Persistent post-concussion symptoms (PCS) affect up to 30% of concussion patients and are defined as symptoms lasting more than 10–14 days in adults or 4 weeks in youth (1). These symptoms may include dizziness, headaches, fatigue, neck pain, difficulty concentrating, and light or noise sensitivity — and can significantly impact quality of life if not properly managed.

Fortunately, there are five highly effective, evidence-based treatments for persistent concussion symptoms. Here’s what the research — and over a decade of clinical experience — tells us works.

 

Person running on a treadmill as part of a clinical Buffalo Concussion Treadmill Test for post-concussion treatment.

1. Subthreshold Aerobic Exercise

Subthreshold aerobic exercise improves blood flow, reduces symptom severity, and enhances autonomic function in PCS patients. It is one of the only treatments backed by multiple randomized controlled trials and meta-analyses (2–5).

This form of exercise is done below symptom threshold and guided by tests like the Buffalo Concussion Treadmill Test (6). Within just 1–2 weeks, patients often experience reduced fatigue, dizziness, and cognitive fog (2,7).

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Clinician performing manual neck therapy on a male patient to treat cervical dysfunction related to concussion symptoms.

2. Cervical Spine Therapy

Neck dysfunction is present in approximately 60–80% of PCS cases and may mimic or contribute to symptoms such as headaches, dizziness, and blurred vision (8,9). Manual therapy, neuromuscular re-education, and proprioceptive exercises have been shown to improve cervical-related symptoms (10,11).

Schneider et al. found that cervical spine treatment combined with vestibular rehab reduced recovery time by 50% in patients with persistent symptoms (12).

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3. Diet, Nutrition & Supplementation

Neuroinflammation, oxidative stress, and mitochondrial dysfunction are emerging targets in concussion rehabilitation. An anti-inflammatory, nutrient-dense diet may help reduce ongoing inflammation in the brain (13–15).

Specific nutrients studied for their neuroprotective and anti-inflammatory effects include:

  • Omega-3 fatty acids (DHA/EPA)
  • Creatine
  • Magnesium
  • Vitamin D
  • Curcumin
  • Resveratrol

In animal and human studies, these nutrients have been shown to reduce cell death, support mitochondrial function, and reduce symptom severity post-TBI (15–21).

Hydration, electrolyte balance, and gut-brain axis support also play a role in managing PCS symptoms like fatigue and nausea (22–24).

🎓 Join the Free Patient Webinar to learn how diet impacts recovery and how to reduce chronic neuroinflammation driving headaches, fatigue, and brain fog.

 

Man with closed eyes and glasses in hand, experiencing vision fatigue or motion sensitivity from persistent concussion symptoms.

4. Vision & Vestibular Rehabilitation

Visual and vestibular dysfunctions are highly prevalent in PCS patients and often correlate with symptoms like dizziness, blurred vision, motion sensitivity, and poor concentration (25–28).

Vision therapy may include convergence training, saccades, and smooth pursuit exercises. Vestibular therapy addresses gaze stabilization, balance retraining, and motion desensitization (29–31).

Studies show that when these systems are properly evaluated and treated, patients report significant symptom improvement and faster recovery (28,32).

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5. Education & Reassurance

Patients with persistent symptoms often feel anxious or fearful, which can heighten symptom perception and slow recovery. Research shows that simply providing reassurance and education about the normal recovery trajectory improves outcomes (33–35).

Key messages include:

  • PCS is real but treatable
  • Symptoms are often caused by treatable dysfunctions (not brain damage)
  • Recovery is rarely linear but highly achievable with proper care

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Recovery from persistent concussion symptoms requires a multifactorial and individualized plan. These five treatments — when delivered by a trained concussion provider — offer the best path to symptom resolution and long-term success.

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References
  1. McCrory P, Meeuwisse WH, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam 2022. Br J Sports Med. 2023.
  2. Leddy JJ, Haider MN, Ellis MJ, et al. A randomized controlled trial of subthreshold aerobic exercise for post-concussion syndrome in adolescents. JAMA Pediatr. 2019;173(4):319–325.
  3. Lawrence DW, Hutchison MG, Comper P. Descriptive epidemiology of musculoskeletal injuries and concussions in the National Football League, 2012–2014. Clin J Sport Med. 2016;26(5):369–375.
  4. Willer B, Leddy JJ. Management of concussion and post-concussion syndrome. Curr Sports Med Rep. 2013;12(5):256–262.
  5. Silverberg ND, Iverson GL. Activity-related symptom exacerbations after pediatric concussion. Arch Phys Med Rehabil. 2019;100(6):1130–1143.
  6. Leddy JJ, Kozlowski K, Donnelly JP, et al. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2011;21(2):94–99.
  7. Haider MN, Leddy JJ, Pavlesen S, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. Br J Sports Med. 2021;55(22):1265–1272.
  8. Marshall CM, Vernon H, Leddy JJ, et al. The role of the cervical spine in post-concussive syndrome. J Head Trauma Rehabil. 2015;30(2):E36–E44.
  9. Kennedy JE, Jaffee MS, Leskin GA, et al. Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury. Mil Med. 2007;172(9):952–956.
  10. Snodgrass SJ, Rivett DA, Robertson VJ, et al. Manual therapy treatment and exercise for cervicogenic dizziness: a systematic review. Musculoskelet Sci Pract. 2021;53:102396.
  11. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. J Orthop Sports Phys Ther. 2017;47(7):492–502.
  12. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med. 2014;48(2):129–133.
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  14. Oliver JM, Jones MT, Kirk KM, et al. Effect of omega-3 fatty acids on markers of inflammation in young adults following concussion: a randomized controlled trial. J Int Soc Sports Nutr. 2016;13:22.
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  22. Costanzo M, Russo R, Finicelli M, et al. Inflammation and brain injury: the role of the microbiota-gut-brain axis. Neurotherapeutics. 2021;18(4):2228–2240.
  23. Gill J, Motamedi V, Osier ND, et al. Biomarker responses following sports-related concussion in collegiate athletes. Neurotrauma Rep. 2020;1(1):20–31.
  24. Torres-Rosas R, Yehia G, Peña G, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Science. 2014;345(6197):1138–1142.
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