Symptoms post concussion syndrome

What to know about post-concussion syndrome

Treatment for PCS focuses on providing symptom relief to help a person manage the condition. Rest is one of the most important components of PCS treatment as it allows the brain to recover and heal from a concussion.

Where possible, doctors often avoid using medication to treat PCS symptoms because an injury to the head can make the brain more sensitive to drug use and possible side effects.

Doctors may advise people to wait several weeks before starting an active treatment, such as an exercise plan or another type of therapy. In addition, suffering multiple concussions in short span of time can significantly worsen symptoms and delay recovery.

People can try a range of different therapies that may help their recovery from PCS. For all of these therapies, a person will work with a medical professional who will monitor their progress and can adjust the treatment plan as necessary to suit them.

Vision therapy

Vision therapy uses a range of exercises to help people who have vision problems due to PCS. The exercises can help repair damage to the visual system or help the brain adapt to changes in connectivity.

Neuro-optometric rehabilitation

Neuro-optometric rehabilitation also works to target any vision problems that people may be experiencing. A treatment plan will combine the use of lenses, prisms, and filters to help stimulate parts of the brain that are not working as usual.

Balance therapy

Balance, or vestibular, therapy can help people if they are experiencing a lot of dizziness as a symptom of PCS. Exercises to encourage balance and stability can help reduce this disorienting symptom.

Physical therapy

If PCS causes physical pain in the body, physical therapy can help relieve symptoms. This therapy might include massage, gentle exercise, and heat therapy to relax the body and aid recovery.

Exertion therapy

Exertion therapy uses gentle aerobic exercise to help the body recover. People might use a pool or a piece of gym equipment, such as a treadmill, that carries minimal risk of head injury.

A medical professional will monitor the individual carefully during this therapy to make sure that they are not overdoing the exercise, which may slow down recovery.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) may help people who have mood-related PCS symptoms, such as depression, anxiety, or mood swings.

CBT helps people become aware of negative thought patterns and behavior and provides them with practical tools to overcome these issues.

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.

Post-Concussion Syndrome: What You Need To Know

After suffering a head injury that causes concussion, you might expect to feel off your game for a few days before returning to your regular state of mind and ability to function.

But if you experience lingering symptoms, including headache, dizziness, fatigue, trouble concentrating, insomnia, or mood changes, for weeks or months after the initial injury, you might be suffering from post-concussion syndrome.

“It’s a controversial diagnosis because there’s debate about whether post-concussion syndrome refers to a unitary condition,” says Prin Amorapanth, MD, PhD, a clinical instructor of rehabilitation medicine at the Rusk Rehabilitation Center at the NYU Langone Medical Center in New York City. “There’s no real consensus about how to make the diagnosis. It depends very much on the clinician you’re speaking to.”

There also isn’t a consensus about how long symptoms need to last for it to be considered post-concussion syndrome. Some clinicians use the presence of symptoms beyond two weeks as a cut-off to make the diagnosis, while others use three months or longer.

Symptoms and Risk Factors of Post-Concussion Syndrome

Generally, post-concussion syndrome is diagnosed after someone suffers a mild traumatic brain injury (TBI), or a concussion, and has three or more of the following symptoms:

  • Headache
  • Dizziness
  • Fatigue
  • Irritability
  • Problems with memory or concentration
  • Insomnia
  • A reduced tolerance for noise or light

Andrew Gregory, MD, an associate professor of orthopedics, neurosurgery, and pediatrics at the Vanderbilt University School of Medicine in Nashville, Tennessee, notes that there’s no way to know how long the syndrome will take to resolve — it could be weeks to months to a couple of years in severe cases. “It’s open-ended,” Dr. Gregory says.

Surprisingly, there isn’t necessarily a correlation between the severity of the TBI and post-concussion syndrome — but there are other contributing factors at play. For example, people with co-occurring conditions (comorbidities) tend to take longer to recover, Gregory says. In particular, those who suffer from anxiety, depression, or attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) are more likely to experience post-concussion syndrome.

People who suffer from chronic pain, such as migraines, appear to be more susceptible to long-lasting post-concussion symptoms, Gregory notes. There’s also some evidence that those with higher stress levels or a poor social support system in general may be especially vulnerable.

