagreement throughout the symptoms required for this diagnosis.

Physical therapy is very important for the management of PCS, particularly if there are other injuries, such as neck pain and whiplash, from the same incident. These injuries may interact with the concussion and make the symptoms worse.

PT helps patients reintroduce their regular activities and sports without overdoing it, which could make their symptoms return. They also work to help people who have problems with cognitive changes (e.g., difficulty concentrating, memory deficits) return to work or school with appropriate strategies and support. They can also refer to speech and language pathologists or occupational therapists trained in Concussion Recovery Treatment (CRT) who can teach coping skills to help manage the effects of these changes.

Referrals

While most patients recover from a concussion with rest and avoiding strenuous activities, some continue to experience symptoms that affect their ability to work, study, play sports or other leisure activities for weeks, months or even years. These lingering symptoms are known as post-concussion syndrome (PCS).

PCS often involves subjective complaints that are difficult to evaluate using a physical exam alone, such as headache, dizziness and balance problems or difficulty concentrating and remembering. Neuropsychological testing can reveal these problems. Both traditional pen-and-paper and computerized neurocognitive assessments are used to assess PCS. However, the interpreting physician must have the training and expertise to interpret these tests and properly provide an accurate diagnosis.

Various rehabilitation programs are available to treat PCS, including vestibular, exertional, oculomotor and general physical therapy. Depending on the severity of your symptoms, these may be needed in addition to cognitive treatment. Longitudinal studies involving standardized assessment and diagnosis strategies and evidence-based intervention are necessary for adult and pediatric mTBI patients to optimize recovery and reduce this significant socio-economic burden.