Understanding Post Concussion Symptoms: Concussion Clinical Trajectories

No two concussions are the same and each individual experiences different symptoms in their clinical recovery from a concussion. 

Concussions fall into six clinical trajectories each with specific symptoms and each trajectory demands specific treatment intervention to bring resolution to the symptoms.

The first week post concussion many of these symptoms are present in most individuals recovering from a concussion and typically most individuals will recover within the first 14 days while being closely monitored by a healthcare provider who has completed specialized training in the assessment and management of concussion.  10-20 percent of individuals do not fully recover in the first 14 days following their injury and their treatment must be specifically tailored to the needs of the individual and their clinical trajectory presentation. 

The concussion clinical trajectories often do not occur in isolation and often there is overlap with individuals suffering from symptoms in multiple clinical trajectories.

The 6 Clinical Trajectories are:

  • Anxiety/Mood

  • Vestibular

  • Post Traumatic Migraine/Headache

  • Ocular-Motor

  • Cognitive

  • Cervical

The Anxiety/Mood Trajectory often presents with persistent emotional and mood changes. This is commonly seen in individuals who have a history of being high-functioning performers and students. This trajectory often presents in females and their return to activity must be closely balanced with their symptoms. These individuals often have trouble turning their thoughts off, worry excessively and may become anxious.

The Vestibular Trajectory often presents with problems with balance and motion. Individuals with this clinical trajectory often experience motion sickness, dizziness, fogginess, feeling detached, nausea, difficulty in busy environments, anxiety, increased emotional intolerance to over-stimulating busy environments, difficulty focusing, fatigue, blurred vision and impaired balance. 

The Post-Traumatic Migraine/Headache Trajectory  presents with persistent chronic headaches, sensitivity to light, noise and nausea. Symptoms are exacerbated with certain activities.  These individuals often have a history of suffering from migraine headaches prior to their concussion.  

The Ocular-Motor Trajectory presents with individuals having eye pain, headaches, slowed reaction time, slowed processing, difficulty with their eyes not moving together and not moving in tandem. Their symptoms are often made worse with screen time on their computer, phone, or when watching television.

The Cognitive Trajectory presents with individuals feeling “slowed down,” and they often experience drowsiness, fatigue, light/noise sensitivity, dizziness, difficulty remembering, difficulty concentrating at school, misplacing items, difficulty concentrating and impaired memory.

The Cervical Trajectory is often overlooked and individuals will present with neck pain, headaches, decreased range of motion and flexibility. 

Concussions follow different clinical trajectories in different people. Treatment needs to be directed to focus on resolving the specific clinical trajectory symptoms and factors for optimal recovery.  

It is important that individuals are treated by a healthcare provider who specializes in assessing and treating the six clinical trajectories.  Britt Zink is a certified concussion specialist and can work with you to bring resolution to your symptoms.