Why Do I Still Have Symptoms Months After a Concussion?

CoTrauma After a Head Injury

The brain is brilliant at survival, which can make your recovery more difficult. 

A head injury can change everything. Your brain is smart - and adaptable. However, due to the nature of head injury or whiplash, your brain may stay locked into a protective response, long after the danger has passed, stalling your healing process. 

Imagine enduring a rock concert 24/7 under the loudest speaker - this is what it can feel like with a ricochet of symptoms after a concussion.

After a traumatic brain injury (TBI) or concussion, you may feel “fine” at first. But weeks,  months, or even years later, lingering symptoms often appear, such as:

• Brain fog and slowed thinking

• Headaches or migraines

• Word-finding difficulties

• Memory problems

• Dizziness, nausea, or balance issues

• Sensitivity to light and sound

• Mood Issues like Depression or Anxiety

These aren’t random side effects—they are likely the result of both physical injury and your intelligent nervous system creating negative adaptations (hello trauma). 

What Happens During a Head Injury?

The brain is like jello in a jar. It’s cushioned by cerebrospinal fluid, fascia, dura mater, and the skull. But during an impact, the brain can be impacted by the hard skull, or changes in fascial restriction and blood flow can occur. 

Even without loss of consciousness, this can set off a chain reaction:

1. Structural and Physical Stress

• Tissue constriction or shearing

• Reduced blood flow and oxygenation

• Strain in the neck, spine, and surrounding structures

2. Physiological Nervous System Response

• The brain prioritizes survival by slowing high-level processing.

• Chemical, emotional, and physical imprints are encoded in the nervous system.

• Even if you feel “okay,” your body may react as if the trauma is still happening. You are likely not even consciously aware of the impact chemically, physically and emotionally. This is where our body compensates with difficult symptoms that lock this history in our tissues.

This explains why many people develop ongoing sensory overload, fatigue, mood changes, or sleep problems long after the initial injury. Or why you aren’t responding to very helpful therapies.

Why Symptoms Persist

Trauma locks the nervous system into a contradictory state:

• One foot on the gas: hyperarousal, anxiety, irritability, poor sleep.

• One foot on the brake: brain fog, fatigue, poor recall, slowed processing.

You can’t drive with a parking brake! The Colorado Concussion Center can help. 

In addition to cognitive, physical and vision therapies, we provide a specific form of Neurofeedback technology called the LENS, which works to help the brain shift out of trauma patterning, and the results are often dramatic. 

LENS Therapy has shown rapid, even startling improvement (Larsen, 2006. The Healing Power of Neurofeedback)

How LENS Neurofeedback Helps

Your brain can repair itself. The Low Energy Neurofeedback System (LENS) offers a gentle way for your nervous system to downshift, so your brain can reset itself. 

“The LENS seems to increase cortical flexibility, decrease rigid and inflexible adaptations, and harmonize and balance the activity of the CNS” (Larsen, 2006).

• Tiny signal: Sensors measure brain activity and send back a signal offset from the brain’s own rhythm—1,000 x weaker than traditional neurofeedback.

• Breaks stuck patterns: This slight nudge bypasses protective filters and helps the brain reorganize, likely increasing blood flow, balancing brainwave function and boosting neuroplasticity.

• Encourages natural repair: Your brain isn’t forced to change in a specific way - with the LENS, your brain drives the feedback to change itself.
  

Research supports LENS as an effective therapy for symptoms of both TBI and trauma:

• Traumatic Brain Injury: LENS therapy has been shown to result in “reports of restored cognition, reduced headaches, and even recovery of smell after head trauma (Hammond, 2007, 2017).
  

• PTSD & Trauma: LENS reduces hyperarousal, improves sleep, and helps restore balance to emotional processing (Larsen, 2006). Most patients often describe feeling calmer, clearer, and less reactive.
  

Schedule a LENS Brain Mapping 

If you’re struggling with brain fog, dizziness, headaches, or mood changes after a head injury, it may not be the impact itself causing ongoing problems—but your nervous system’s protective response.

Even if you’ve tried everything - the LENS is different. Schedule your first LENS session at the Colorado Concussion Clinic. 

Your brain wants to heal. It’s time to let go of the brakes. 

CITATIONS

Larsen, S. (2006). The healing power of neurofeedback: The revolutionary LENS technique for restoring optimal brain function. Rochester, VT: Healing Arts Press.

Hammond, D. C. (2007, 2014). QEEG evaluation of LENS treatment of TBI. Journal of Neurotherapy, 14, 170-177.

How LENS Neurofeedback Works - A Novel Therapy for TBI and Head Injury Recovery

Living with Lingering Symptoms After a Head Injury

If you’ve experienced a concussion or head injury, you know recovery can feel frustratingly slow. Even months later, you might still struggle with:

• Poor cognitive function or brain fog

• Trouble thinking or concentrating

• Sensitivity to light, sound or movement

• Mood changes like anxiety, irritability or depression

• Anxiety, depression or irritability

• Chronic headaches, chronic pain or body tension

• Poor energy or sleep
  
  

For many patients, these symptoms can get worse over time after head injury and may not resolve even with rest, medication or therapy alone. 

