Post-Concussion Syndrome (PCS), Mild Traumatic Brain Injury (mTBI), Whiplash and Second Impact Syndrome (SIS).

Concussion & TBI

Concussion / Traumatic Brain Injury (TBI)

A video by Nucleus Medical Media, Explaining what happens in the brain when you have a head injury.

Even Mild Head Injuries:

There is more and more evidence accumulating that even mild head injuries can have serious consequences. Furthermore, you do not even need to lose consciousness or lacerate the skull to experience the cognitive difficulties associated with post-concussion syndrome, such as memory loss and attention problems, impulsivity, mood disorders and headaches.

In fact, it is not even necessary to have a physical blow to the head. In sudden deceleration from 20 miles an hour to zero such as in sudden falls or car accidents, the brain can suffer from a “shock wave”, much like the bomb blasts soldiers can experience. The shock wave sends the brain bouncing and jolting within the skull. The brain cells react by taking up more sodium from the extra-cellular fluid. This immediately shuts down the electrical signalling that makes brainwaves, so it’s lights out for the affected person.

Given that many of us will have bumped our head, often several times, it is quite possible that many of the problems people experience in everyday life, can be attributed to or exacerbated by a forgotten head injury. It is not uncommon for us to find a Child's difficulty at school, such as ADHD or depression can be traced back to what appeared to be a quite minor head injury in the past.

However, there is good news, the brain is “plastic”, this means it can change and with the right therapeutic interventions it can be possible to recover much of the previous function after a head injury.

A quantitative Electroencephalography (qEEG) and Event Related Potential (ERP), “Brain Map” assessment can help to identify the brain regions and networks that are associated with these symptoms and that have been compromised by a head injury. The Brain Map can also help to identify appropriate therapeutic options such as neurofeedback or transcranial direct current stimulation. By recording a standard assessment procedure and comparing this to the data of over 1000 people who have not had a head injury, it is possible to identify brain regions and networks that are either under or over activated.

For example, commonly in closed head injuries the area that was damaged produces more of the slow Delta and Theta brain wave activity, which indicates that this area is under activated. However, often at the same time there is an increase in beta activity around the damaged area, indicating an overactivation of these areas, as an attempt to compensate for the damaged area. Thus, any therapy that attempted to reduce the beta activity, on the grounds that it was “statistically deviant” without addressing the Theta activity, would probably make symptoms worse.

Therefore, the challenge is to identify the most appropriate therapeutic intervention. However, basing this decision solely on a list of symptoms can be problematic. For example, if a person has an attention problem, is this because of the head injury, or because they have a very stressful life, or they have undiagnosed ADHD that was exacerbated by the head injury. Merely identifying that someone has an attention problem, would not help to unpick these questions. However, the underlying brain functions could look quite different and the most appropriate therapy could be very different.

Scientific Literature

In a review of the scientific literature by Dr Jacques Duff (Duff, J. (2004). The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clinical EEG and Neuroscience, 35(4), 198-209) concluded that the research:

“attest to the high reliability and discriminant validity of QEEG discriminant functions in revealing patterns consistent with mTBI or post-concussion syndrome.”


“These studies lend support to the use of QEEG as an objective assessment to evaluate whether there is an organic basis to the symptoms reported by sufferers of post-concussion syndrome who are often dismissed as malingerers or as suffering from psychological, personality or somatization disorders.”

Weinstein, Et al. (2013)

Second Impact Syndrome (SIS)

Furthermore, newer research is showing the danger of receiving a second head injury in the hours and days following the first injury. This is known as ‘Second impact syndrome’ (SIS). If the first injury has shut down the brain waves sufficiently, the second injury can cause brain bleeding and swelling much more than it would normally, if it had been a first-time impact, and in nearly 50% of cases it can be fatal. (Richard Roberts “Impact on the Brain”, Scientific American – Mind. December 2018)

The conventional way to identify if a blow to the head or a sudden deceleration has caused a dangerous complication like bleeding in the brain, was to watch the individual for any signs of speech or motor coordination problems in the minutes and hours after the injury. So, all sports coaches and even parents of kids who ride bikes around furiously, must be aware of the dangers and look for the signs such as feeling dizzy, losing balance, poor coordination, headache, nausea, blurred vision or hearing, sensitivity to noise and light. The most worrying symptom is the fact that the person has had a prior head injury, even as far back as months before.

