Still not feeling right after concussion?
Headache, dizziness, brain fog, fatigue, visual symptoms or exercise intolerance can continue well beyond the first few weeks after a concussion.
When recovery stalls, simply waiting longer is not always the most useful next step. Persistent symptoms need a fresh assessment to work out which systems are still limiting you and what can be targeted in rehabilitation.
Persistent symptoms are not one single problem.
Current Australian and Aotearoa New Zealand concussion guidelines use the term persisting symptoms when symptoms continue beyond four weeks after concussion.
The older terms post-concussion syndrome and persistent post-concussion symptoms are still commonly used, but the important point is that ongoing symptoms are often influenced by several overlapping factors rather than one simple cause.
Headache, dizziness, poor sleep, fatigue, cognitive difficulty, neck pain, visual problems, mood changes and exercise intolerance can occur after concussion, but they can also overlap with other conditions.
That is why assessment should focus on the symptoms and impairments that are actually present.
Instead of asking “Why am I still concussed?” we ask “What is still limiting recovery?”
That change in focus allows rehabilitation to be directed at the headache, neck, vestibular system, vision, exercise tolerance, sleep, cognition, mood or other factors that are relevant to you.
Recovery can get stuck in very different ways.
Some people have one dominant symptom. Others experience several symptoms that interact with each other and make work, school, exercise or everyday life difficult.
Headache + neck pain
Persistent headache, migraine-like symptoms, pressure, upper neck pain or headache aggravated by movement or sustained posture.
Dizziness + balance
Unsteadiness, motion sensitivity, nausea, vertigo or difficulty tolerating busy environments.
Vision + eye movement
Blurred vision, eye strain, difficulty reading, sensitivity to screens or symptoms triggered by visual motion.
Brain fog + cognition
Slowed thinking, reduced concentration, memory difficulty, trouble multitasking or becoming overwhelmed by cognitive load.
Fatigue + sleep
Low energy, poor sleep quality, increased sleep need, difficulty falling asleep or fatigue that builds through the day.
Exercise intolerance
Headache, dizziness, fatigue or other symptoms returning as heart rate and physical activity increase.
Ongoing symptoms can have several contributors.
Persistent concussion care should look for the physical, cognitive and psychological factors that may be prolonging symptoms rather than treating everyone with the same approach.
Headache + migraine
Post-traumatic headache can resemble migraine and may be influenced by sleep, activity, sensory load and other headache factors.
Cervical spine
Neck injury can occur alongside concussion and may contribute to headache, neck pain, dizziness or difficulty tolerating movement.
Vestibular system
Vestibular dysfunction may contribute to dizziness, motion sensitivity, imbalance and symptoms in visually busy environments.
Oculomotor + visual function
Problems with eye movement control or visual tolerance can make reading, screens, driving and school or work tasks difficult.
Exercise + autonomic function
Some people develop symptoms as physical load increases and may need structured assessment of exercise tolerance and cardiovascular response.
Sleep, mood + cognitive load
Sleep disturbance, fatigue, anxiety, low mood, attention difficulties and stress can interact with physical symptoms and slow functional recovery.
We reassess the whole picture.
If symptoms have continued for several weeks, it is worth looking beyond the original diagnosis and reassessing the areas that remain symptomatic.
Your assessment is guided by your main symptoms, how they are affecting your day and the activities that continue to provoke them.
- Detailed injury and recovery history
- Current symptom pattern and symptom triggers
- Headache and cervical spine assessment
- Balance and postural control
- Vestibular and ocular motor assessment, including VOMS where appropriate
- Cognitive screening where relevant
- Sway Medical objective measures where appropriate
- Exercise tolerance assessment and Buffalo Concussion Treadmill Test when indicated
- Review of school, work and daily activity tolerance
- Sleep, fatigue, mood and other factors that may be influencing recovery
Persistent symptoms are often multi-factorial. Not every test is required for every person, and some assessments may be completed over more than one appointment.
Rehab should match what the assessment finds.
There is no single treatment for persistent post-concussion symptoms. The most useful approach is usually symptom-based and may involve several parts working together.
Graded aerobic exercise
Where exercise intolerance is present, sub-symptom aerobic exercise can be prescribed and progressed using your individual tolerance rather than avoiding exertion indefinitely.
Vestibular rehabilitation
Dizziness, balance problems and motion sensitivity may respond to exercises targeting gaze stability, balance, head movement tolerance and habituation.
Visual + oculomotor rehab
Where visual symptoms are identified, rehabilitation may target eye movement control, visual tolerance and the demands of reading, screens or busy environments.
