Head / Face
Post-Concussion Syndrome
뇌진탕 후 증후군
Persistent symptom complex of headache, dizziness, and cognitive difficulty after mild TBI
- How common
- 10–30% of concussion patients
- Typical age
- All ages
What is it?
Mild TBI causes diffuse axonal microinjury, neurometabolic cascade, and autonomic dysregulation with coexisting cervicogenic and vestibular dysfunction.
Commonly affected: Cerebral white matter, vestibular nuclei, upper cervical myofascia
How it develops
- Mechanical TraumaRotational forces shear axons
- Neurometabolic CascadeGlutamate release, calcium influx, energy crisis
- Autonomic DysregulationImpaired HRV and cerebral autoregulation
- Cervicogenic/Vestibular ComponentCoincident whiplash and vestibular mismatch drive dizziness
Symptoms
- Persistent headacheTension-type or migrainous pattern
- Dizziness/imbalanceWorse with motion or visual stimuli
- Cognitive slowingImpaired concentration, memory, processing speed
- Sleep disturbanceInsomnia, hypersomnia, poor sleep quality
- Emotional lability/irritabilityIncreased depression, anxiety, irritability
How it is examined
- VOMS assessmentVestibular-Ocular Motor Screening provokes symptoms
- Cervical tenderness/ROM lossUpper cervical suboccipital tenderness common
- BESS balance testBalance error scoring system abnormalities
- Neurocognitive testingImPACT/SCAT scores below baseline
Imaging
Cervical X-ray if whiplash suspected; skull X-ray not recommended.
- Usually normal
- Possible cervical straightening
- No structural abnormality
Conventional MRI usually normal; DTI/fMRI may show diffuse axonal injury. Performed to rule out hemorrhage/contusion with red flags.
- Normal on conventional MRI
- Possible reduced FA on DTI (DAI)
- No hemorrhage or contusion
Non-surgical care
- Graded return to activityRelative rest then symptom-limited graded exertion
- Vestibular/cervical rehabCombined vestibular rehab and upper cervical manual therapy
- Sleep/stress managementSleep hygiene, CBT
- Headache pharmacotherapyAmitriptyline or beta-blocker for persistent headache
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
No surgical indication (unless structural lesion identified)
Procedures that may be discussed
- Non-operative care only
Outlook
80–90% recover within 3 months; a minority persist for months to years.