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Post-concussion syndrome - what is it, what influences it?

At what point does a concussion become post-concussion syndrome, and which factors contribute to this?

It is estimated that 42 million head injuries occur globally each year. In countries such as the United States, it is estimated that up to 1.5 million head injuries occur annually, but statistics for other nations are not as well-documented.

Post-concussion syndrome (PCS) is the clustering of symptoms that persists beyond 3 months after trauma, and often results in debilitating symptoms such as persistent headaches, fatigue, and difficulty engaging in employment and social roles.

This study investigated the prevalence of PCS, specifically in a rural country such as Ethiopia, and the impact of on-going concussion symptoms and PCS in this area. This study also sought to establish if the factors impacting the criteria for PCS were similar in Ethiopia as compared to other countries with documented PCS input, such as the United States and New Zealand.

While this study has several limitations, such as a lack of controls or blinding, it is interesting to see that external factors may play a role in the risk of development of PCS. Societal differences and cultural beliefs may potentially explain the variations between different countries and the rates at which PCS is reported.

Additionally, the differences in students vs. other employed workers may raise questions for further research, such as how socioeconomic status impacts head injury recovery and personal coping strategies, and the likelihood of the developing PCS.

> From: Bedaso et al., J Headache Pain 19 (2018) 1-6 . All rights reserved to The Journal of Headache and Pain. Click here for the online summary.

Expert opinion

As said, this article has certain limitations, but it does raise some interesting questions on the potential factors that contribute to PCS.

In a clinical setting, PCS is sometimes incorrectly diagnosed, there is no valid basis for naming it PCS vs. concussion. However, with the definition of multiple symptoms lasting longer than 3 months, and by using the validated Rivermead Questionnaire, specific criteria for PCS are available.

Finally, no 2 injuries are the same. Concussion therapy should do more than just addressing the injury, and multidisciplinary treatment has to be considered. In addition to physiotherapy, occupational therapy, psychological and medical support may be needed to achieve resolution of the concussion and limit the risk of progression to PCS.

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