Navigating Delayed Concussion Symptoms: Understanding, Diagnosing and Treating Post-Concussion Syndrome (PCS)

Each year, an estimated 1.5 million Americans survive a traumatic brain injury. However, not all concussion symptoms appear right away. Delayed concussion symptoms, or post-concussion syndrome, can emerge weeks, months or even years after the initial injury.

Living with PCS can be challenging, but recovery is possible, even long after a brain injury. If you or your loved one believes they have post-concussion syndrome, the Aviv Clinics team is here to help. We help individuals navigate delayed concussion symptoms with personalized, evidence-based programs designed to restore brain health and quality of life.

Understanding Post-Concussion Syndrome

At one time, a mild traumatic brain injury (mTBI), which many know simply as a concussion, was thought to be a benign event. Research now shows that even minor injuries to the brain can have significant effects, especially with multiple traumatic incidents. These injuries can contribute to adverse neuropsychological outcomes, both acutely and long-term.

For most patients, concussion symptoms alleviate within about two weeks. When concussion symptoms last or continue to develop over a much longer period, these persistent post-concussive symptoms are known as post-concussion syndrome.

What Is Post-Concussion Syndrome (PCS)?

Post-concussion syndrome (PCS) is a condition where concussion symptoms continue beyond the expected recovery period, often months or even years. PCS occurs from traumatic brain injury (TBI), a blow or jolt to the head from accidents such as falls, car accidents, and sports injuries. Even a whiplash injury can cause damage to delicate brain tissue. Mild to severe cases of TBI can lead to PCS. 

Symptoms of post-concussion syndrome include a variety of physical, cognitive, emotional, and sleep indicators, such as: 

• Headaches that won’t go away
• Feeling more exhausted or fatigued than usual
• Having trouble concentrating and remembering
• Having difficulty falling or staying asleep

Even injuries that seemed minor at the time can trigger long-term changes in cognition, sleep, or emotional health.

It is possible to have a traumatic brain injury and not know it. There are over 2.8 million people who sustain a TBI each year in the United States. When a TBI isn’t treated properly or the recovery isn’t complete, post–concussion syndrome can manifest.

Why Concussion Symptoms Can Be Delayed

When someone experiences a traumatic brain injury, this blow or jolt to the head makes the brain rattle within the skull. Not only can this create bruising or bleeding within the brain, it can cause shear force trauma to connective blood vessels and cells. This sudden movement can:

• Disrupt blood flow to specific brain regions
• Trigger chemical changes in the brain
• Stretch and damage brain cells

These activities put stress on your brain and prevent it from functioning normally.

Delayed concussion symptoms can occur for several reasons. When someone experiences a traumatic brain injury (TBI), this causes physical, metabolic, and chemical changes to the brain. Even if you feel okay and only experience mild effects after a concussion, this can change later. 

Here’s why. 

The brain has pathways. Think of these as different routes you may take to work. Some roads have more traffic than others. Sometimes, because of an accident, blockage, or road closure, you have to take the long way to get home. Brain pathways work the same way. 

Let’s say you suffer a head injury. Some brain pathways become damaged and can’t deliver the supply of blood and oxygen the brain needs. Fortunately, other pathways and cells can take over to do the job, but they now have to travel a longer route. These previously healthy brain pathways then have to overcompensate, over time, for the injured or damaged pathways. Your brain grows tired of the extra effort, and delayed concussion symptoms emerge. The evolution of concussion symptoms over time emphasizes the importance of ongoing monitoring and seeking adequate treatment. 

While some symptoms surface immediately after a head injury, delayed concussion symptoms are possible due to the complex way the brain responds to trauma. The severity of the injury and the specific areas of the brain affected can influence both the type of symptoms and their timing.

Although there isn’t a quick test for PCS, there is ample research and understanding to help explain the signs and symptoms. A clinical evaluation is warranted for symptoms that linger past the typical timeframe for recovery.

