Coincident stress may contribute to PCS

WESTBOROUGH, MA September 25, 2016 There are several studies I recently reviewed that suggest the level of stress and perhaps, the coincident stressors in a person’s life may add to the complexity of recovery from concussion.  It should be noted that there is a subset of mTBI cases that develop symptoms that persist for months and are diagnosed with post concussion syndrome (PCS).  Symptoms include chronic headaches, fatigue, body aches, decreased memory, poorly deployed attention and upper body discomfort. It is difficult to predict which patients may go on and develop symptoms that are refractory to recovery.  Now, some believe people who experience life events that are outside the scope of normal experience may be at risk for developing PCS.  It is important to assess the individual’s usual response to stress at other times in their life history.
“A history of migraine headaches may be a predictor of post concussive headaches. Other stressors like divorce, loss, financial problems and others may change the trajectory of recovery.”
Michael Sefton
In the Journal of Neurology, Neurosurgery, and Psychiatry, a 2011 study suggested that pre-incident trauma may confound the recovery from concussion. “Several potentially life-altering stressful events were endorsed by at least 25% of participants as having been experienced prior to injury. The incidence of stressful life events was a significant predictor of all four outcome variables.”
I have started asking about significant life events when taking a history at the start of treatment.  For a long time I attributed the presenting symptoms to the concussion alone.  Obviously every patient has a distinct history that confounds their recovery. A history of migraine headaches may be a predictor of post concussive headaches. Other stressors like divorce, loss, financial problems and others may change the trajectory of recovery.  “A history of stress should be assessed during the early stages after mTBI to help identify those who could benefit from therapies to assist with emotional adjustment and maximize recovery.”

von Vonvelhoven, 2010
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