However, a few days after the head injury, when these extreme symptoms have passed, people can be left with a plethora of nonspecific issues that are often misattributed to other conditions such as ADHD, sleep disorders, depression or even malingering.

Nowadays with a non-invasive qEEG/ERP assessment, it is possible to identify past head injuries with a high degree of accuracy (Thornton, K. E. (1999). Exploratory investigation into mild brain injury and discriminant analysis with high frequency bands (32-64 Hz). Brain Injury, 13(7), 477-488), and identify the brain regions and networks that need improvement.

Dr Daniel Amen

Dr Daniel Amen has some very interesting videos including a Ted talk

“The most important lesson from 83,000 brain scans” and “Concussions & Pro Football: 1 Team Wins, All Players Lose”.

Amen Clinics Website

Dr Daniel Amen

Concussions & Pro Football: 1 Team Wins, All Players Lose

Dr. Mushtagh, ND

Talks about self-healing and the connection between head injuries and ADHD.

IMH Concussion Clinic


Duff, J., The usefulness of Quantitative EEG (QEEG) and Neurotherapy in the Assessment, and Treatment of Post-Concussion Syndrome. Clinical EEG and Neuroscience, 2004. 35(4): p. 1-12. Paper.

Voller, B., et al., Neuropsychological, MRI and EEG findings after very mild traumatic brain injury. Brain Inj, 1999. 13(10): p. 821-7. Paper.

Thatcher, R.W., et al., Biophysical Linkage between MRI and EEG Amplitude in Closed Head Injury. Neuroimage, 1998. 7(4): p. 352-367. Papers.

Thatcher, R.W., et al., Biophysical linkage between MRI and EEG coherence in closed head injury. Neuroimage, 1998. 8(4): p. 307-26. Paper.

Thatcher, R.W., et al., EEG discriminant analyses of mild head trauma. Electroencephalogr Clin Neurophysiol, 1989. 73(2): p. 94-106. Paper.

Thatcher, R.W., et al., QEEG and traumatic brain injury: rebuttal of the American Academy of Neurology 1997 report by the EEG and Clinical Neuroscience Society. Clin Electroencephalogr, 1999. 30(3): p. 94-8. Paper.

Sterman, M.B., Sensorimotor EEG operant conditioning: Experimental and clinical effects. Pavlovian Journal of Biological Science, 1977. 12(2): p. 63-92.

Sterman, M.B., EEG biofeedback: physiological behavior modification. Neurosci Biobehav Rev, 1981. 5(3): p. 405-12. Paper.

Thatcher, R.W., EEG operant conditioning (biofeedback) and traumatic brain injury. Clin Electroencephalography, 2000. 31(1): p. 38-44. 

Concussion in General
Hugenholtz, H., et al., How long does it take to recover from a mild concussion? Neurosurgery, 1988. 22(5): p. 853-8.

Slagle, D.A., Psychiatric disorders following closed head injury: an overview of biopsychosocial factors in their etiology and management. The International Journal of Psychiatry in Medicine20(1), 1-35.

Fann, J.R., et al., Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. Am J Psychiatry, 1995. 152(10): p. 1493-9. Paper.

Max, J.E., B.A. Robertson, and A.E. Lansing, The phenomenology of personality change due to traumatic brain injury in children and adolescents. J Neuropsychiatry Clin Neurosci, 2001. 13(2): p. 161-70. Paper.

Weinstein, E., Turner, M., Kuzma, B. B., & Feuer, H. (2013). Second impact syndrome in football: new imaging and insights into a rare and devastating condition: case report. Journal of Neurosurgery: Pediatrics, 11(3), 331-334. Paper.