Symptoms of Delayed Concussion

Delayed PCS symptoms can be divided into four categories:

1. Physical Symptoms of PCS

Physical PCS symptoms are the most commonly recognized signs. Individuals with PCS may experience debilitating pain and discomfort, such as:

• Headaches
• Dizziness
• Nausea
• Vomiting
• Trouble balancing
• Vision problems

2. Cognitive Symptoms of PCS

Cognitive issues are often the PCS symptoms that compel patients to seek medical advice. These cognitive post-concussion symptoms include:

• Feeling mentally foggy
• Feeling slowed down
• Having difficulty concentrating
• Having trouble remembering
• Being forgetful of recent information and conversations
• Experiencing confusion about recent events
• Answering questions or reacting slowly

3. Psychological and Emotional Symptoms of PCS

Psychological and emotional symptoms can often be difficult to identify and associate with head injuries. Many people tend to overlook these emotional changes when, in reality, these changes can be a manifestation of physical trauma to the brain. These psychological/emotional changes include:

• Irritability
• Sadness or depression
• Nervousness or anxiety
• More emotional in general or mood swings

4. Sleep-Related Symptoms of PCS

Last but not least, PCS symptoms can manifest in sleeping patterns. For example, those with PCS may:

• Feel drowsier than normal
• Sleep more than usual
• Sleep less than usual
• Have trouble falling asleep

The location of the damaged tissue in the brain also plays a relevant role in the type of PCS symptoms that develop.

For example, when head trauma inflicts damage to the frontal lobe of your brain, the area that manages emotional expression, focus, attention, and memory, this may stimulate emotional/behavioral changes, including “impaired basic and social emotion processing” and cognitive shifts.

While individuals may initially feel relatively normal immediately after a head injury, symptoms can evolve in unexpected ways and even become more pronounced over time. Experiencing delayed concussion symptoms may signal that changes in the brain triggered by the injury took time to fully manifest noticeable effects. 

Diagnosing Post-Concussion Syndrome

Diagnosing post-concussion syndrome involves a comprehensive assessment that examines multiple factors to get a clear picture of the patient’s experience. Obtaining a PCS diagnosis can be complex. Post-concussion syndrome symptoms and severity can vary daily, making the experience sometimes confusing. If you feel anything is off, we recommend reaching out to the experienced team of physicians at Aviv Clinics. 

To diagnose PCS, your doctor will likely carry out a series of exams. These tests may entail: 

• Discussing your health and concussion history
• Conducting a physical examination 
• Advanced MRI that maps out specific parts of your brain 
• SPECT scan that points out blood flow in negatively affected brain areas
• Neurocognitive testing that examines your motor, verbal, and memory skills
• Neurological exams that may involve using lights and reflex hammers to assess your nervous system

It’s important to note that post-concussion syndrome is often a diagnosis of exclusion, meaning physicians must rule out other potential causes of PCS symptoms. The diagnosis can also evolve as symptoms persist or change.  A thorough evaluation ensures delayed concussion symptoms are properly identified and addressed.

Treatment Options for Delayed Concussion Symptoms

The good news is that various treatments are available to help mitigate your PCS symptoms. 

Some facilities depend primarily on cognitive behavioral therapies, which have shown strong results in improving sleep for those suffering from PCS. Others may focus on vestibular therapies for improved balance, psychological interventions for symptoms like depression or anxiety, or neuro-optical therapy for blurred or double vision. 

However, in most cases, these treatments only address the symptoms of post-concussion syndrome and not the underlying cause. 

Take time to learn more about your treatment options for post–concussion syndrome. Here are treatment options you may consider if you’ve experienced any type of brain trauma. Each method holds unique strengths that may target the specific symptoms you are experiencing.

Vision Therapy

Vision therapy involves a variety of techniques that train your visual system. Those who may benefit from this are people who experience eye pain, vision problems, dizziness, and headaches.

Clinical studies in patients with post-concussion vision issues show that “the vast majority of cases” notice improvement after participating in vision therapy.

Neuro-Optometric Rehabilitation (NOR)

Neuro-optometric rehabilitation (NOR) therapy uses therapeutic prisms, lenses, and filters to stimulate parts of the brain that are not functioning properly. Those suffering from visual injuries and complications may find relief through NOR.

There is growing evidence NOR can enhance “visual skills and reduce visual symptoms” in patients with post-concussion syndrome.

Physical Therapy (PT)

Physical therapy (PT) is a form of care that aims to ease pain and help you move and live better. This may include massage, range of motion stretching, exercises, and heat treatments.

PT may “facilitate recovery and improve function” for those who struggle with physical symptoms of PCS. One small study where participants averaged 7 PT sessions reported that their physical symptoms became more manageable after treatment.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a psychological treatment that addresses problems such as depression and anxiety. CBT generally strives to change thinking and behavioral patterns. Studies indicate CBT may be an effective treatment method for “improving depression, anxiety, and social integration” in those with TBI.

Neuropsychology

Neuropsychology is a subset of psychology that focuses on how the brain and nervous system influence your thoughts and behaviors. It takes an educational approach, teaching patients about their minds and engaging in unique exercises.