“The trick is to try to tease out whether there are other things going on that could be contributing to the lingering symptoms,” Gregory says.

There’s also some evidence that women report greater post-concussive symptoms. In a study published in June 2017 in the journal Psychiatry Research, researchers examined the gender disparity with post-concussion syndrome and looked at whether anxiety sensitivity (which is higher among women) or distress tolerance (which is lower among women) played a role. It turns out, higher anxiety sensitivity partly explained the gender disparity, which makes sense, as the researchers pointed out, because if someone interprets post-concussive symptoms as dangerous, it amplifies her perception and experience of the syndrome’s severity.

Having a history of multiple concussions can also prolong recovery. In a study published in April 2016 in the journal Neurosurgical Focus, research into college athletes from a variety of sports found that recurrent concussions and certain concussion-related symptoms — especially retrograde amnesia (a loss of memory about how the injury happened) and difficulty concentrating — were most closely associated with a higher risk of developing post-concussion syndrome.

“The more concussions you have, the longer it takes to recover and the less injury it takes to cause concussion,” Gregory explains. “If you’ve had two concussions, your risk of having another one is twice as high; if you’ve had three concussions, it’s three times higher.”

How to Treat Post-Concussion Syndrome

Treating post-concussion syndrome can also be as challenging as it is to diagnose, partly because the symptoms are so varied and there isn’t a central cause.

“The recognition of specific symptoms is what directs treatment,” Dr. Amorapanth says. If you’re having balance problems, you might be sent for vestibular therapy. A small study published in October 2017 in the journal Gait & Posture found that when people with balance problems due to post-concussion syndrome did daily balance, visual, and neck strengthening exercises that were prescribed by a physiotherapist, they gained significant improvements in balance control (with their eyes open or closed) over the course of eight weeks.

Lingering vision problems might warrant ocular therapy, whereas if you are struggling with mood or emotion regulation, you might be referred for psychotherapy or medication, such as antidepressants.

In general, there are a few things anyone suffering from post-concussion syndrome should do while recovering:

  • Eat a healthy diet. It’s important to consume a healthy diet so your brain gets the macro- and micronutrients and the calories it needs for recovery and proper functioning, Amorapanth says. In particular, make an effort to consume plenty of essential fatty acids (from fatty fish, walnuts, chia seeds, and flaxseeds), because they help optimize memory and cognitive function, according to previous research published in the journal Surgical Neurology.
  • Get exercise. Aerobic activity, under a clinician’s supervision, is crucial for recovery after a concussion because it supports the restoration of normal blood flow in the brain, as well as neuroplasticity, the rewiring of brain circuitry that’s crucial for rehabilitation, Amorapanth notes. Stop exercise immediately if you begin to experience any post-concussion symptoms, though.
  • Practice good sleep hygiene. “For people recovering from a brain injury, sleep needs to be a priority,” Amorapanth says. “It’s a restorative state through which the brain recovers from the challenges of the day and consolidates new information and other changes.” If insomnia is giving you problems, talk to your doctor about whether you’d benefit from taking melatonin, which can reset your body’s internal clock to help you sleep at night, Amorapanth says.
  • Manage stress. Taking steps to relieve stress can help ease the strain on your brain as you’re recovering, Amorapanth says. In fact, research published in August 2013 in the Journal of Head Trauma Rehabilitation found that after people with post-concussion syndrome participated in a weekly mindfulness-based stress reduction program, they gained significant improvements in their quality of life and self-efficacy, as well as smaller boosts in their working memory and attention after 10 weeks. Meanwhile, “resume school or work activities as soon as you can, but take breaks or extra time as you need it, and use earplugs” to minimize noise and distractions, Gregory says.

“Being evaluated by a clinician with specific experience in identifying the many possible presentations of concussion is crucial to successful diagnosis and treatment,” Amorapanth says. With the right interventions, you can enhance your chances of getting back to feeling and functioning like your usual self.

Delayed concussion symptoms

The symptoms of a severe concussion are immediate – dizziness, blurred vision, memory loss or even loss of consciousness, but for a mild concussion that doesn’t involve being knocked out, symptoms may not seem obvious until days later.

