Persistent post-concussion symptoms: what helps?
The fall or blow was weeks ago, sometimes months. The scan showed nothing, “it will pass”, they said. But the headaches remain, light and sound come in too hard, one day of work costs three days of recovery, and nobody seems to understand why it is taking so long.
If you recognise this: you are not alone, and you are not imagining it. In a substantial group of people, symptoms after a concussion persist for weeks to months. This is known as persistent post-concussion syndrome. On this page I will walk you through what is going on, which treatment options exist (all of them, not just mine) and what you can start doing this week.
Why symptoms persist while the scan is clean
A clean scan means: no visible damage. It does not mean nothing is wrong. After a concussion, the brain’s calibration can become dysregulated: the stimulus filter no longer works automatically and the stress system stays in heightened alert. Stimuli come in unfiltered, and everything you do costs more energy than it returns.
A second layer often builds on top: out of fear of the symptoms you start avoiding more and more, or you push through and crash again and again. Both keep the dysregulation in place. The good news: a disturbed calibration is not damage, and it can learn to regulate again.
Which treatment options exist?
Honesty first: there is no miracle cure, and the scientific evidence per treatment is still developing. This is the palette most clinicians agree on.
1. Understanding what is happening (psycho-education)
Knowing that the symptoms come from a dysregulated calibration, and not from permanent damage, takes the fear out. And fear is exactly what keeps the alarm system sharp. This is not “reassurance”, it is the first treatment step.
2. Graded build-up instead of complete rest
The old advice of “a dark room until it passes” is outdated. The current approach: after the first days of rest, build up gradually, in steps your system can handle. Dosing is the key word: too many stimuli crash you again and again, complete avoidance keeps the hypersensitivity in place. Short and successful is the norm, not long and exhausted.
3. Energy and stimulus management (occupational therapy)
An occupational therapist translates this into your daily life: structuring your day around what your brain can handle (pacing), dosing stimuli, and building up work, study or sport step by step.
4. Complementary: training stimulus processing with ReAttach
In my practice I combine occupational therapy with ReAttach: a brief, low-burden therapy that trains stimulus and information processing while arousal is actively kept low. This suits persistent concussion symptoms well, because intensive therapy is often still too demanding. About the evidence I am honest: research is ongoing. In 2025 I published a research protocol with prof. dr. Aida Mehrad (Universitat Internacional de Catalunya) on ReAttach for persistent post-concussion syndrome; this symptom profile is the core of my research work. It also strongly overlaps with long COVID brain fog and sensory overload.
5. Further steps if recovery stalls
With persistent or worsening symptoms, a rehabilitation physician, neurologist or neuropsychologist should be involved, certainly with loss of function, double vision or worsening headaches. A good clinician refers on time. That applies to me as well.
What you can do this week
My father used to say: it is not about what people say, it is about what people do. Five actions:
- Start your day with a short walk in a quiet environment, before the day’s stimuli begin.
- Work or read in blocks of no more than 15 minutes, with a stimulus break in between: eyes closed, no screen, no sound.
- Alternate deliberately: one demanding activity, then one rest moment. Not everything first and then collapse.
- Pick one stimulus situation per day (supermarket, gathering, screen) that you deliberately seek out briefly and leave on time.
- Keep a simple diary for one week: what did I do, how demanding was it (1 to 10)? You will see your own pattern, and that is the basis of every good build-up.
The healing power is already yours. My job is to activate it, not to take it over.
Working with me
I am Sieto Reitsma, occupational therapist with more than thirty years of experience in neurorehabilitation, based in the Netherlands, and researcher on ReAttach for persistent post-concussion syndrome. In my practice, and partly online in English, I support people with persistent concussion symptoms, post-COVID symptoms and burnout. An introductory conversation is free of obligation.
Dutch speaker? Read this page in Dutch: aanhoudende klachten na een hersenschudding.
Frequently asked questions
How long do symptoms after a concussion normally last?
Most people recover within two to four weeks. In a substantial group, symptoms persist for weeks to months; this is called persistent post-concussion syndrome. Recovery is still very possible then, but usually not by itself: it requires a structured build-up.
The scan was clean. Why do I still have symptoms?
A scan shows damage, not calibration. Persistent symptoms usually come from a dysregulated stimulus filter and a stress system stuck in heightened alert. That is invisible on a scan, but very possible to influence with the right approach.
Should I rest in a dark room?
No, that advice is outdated. After the first days, gradual, dosed build-up of activities and stimuli is the approach that promotes recovery. Complete stimulus avoidance keeps the hypersensitivity in place.
Can I exercise and work with persistent symptoms?
Yes, in doses. Gentle movement (walking, light cycling) promotes recovery. Build up work and sport step by step, slightly below your maximum, so your system adapts without crashing.
What is ReAttach and is there research on it?
ReAttach is a brief, low-burden therapy that trains stimulus and information processing while arousal stays low. Research is ongoing: in 2025 a research protocol by Sieto Reitsma and prof. dr. Aida Mehrad was published on ReAttach for persistent post-concussion syndrome. ReAttach is used as a complement to regular care, never as a replacement.
Do you offer online sessions in English?
Yes. Part of the support, including psycho-education and energy management, can be done online in English. Get in touch to discuss what is possible in your situation.