Neuropsychology may be ideal for those with memory and concentration issues, as well as anxiety and depression. Research notes neuropsychology may play a vital role in helping better understand the link between the area of injury in the brain and their PCS condition and the “severity of concussion and who develops” the syndrome. 

Aviv Clinics’ Approach to Delayed Concussion Symptoms

At Aviv Clinics, treatment goes beyond symptom management. The Aviv Medical Program combines advanced assessments with personalized therapies, including a specialized hyperbaric oxygen therapy (HBOT) protocol, to stimulate long-term brain recovery.

HBOT is a medical treatment that increases oxygen levels in the brain and body. Patients breathe oxygen while in a pressurized special chamber. The combination of oxygen and pressure allows the blood to absorb more oxygen and deliver it to tissues.

HBOT at Aviv Clinics employs a specialized HBOT protocol used in successful clinical trials and differs from the process of “traditional” hyperbaric oxygen therapy. In this evidence-based protocol:

• Patients are treated inside a large hyperbaric oxygen suite designed for comfort and safety, and receive treatment for two hours.
• With a medical professional inside the HBOT suite, the air is pressurized higher than normal air levels, allowing 10-15 times more oxygen to be absorbed in the body
• While the suite is pressurized with air, patients breathe 100% pure oxygen via a specialized mask.
• Patients keep the oxygen mask on for 20 minutes and then spend five minutes with the oxygen mask off to fluctuate oxygen levels and encourage the body to release its natural healing mechanisms
• The process is repeated five days per week for up to 12 weeks, depending on the recommended treatment plan.

Studies illustrate that HBOT delivered in this particular, unique protocol “can induce neuroplasticity”—the ability of the brain to modify and adapt based on environmental interactions—essentially rewiring itself, which may:

• Repair chronically damaged brain functions and tissues
• Improve the overall quality of life for patients with PCS

Additional research shows HBOT can significantly improve “memory, executive functions, information processing speed, and global cognitive scores.”

Research over the last two decades notes that this specific hyperbaric oxygen therapy (HBOT) protocol, in combination with cognitive, physiological, and nutritional training, can lead to significant neurological improvement after a concussion. The Aviv Medical Program is based on this research. 

Personalized, Evidence-Based Care for PCS

Many people go to multiple doctors before getting their post-concussion syndrome diagnosis. Due to the complexity of treating PCS, far too many patients receive minimally effective treatments. The results? Often, short-term fixes that don’t provide what you need.

If you’re looking for PCS relief, the Aviv Medical Program may be your answer.

With the Aviv Medical Program, our team of diverse clinical professionals (medical, cognitive, physical, and nutritional specialties) will perform advanced testing to identify the impact of your brain injury and craft a customized, long-term treatment plan.

• Our program features a group of certified medical professionals focused on your recovery. They will track data on your health and offer individualized solutions to elevate your quality of life. 
• Treatment may include a combination of therapies, including specialized HBOT, cognitive exercises, physical training, and dietary coaching. The specialized HBOT protocol used at Aviv Clinics can yield multiple positive shifts in the brain, such as new blood vessel formation and stem cell proliferation and differentiation. 

Multidisciplinary Treatment for Late-Onset Concussion Symptoms

The Aviv Medical Program takes a holistic approach that encompasses several of the areas we discussed above. We leverage the expertise of a diverse team of medical professionals based on your health assessment.

Aviv Clinics takes a three-step approach:

1. Medical assessment: We start with a health assessment as recommended by our board-certified physicians. This assessment may include cognitive testing, physiological assessments, and medical exams, as well as advanced brain imaging exams (MRI, SPECT, etc.). The goal is to attain an accurate understanding of your individual mind and body.
2. Tailored treatment program: The Aviv medical team will craft a personalized treatment program based on the results of your medical assessments. In addition to the Aviv HBOT protocol, your program may entail cognitive and physical training, physical therapy, or a nutritional regimen. The goal is to maximize your body’s healing process.
3. Post-treatment assessment: At your request, the Aviv clinical team can repeat the tests performed in your pre-assessment to measure your progress and make relevant recommendations for ongoing improvement.

The benefits of our program can include improved:

• Cognitive and motor functioning
• Physical performance (fitness, strength, coordination, balance)
• Immune system
• Stem cell proliferation (the building blocks of tissue rejuvenation)

At Aviv Clinics, our multidisciplinary medical team of physicians, neuropsychologists, physiologists, physical therapists, nutrition specialists, and other clinical experts ensures you receive the thorough medical treatment you deserve.

What Is HBOT’s Role in Relieving TBI Symptoms?