UQ neurologist Professor Michael O’Sullivan explains that part of the problem is that initial symptoms of a concussion – such as memory problems – can sometimes be quite subtle, and aren’t noticed until they become more pronounced.

“It’s the recognition that something isn’t quite right that takes time,” he says.

As for symptoms becoming more severe over time, there can be a few reasons for this, explains QBI’s Dr Fatima Nasrallah.

Every concussion is different, she says. The location and force of some impacts are more likely to cause immediate loss of consciousness or vision problems, and these are hard to miss.

“But It might be that the concussion or impact happened in an area that took a long time to cause further damage,” she says. In this case, the associated symptoms, such as headaches and ability to multitask, may take a little longer to become apparent.

Mild concussions can still cause brain injury

She also points out that even if a concussion doesn’t have any initial symptoms, it doesn’t mean the brain hasn’t been damaged. Even a mild concussion needs time to heal.

This is particularly an issue in sport. If a concussion isn’t obvious at first, continuing to play even the next day or the next week can aggravate the original injury and lead to further damage and the onset of symptoms.

So, as time passes, and new symptoms emerge it’s quite difficult to tell whether these are due solely to the initial concussion or whether additional injuries have accumulated on top of it.

Dr Nasrallah also points out that a person’s prior concussions may influence the severity and behaviour of a new concussion. In particular, previous head injuries might prime the body to react more strongly to the next one.

It’s important to note that with any head injury that causes a concussion, there can be a risk of separate injuries such as swelling of brain tissue or bleeding in the brain, which can be life threatening. So it’s always important to monitor head injuries closely to pick up subtle signs of concussion as well as any signs of more dangerous conditions.

If a head injury results in a loss of consciousness, increasing confusion, vomiting or worsening headache, always seek medical attention.

Image credit: Getty

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What Is a Concussion?

A concussion is a type of mild traumatic brain injury (or mild TBI). It happens when a blow to the head or an injury makes the head move back and forth with a lot of force. This causes chemical changes in the brain and, sometimes, damage to the brain cells.

Teens who follow their health care provider’s recommendations usually feel better within a few weeks of the concussion.

What Are the Signs & Symptoms of a Concussion?

Someone with a concussion might be knocked out (this is called a loss of consciousness). But a person doesn’t have to get knocked out to have a concussion.

Signs and symptoms of a concussion include:

  • headache
  • blurred or double vision
  • dizziness, balance problems, or trouble walking
  • confusion and saying things that don’t make sense
  • being slow to answer questions
  • slurred speech
  • nausea or vomiting
  • not remembering what happened
  • not feeling well

Symptoms of a concussion usually happen right away, but can show up hours or days after an injury. A teen with a concussion may:

  • have trouble focusing
  • have learning or memory problems
  • have a headache that gets worse
  • have sleep problems
  • feel sad, easily upset or angered, or nervous

If you have been diagnosed with a concussion, call your health care provider right away or have someone take you to the ER if you:

  • have a severe headache or one that gets worse
  • have a seizure
  • pass out
  • have other symptoms (such as continued vomiting) that worry you

These could be signs of a serious concussion, and you might need treatment in a hospital.

What Happens in a Concussion?

The skull helps protect the brain from injury. Spinal fluid cushions the brain inside the skull. A blow or jolt to the head can hurt the brain directly or make the brain move around and bang up against the hard bone of the skull. This changes the signals between nerves, which causes concussion symptoms.

How Do Teens Get Concussions?

Most concussions in teens happen while playing sports. The risk is highest for those who play football, ice hockey, lacrosse, soccer, and field hockey.

Concussions can also happen from:

  • car or bicycle accidents
  • a fight
  • a fall

How Are Concussions Diagnosed?

To diagnose a concussion, the health care provider will:

  • ask about how and when the head injury happened
  • ask about symptoms
  • test memory and concentration
  • do an exam and test balance, coordination, and reflexes

If a head injury happens while someone is playing sports, a coach or athletic trainer may do sideline concussion testing. This is when a trained person does a few simple tests after a head injury to help decide if the athlete needs immediate medical care. An athlete who has a head injury must stop playing and see a doctor before returning to play.