Headache + cervical care
If headache or neck findings are clinically relevant, treatment may include cervical rehabilitation, manual therapy and headache management alongside the broader concussion plan.
Work, school + cognitive load
We can help structure a gradual increase in cognitive demands, screens, study, meetings, physical duties and normal daily activity.
Sleep, mood + coordinated care
When sleep, anxiety, low mood, trauma, cognitive difficulty or other medical issues are significant, coordinated care with your GP and other appropriate practitioners becomes part of the plan.
The goal is usually not to wait until every symptom disappears.
Current concussion guidance supports a gradual return to cognitive and low-risk physical activity rather than prolonged strict rest.
With persistent symptoms, activity may need to progress more slowly, particularly if symptom increases are more than mild or take a long time to settle.
A useful rehabilitation question
What can you tolerate now, what reliably triggers symptoms, and how can we gradually expand that capacity?
Mild and temporary symptom increases can occur during rehabilitation. The aim is controlled progression rather than repeated large flare-ups.
Persistent symptoms sometimes need more than one clinician.
When recovery is slow, we work within your broader healthcare team rather than trying to manage every problem in isolation.
Choose the pathway that best matches the problem.
Headache is the main issue
Explore headache patterns and whether migraine or cervical factors may be relevant.
Headache After Concussion →Work is difficult
Build hours, cognitive demand, screens and physical duties back gradually.
Return To Work →School is difficult
Structure a gradual return to learning before higher-risk sporting activity.
Return To School →Sport is the goal
Progress exercise, training and eventual contact through a structured return pathway.
Return To Sport →The first step is working out what still needs attention.
60-minute consultation
Structured assessment of your persistent symptoms, relevant clinical and objective testing, and an individualised plan for rehabilitation and return to activity.
Book Your AssessmentVirtual concussion consultations are available.
We can review your history, symptoms, activity tolerance and current management by video, then help identify what can be managed remotely and what requires local or in-person assessment.
Virtual Concussion AssessmentPersistent concussion symptoms FAQs
How long before symptoms are considered persistent?
Current Australian and Aotearoa New Zealand guidelines describe symptoms continuing beyond four weeks after concussion as persisting symptoms. Recovery time varies considerably, so the focus should be on the individual's symptoms, function and progress rather than a deadline alone.
Do persistent symptoms mean my brain is permanently damaged?
No. Persistent symptoms do not by themselves demonstrate ongoing structural brain damage. Symptoms after concussion are non-specific and may reflect several overlapping physical, cognitive, psychological or medical factors.
My MRI or CT was normal. Can I still have symptoms?
Yes. Concussion is primarily a clinical diagnosis and routine structural imaging is often normal. CT and MRI are generally used when clinicians are concerned about other structural injury rather than to measure concussion recovery itself.
Should I keep resting until every symptom is gone?
Prolonged strict rest is not recommended. Current guidance supports gradual return to cognitive and low-risk physical activity. For persistent symptoms, progression may need to be slower and tailored to your symptom threshold.
Can exercise help persistent post-concussion symptoms?
For some people, yes. When exercise intolerance is identified, graded sub-symptom aerobic exercise may form part of rehabilitation. Exercise should be prescribed according to the individual's presentation rather than using the same intensity for everyone.
Can you help if dizziness is my main problem?
Yes. Persistent dizziness may involve vestibular, visual, cervical or other factors. Assessment helps determine which system appears most relevant and whether vestibular or visual rehabilitation, cervical management or referral for another diagnosis is appropriate.
Can you help with headache after concussion?
Yes. Post-traumatic headache can have different patterns, including migraine-like presentations and headaches with a cervical component. The headache is assessed as part of the broader concussion picture so management can be matched to the findings.
What if psychological or cognitive symptoms are a big part of my recovery?
Mood, anxiety, sleep, attention and cognitive difficulties are important parts of persistent concussion care. Where these issues require treatment outside our scope, we work with your GP and can recommend appropriate psychology, neuropsychology, occupational therapy or specialist input.
New or worsening symptoms need medical review.
Seek urgent medical care for a severe or rapidly worsening headache, repeated vomiting, seizure, increasing confusion, weakness or numbness, new double vision, difficulty waking or other significant neurological deterioration.
Persistent symptoms can also overlap with conditions unrelated to concussion. New, progressive or unusual symptoms should be reassessed rather than automatically attributed to the original head injury.
Recovery has stalled. That does not mean there is nothing left to do.
We assess the symptoms and systems that are still limiting you, explain what we find and build the next stage of rehabilitation around your life.
95 Douglas Parade, Williamstown VIC 3016