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It’s been weeks, maybe even months, and you’re still dealing with concussion symptoms. The headaches, dizziness, brain fog, and exhaustion just won’t quit. You’ve tried resting, limiting screen time, maybe even avoiding bright lights and loud noises, but nothing seems to help.
If this sounds familiar, you may be experiencing Persistent Concussion Symptoms (PCS)—a condition where concussion symptoms last beyond the expected recovery period. But here’s the good news: PCS is treatable, and recovery is possible with the right approach.
Let’s break down why some concussions take longer to heal and what science says about the best treatments for PCS.
Why Do Some People Take Longer to Recover?
Most people recover from a concussion within 7–10 days, but about 30–40% of cases develop persistent symptoms lasting beyond four weeks [1]. Why does this happen?
Recovery delays often stem from underlying issues that aren’t being treated, including:
Autonomic Nervous System Dysfunction – Your brain’s ability to regulate blood flow and heart rate is disrupted. This can cause symptoms like dizziness, fatigue, and trouble focusing.
Cervical Spine Dysfunction – Neck injuries often occur alongside concussions. If these aren’t addressed, they can mimic concussion symptoms like headaches, dizziness, and balance issues.
Vestibular and Oculomotor Dysfunction – The brain and inner ear work together to keep you balanced and visually focused. After a concussion, these systems may be out of sync, leading to dizziness, nausea, and visual disturbances [2].
Neuroinflammation and Gut-Brain Connection – Inflammation in the brain and gut can drive persistent symptoms, causing brain fog, fatigue, and even mood changes [3].
Mental Health & Psychological Factors – Anxiety, depression, and PTSD are strongly linked to prolonged concussion recovery. Stress and fear of symptoms can make them worse [4].
How to Treat Persistent Concussion Symptoms: The Science-Based Approach.
Old advice: “Rest in a dark room until you feel better.” ❌ New advice: “Start exercising early—but at the right intensity.” ✅
The latest research shows that strict rest makes PCS worse. Instead, early aerobic exercise tailored to your symptom threshold is one of the most effective ways to speed up recovery [5].
How to do it:
Start with a light walk or stationary cycling at 50–60% of max heart rate.
Increase intensity only if symptoms do not worsen.
Use the Buffalo Treadmill Test (if available) to find your ideal heart rate for recovery [6].
Why it works: Exercise restores blood flow to the brain and helps regulate the autonomic nervous system, reducing dizziness, brain fog, and fatigue [7].
2. Treat Your Neck & Spine
Many PCS symptoms aren’t from the brain at all—they come from the neck. A whiplash injury can cause headaches, dizziness, nausea, and even cognitive issues [8].
What helps?
Manual therapy & chiropractic care
Postural correction exercises
Neck-specific rehab
Bottom line: If you’re still dizzy and have headaches, get your neck assessed by a trained professional.
If you feel dizzy in busy environments (e.g., grocery stores), struggle with blurry vision, or feel like your eyes can’t keep up with movement, you may have vestibular or oculomotor dysfunction [9].
Probiotics & prebiotics – gut health supports brain health
Hydration & electrolytes – essential for brain function
Pro Tip: If you have brain fog and fatigue, try eliminating gluten and dairy for 4 weeks—some PCS patients report dramatic symptom improvement.
5. Address Mental Health Factors
Persistent symptoms can cause anxiety, depression, and stress, which in turn, make symptoms worse. Many PCS patients fear they will never recover—but this fear itself can prolong symptoms [12].
Effective strategies:
Cognitive Behavioral Therapy (CBT) – retrain the brain’s fear response to symptoms
Prioritize sleep – melatonin, blue light blocking, and relaxation techniques
Daily movement – walking and social activities boost mood
Reduce stress – deep breathing, mindfulness, gratitude practices
Key takeaway:Mental health and concussion recovery go hand-in-hand. Tackling stress, anxiety, and depression helps improve brain function and symptom resolution [13].
How Long Does PCS Recovery Take?
It depends! Most patients improve significantly with targeted treatment within 6–12 weeks. Some cases may take longer, but with the right approach, nearly all PCS patients recover.
Take Action Now:
Stop waiting for symptoms to go away on their own. Seek treatment early.
Find a concussion-trained healthcare provider (physical therapist, chiropractor, neuro-optometrist, etc.).
Start a guided exercise program—even if symptoms are still present.
Work on nutrition, sleep, and mental health support to optimize recovery.
Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711.
Leddy JJ, Haider MN, Ellis MJ, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatr. 2019;173(4):319-325.
Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 2019;53(4):213-225.
Silverberg ND, Iverson GL. Etiology of the post-concussion syndrome: Physiogenesis and psychogenesis revisited. NeuroRehabilitation. 2011;29(4):317-329.
Leddy JJ, Sandhu H, Sodhi V, et al. Rehabilitation of concussion and post-concussion syndrome. Sports Health. 2012;4(2):147-154.
Leddy JJ, Kozlowski K, Fung M, et al. Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post-concussion syndrome: implications for treatment. NeuroRehabilitation. 2007;22(3):199-205.
Giza CC, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery. 2014;75(Suppl 4):S24-S33.
Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment. Brain Inj. 2015;29(2):238-248.
Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87-93.
Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. 2014;48(17):1294-1298.
Hoffman JR, Maresh CM, Armstrong LE, et al. Effects of a pre-exercise meal on emptying and gastrointestinal blood flow. Med Sci Sports Exerc. 1995;27(3):341-347.
Silverberg ND, Iverson GL. Is rest after concussion “the best medicine?”: recommendations for activity resumption following concussion in athletes, civilians, and military service members. J Head Trauma Rehabil. 2013;28(4):250-259.
Silverberg ND, Iverson GL. Depression after concussion. Sports Health. 2011;3(4):263-266.
Complete Concussions specializes in collaborative, evidence-based concussion care. Our evidence-based training programs and integrated healthcare technologies empower multidisciplinary teams to implement standardized care for those impacted by concussions.
Our network and patient database enables large-scale research to advance concussion management, and ultimately, the long-term health and well-being of concussion patients and also teach them some concussion care at home.
We analyze leading research to develop best-in-class approaches to concussion care.