Many schools or sports leagues are using baseline concussion tests. Baseline testing uses computer programs to test a player’s normal brain function. It checks attention, memory, and speed of thinking. Doctors compare testing after an injury with baseline results to see how someone is recovering.

Concussions do not show up on a CAT scan or MRI. So, the doctor may not order a brain scan for a mild concussion. A CAT scan or MRI might be done to look for other problems if someone:

  • was knocked out
  • keeps vomiting
  • has a severe headache or a headache that gets worse
  • was injured in serious accident, such as from a car accident or very high fall

How Are Mild Concussions Treated?

Each person with a concussion heals at their own pace. It’s important to find a balance between doing too much and too little.

At first, you need to cut back on physical activities and those that require a lot of concentration. Then, you can start trying these activities again. Your symptoms don’t have to be completely gone for you to add activities. But if symptoms interfere with an activity, take a break from it. You can try it again after a few minutes, or you can try a less strenuous version of the activity.

Rest (for 1–2 days after the concussion)

  • Relax at home. You can do calm activities, such as talking to family and friends, reading, drawing, or playing a quiet game. If symptoms interfere with an activity, take a break from it. You can try it again after a few minutes or longer, or you can try a less strenuous version of the activity.
  • Avoid or cut down on screen time. Video games, texting, watching TV, and using social media are likely to cause symptoms or make them worse.
  • Don’t drive.
  • Avoid all sports and any activities (such as roughhousing with friends, or riding a bike or skateboard) that could lead to another head injury.
  • Sleep:
    • Get plenty of sleep (at least 8–10 hours in a 24-hour period).
    • Keep regular sleep and wake times.
    • No screen time or listening to loud music before bed.
    • Avoid caffeine.
    • Nap during the day, as needed.
  • For the first few days after the injury, if you have a headache and your health care provider says it’s OK, you can take acetaminophen (Tylenol® or a store brand) or ibuprofen (Advil®, Motrin® or a store brand).

Light Activity (usually within a few days to a week after the concussion)

  • Slowly try more activities, such as going for a walk or watching TV. If symptoms interfere with an activity, take a break from it. You can try it again after a few minutes or longer, or you can try a less strenuous version of the activity.
  • After a few days, you should feel well enough to return to school. Work with your health care provider and a school team to create a plan for returning to school. You may need to start with a shorter day or a lighter workload. If you’re not back in school by 5 days after the concussion, call your health care provider.
  • Ask your health care provider when you can drive again.
  • Keep avoiding all sports and any activities that could lead to another head injury.
  • Keep getting plenty of sleep. If you don’t feel tired during the day, you don’t need to nap.
  • If you still need medicine for headaches, talk to your health care provider.

Moderate Activity (usually about a week after the concussion)

  • If your symptoms are nearly gone, you can go back to most activities, including regular schedules for school and work.
  • Keep avoiding all sports and any activities that could lead to another head injury.
  • If symptoms interfere with an activity, take a break from it. You can try it again after a few minutes or longer, or you can try a less strenuous version of the activity

Regular Activity (usually within a month of the concussion)

  • If you no longer have any concussion symptoms, you can go back to all other activities, except sports, that you used to do.
  • For sports, your health care provider will work with your coach and athletic trainer (if available) to create a clear, written plan for a gradual return to play. Don’t go back to playing sports until your health care provider says it’s OK.

When Can Teens Go Back to Sports After a Concussion?

Student athletes must wait until their health care provider says it’s safe before returning to sports. This means that they:

  • have had a physical exam
  • are back in school
  • have no symptoms
  • aren’t taking any medicines for concussion symptoms
  • are back to their baseline results on physical and cognitive testing

Hurrying back to sports and other physical activities puts teens at risk for second-impact syndrome. This is when someone gets another head injury before the concussion has healed. Although very rare, second-impact syndrome can cause lasting brain damage and even death. Almost every state has rules about when teens with concussions can start playing sports again.