Dedicated research into brain healing reveals a therapy that has produced positive results in cases of TBI and post-concussion syndrome. Hyperbaric oxygen therapy (HBOT) has historically been accepted as an effective treatment for medical issues like wound healing, severe burns, and decompression sickness. 

However, research in the last two decades reveals that HBOT, can repair areas of the brain that have been damaged due to TBI and concussion, as well as stroke, post-traumatic stress disorder, fibromyalgia, Lyme disease, and other neurological conditions.

What Results Can Individuals Expect?

To understand how studies show HBOT works as a treatment tool intended to address TBI and post-concussion damage, it’s important to know what changes occur in the brain during those injuries. Structural damage indicates a physical impact on the brain, such as bleeding. Metabolic damage is present when the brain’s cells are affected.

Traditional scans like CT and MRI may not be able to detect metabolic damage, especially if an injury occurred years ago. More advanced scans, like functional MRI and SPECT, are better able to identify areas of the brain that may be producing chronic post-concussion symptoms.

Research shows that  HBOT and the nutritional, cognitive, and physiological therapies that can be included in the Aviv Medical Program may yield multiple changes in the brain:

• New blood vessel formation (angiogenesis)
• New and stronger neural connections
• Stem cell proliferation and differentiation 

These neural, vascular, and cellular changes contribute to cognitive improvements in memory, executive function, attention, processing speed, and spatial memory. Individuals with brain-based motor skill challenges also benefit from this comprehensive therapy.

“HBOT can be successful because it addresses the cause of the symptoms, not just the symptoms alone. In combination with cognitive, physical, and nutritional coaching, some HBOT protocols can be very effective.” —Dr. Mohammed Elamir, MD, FACP

The physiological and nutritional aspects of the customized Aviv Medical Program elicit enhancements such as greater aerobic fitness, higher energy levels, improved sleep, and reduced pain. Overall, individuals report a significant improvement in their quality of life after completing the program.

For more research insights, explore the data and studies conducted by The Sagol Center, the world’s largest hyperbaric research and treatment facility.

Finding Relief From Delayed Concussion Symptoms

It’s easy to feel alone when living through PCS. Hope is here at Aviv Clinics. See how our team of certified medical professionals has helped a variety of individuals with unique health backgrounds get back to optimal health. 

Here are two PCS patients who have leveraged Aviv Clinics’ comprehensive treatment program. Both received access to our multidisciplinary team of healthcare specialists and in-depth assessments: 

Linden Perry: At just 15 years old, Linden suffered concussions from playing basketball and soccer. Her lingering PCS symptoms left her with balance issues, nausea, headaches, and blurred vision. Upon her customized treatment plan at Aviv Clinics, Linden returned to where she had started, academically and athletically.

Rodger Penley: Rodger suffered a severe head injury after falling backward and hitting his head. He suffered from persistent and intense headaches and couldn’t walk without any support. After joining the Aviv Medical Program, his headaches rapidly reduced in number. By the conclusion of the program, Rodger fully restored his autonomy and independence.

 

Before you pursue any treatment plan, keep three things in mind:

• Speak with a physician first about your symptoms and health history. This can help them gain a comprehensive assessment and provide a personalized treatment plan.

You can speak to an Aviv Clinics physician at the clinic or over a virtual meeting for free.

• Be patient. Finding the right combination of therapies that work for you may take some time, but don’t give up. With the right medical program, you can receive the holistic treatment you deserve and find some relief.
• TBI and concussion can affect everyone of all ages. Thus, there is no standard/solid timeline for recovery. It may take several weeks or more to see improvement.

Aviv’s clinical team helps individuals of all ages and backgrounds win lasting health—the foundation of a good life. Our unique protocol has proven to give patients the vitality, health, and confidence they need to move forward.

Feel Your Best with Aviv Clinics

Post-concussion syndrome is a common complication during concussion recovery. Most individuals with PCS can recover even years after their accident, but finding a comprehensive treatment plan can be challenging. We’re here to get you on the right path.

If you or a loved one is experiencing delayed concussion symptoms, the first step is a thorough evaluation by a physician. Aviv Clinics offers complimentary physician consultations that can be conducted either in our clinic or virtually.  With a tailored, multidisciplinary approach, even long-standing post-concussion symptoms can be addressed, helping you rclaim cognitive, physical, and emotional health.

Click the button below to contact Aviv Clinics. We’ll put you in touch with our certified team of physicians who can help craft a customized plan to aid in your healing process. Focused on service, safety, and comfort, Aviv Clinics is your first stop in getting back to optimal health and back to life.

 

Last Update: September 23, 2025