Looking Ahead

People are much more likely to get a concussion if they’ve had one before. So preventing concussions is very important after a head injury. To prevent another concussion:

  • Be sure that any teams you are on have rules to reduce the risk of concussions, such as limits on tackling (football) or heading the ball (soccer).
  • Be sure to wear a helmet when skiing, snowboarding, biking, riding a scooter, skateboarding, or rollerblading. A concussion still can happen while you wear a helmet, but the helmet can protect you from a skull fracture and serious brain injury.
  • If you do get another head injury, never ignore symptoms or try to “tough it out.” Stop the sport or activity that you are doing and get medical care right away.

Reviewed by: Rochelle E. Haas, MD Date reviewed: February 2019

Life with Post-Concussion Syndrome (PCS) is hard. Symptoms can get in the way of anything that requires you to use your brain: school, work, social life, and hobbies all find themselves on the back burner while the brain slowly heals. Here are some tips about how to cope, from those of us that have been there.

Trust yourself: PCS is real.

Not everyone is aware of Post-Concussion Syndrome – even some doctors don’t know that concussions can linger for so long. But rest assured, this is a real thing that happens to real people. The first step to recovery, after all, is admitting there is a problem. Don’t listen to the haters.

Settle in for the long haul.

PCS doesn’t get better tomorrow, but it does get better. Timelines for PCS are usually counted in weeks and months, not days. Along that timeline you will have good days and bad days, and often times you will make a big improvement, then plateau, and maybe even take steps backwards. Don’t worry about it – eventually, the bad days will become the exception, not the rule. Try to take things day by day (even though it’s hard!), and remember that you can have a bad day, or even a bad week, and still be on the right track to recovery.

Parents: If your child is suffering from PCS, be their advocate

Parents, you can make a world of difference in the way you help your child suffering from Post-Concussion Syndrome. You can help manage physical symptoms like headaches and nausea, but you also play a crucial role in helping your child deal with the emotional and social hardship of having an invisible injury. As a parent, you know your child better than anyone and can help fight for them when they can’t do it themselves. Whether it’s working with their school to set up accommodations, not pressuring them to return to sports too soon, or simply believing them when they say they are struggling, your support can make all the difference.

In this PCS Resources video, the Lovett and Bond families share what they learned about concussion advocacy through their children’s experiences with PCS. Also, hear from Concussion Legacy Foundation medical director Dr. Robert Cantu on the role families can play in their child’s concussion recovery.

Find a strategy that helps you manage your symptoms.

Every case of Post-Concussion Syndrome is different, and what works for some won’t work for all. Find something that works for you, and stick to it. Be sure to keep trying new things, even after other strategies don’t work. It’s hard to know what will work until you try! Here are some things that have helped other PCS patients stay on the right track.

Even if it’s graduation day, Ally will have her Concussion Kit with her. Read more about Ally.

Ally is prepared.
Ally from Massachusetts has been suffering from PCS for several years. She makes sure to never leave home without her Concussion Kit – a small bag filled with sunglasses for when things get too bright, ear plugs for when things get too loud, an eye mask in case she needs a nap, and extra note pads to help her remember appointments and other things she’s likely to forget. Read Ally’s story.

Quentin has an escape plan.
Quentin has been suffering from PCS for years, and he’s learned that he needs to have an escape plan to get out of social situations in case his symptoms get too intense. Working out his escape options before entering a situation gives him confidence to not worry about what will happen if his symptoms get worse, and makes for a quick exit so he can regain his composure when he needs to.

Scott is a nap ninja.
Scott from Scarsdale, NY has become an expert at grabbing some z’s when he needs to, especially in the afternoons when his symptoms tend to get worse. Finding a quiet place to lay down during his free periods and making a point to nap when he gets home helps keep his symptoms at bay, and gives him something to look forward to. Read Scott’s story.

Scott, a nap ninja, with Concussion Legacy Foundation CEO Chris Nowinski, PhD. Read more about Scott.

Georgia knows what to expect.
The worst part for Georgia from Boston was not knowing when her symptoms were going to ruin her day, so she started keeping track of when her symptoms would appear and get worse. She realized that some symptoms would come and go no matter what she did, while others could be nipped in the bud with some quiet time. Knowing what to expect helps her be prepared for today, and watching her symptoms gradually improve as time passes keeps her optimistic about tomorrow.

Esther Lovett has a blog chronicling her battle with PCS. Take a look.

Esther changed her game.
Esther suffered a concussion that took her out of school for a year, and out of soccer forever. After a difficult retirement from the sport she loved, she turned to other sports to find another activity that she could focus on. Her new pursuits led to new friends, new opportunities, and a positive new outlook, despite her PCS. Watch Esther’s story or read blog posts from Esther on losing the sport she loved, how you can spread awareness of PCS, what you don’t want to hear while battling PCS, and adapting to daily life with PCS.

Noah Bond and Esther Lovett were the Resilience Award recipients at the 2017 Concussion Legacy Gala.

Noah has a buddy to confide in.
Noah from Hull, GA says that so much goes through your head while you’re living with PCS that it can feel overwhelming. A lot bothers you; you can feel hurt, depressed, not happy, anti-social. But you NEED to have someone you can talk to. Noah found that talking to someone about what is wrong and how he is feeling can help in unexpected, incredible ways. Holding in how you feel can push you to your limit and one day set you over the edge. Talking to someone can often allow the stress to roll off of you. Get a buddy and talk to them often! Watch Noah’s story.

Are there coping strategies that have helped you live better with PCS? Let us know at [email protected]

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This article is not intended as a substitute for the medical advice of doctors and/or healthcare professionals. The reader should consult their physician and/or healthcare providers in matters relating to their health, and in particular, with respect to any concussion and/or symptoms that may require diagnosis or medical attention.

Coping with Post-TBI Anxiety & Stress

“Social engagements became opportunities for embarrassment and ridicule, causing Melissa terrible personal conflicts. She wanted to be out among the crowds, but simultaneously felt vulnerable and frightened by them. Melissa sank into long sulks and quiet withdrawals. The invitations stopped coming and the phone rarely rang,” writes author and TBI case manager Michael Paul Mason about Melissa Felteau who sustained a brain injury in a car crash.

Anxiety can come in many colors and textures following a brain injury. It can bubble up in crowded, noisy places. It can surface when there is too much quiet — when worries seem to snowball and there is no place to hide.

What exactly are anxiety and stress?

Following a life-changing event like a brain injury, it’s normal to feel intense stress. But sometimes stress can build up and lead to anxiety. The main symptoms of anxiety are fear and worry. In turn, anxiety can cause or go hand-in-hand with other problems including:

  • Restlessness
  • Sleeplessness
  • Depression
  • Difficulty concentrating
  • Difficulty completing tasks
  • Difficulty getting along with others

People can express anxiety in both emotional and physical ways — from being inordinately irritable to experiencing shortness of breath or feelings of panic. Anxiety becomes a significant concern when these feelings intensify to a point where they interfere with the tasks of life. Anxiety can also be a symptom or effect of post-traumatic stress disorder.


Like depression, chronic anxiety can cause low self-esteem and poor quality of life, and without treatment, symptoms can last longer or return. Anxiety is usually treated with medication and/or psychotherapy (counseling) by a trained professional. Treatment is usually quite successful, so there is little reason to delay seeking help. Here are a few strategies that people with anxiety after TBI have suggested:

  • Share things that worry you with others.
  • Set up a routine for your day and try to stick with it.
  • Stay involved in life. Find activities that give you pleasure — ones you used to enjoy, or new ones.
  • Be open to the support of others. Healthy relationships with family and friends are healing.
  • Acknowledge your feelings, and then find ways to accept them. There is no shame in feeling anxious or depressed after a life-changing event like brain injury.

Learning from anxiety

Sometimes facing your darkest emotions, like anxiety and depression, can help you better understand yourself. Melissa Felteau started meditating to help combat her own anxiety and depression; she found a new clarity. “That was my biggest problem,” she says. “I realized that I was always comparing myself to my pre-injury self. I was trapped in a vicious cycle of rumination and depression.”

Six years after her injury, through meditation and mindfulness, Melissa was able to shed her anxiety and use what she had learned to help herself — and others.

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