That’s where LENS neurofeedback, a form of brainwave disentrainment can make a big difference.

What Is LENS Neurofeedback?

LENS (Low Energy Neurofeedback System) is a gentle, non-invasive brain training method. It works by sending a tiny, imperceptible radiowave signal through sensors placed on the scalp. The brain picks up on this signal, which is small enough to get underneath neuroprotective filters. This signal helps the brain outline and sense its own functioning, and the brain responds (the feedback) by releasing “stuck” and inefficient patterning created by injury or trauma. 

Think of Traumatic Brain Injury like a traffic jam in the brain: after an accident, your brain compensates by protecting and slowing down blood flow and neural pathways around the injury, causing symptoms such as reduced cognitive functioning, headaches and brain/body scrambling.

Slowing down in one part of the brain affects other areas, and eventually entire areas of ‘the city’ become less efficient. It takes more and more energy to function in your life and things that were once easy, become a chore. 

The LENS acts like traffic control, helping the brain sense these inefficiencies and access new resources (increased blood flow, neural signaling) to heal. 

Your own brain provides the feedback, as it traces the tiny signal from LENS and exercises out of stuck, inefficient pathways. 

How LENS Supports Concussion Recovery

1. Reduces Stress on the Body and the Brain – LENS is FDA cleared for Stress. The LENS calms overactive fight-or-flight responses, giving your brain and nervous system the support it needs to regulate and repair itself.
   

2. Restores Clarity – Patients often report clearer thinking, better focus, increased concentration and reduced brain fog.
   

3. Improves Sleep & Mood – By helping regulate the nervous system, LENS supports better sleep patterns and emotional balance.
   

4. Accelerates Progress in Therapy – When your brain is less stuck,it becomes receptive again to other treatments (cognitive, speech, vision, or physical therapy) often become more effective.

5. Releases NeuroMuscular Tension + Trauma Patterning - After an accident, the biggest challenge to the brain is the body. When the brain senses motor trauma, or neuromuscular patterns of gripping in response to an accident, functioning slows. The LENS can also be used on the body to release muscle tension, directly influencing the nervous system to repair neuromuscular or structural issues, recover from panic, anxiety or PTSD and reduce chronic pain signaling. 

What to Expect in a Session

• Small sensors are placed on the scalp and ears.

• The system measures brainwave activity and sends back a signal slightly offset from what it reads.

• Sessions are very brief — often just a few minutes of stimulation.

• Entirely Passive! Patients don’t need to “do” anything — your brain does the work.

Most people find the process relaxing, and depending on sensitivity, patients experience gradual or faster changes in mood, energy and cognition as the nervous system reorganizes. 

For 24-48 hours after a session, patients might experience responses based on nervous system changes such as: changes in energy, sleep, brief echoes of past symptoms, increased dreaming, or in the case of trauma - the release of memories without much emotional content. 

Is LENS Right for Post-Concussion Symptoms?

If you’re still experiencing headaches, brain fog, cognitive slowing, mood swings, or sensitivity after a concussion, LENS may help. 

Talk to your doctor and wait at least 2-4 weeks after a major concussion to give your brain time to rebalance, and then try a LENS session. It’s especially supportive when nothing else has worked, or for people who feel stuck in recovery. The LENS can even be helpful for people who are too sensitive to tolerate more stimulating therapies.

Citations: 

Hammond, 2007 (Anosmia). Case reversal of anosmia post-head injury with LENS.

Hammond, 2010 (QEEG TBI case). Quantitative EEG improvement post-LENS.

ISNR Journal 2006 issues. Multiple TBI-related LENS case series.

Larsen, 2009. Theoretical fit of LENS for TBI.

Nelson & Esty, 2012. Veterans with TBI/PTSD – symptom reduction.

Nelson & Esty, 2015. Chronic TBI-related headaches improved with FNS.

Schoenberger et al., 2001. Early randomized trial—FNS in mild to moderate TBI.

St. Clair, 2008. TBI from AVM – LENS application report.

Headaches ... "They come out of nowhere"

One of the most prominent symptoms of concussion is headache. After a concussive injury headaches are often the main symptom that impacts one’s daily functioning. One moment you might be effectively managing your pain and then the next thing you know you have a significant headache that causes you to stop what you are doing. Patients often remark, “It just came out of nowhere!” . Usually, however, there is some kind of trigger that you are unaware of, causing the significant increase in head pain. 

While some triggers are more obvious, such as working for hours, others are less so.  Some triggers can be as simple as looking at a screen for too long, stepping outside without sunglasses, having the TV on in the background, overdoing it with physical exercise, etc.. The best way to understand your personal headache triggers is to monitor your symptoms, record your daily activities and any increase in symptoms you notice. Everyone is different, some symptoms may increase immediately at the onset or just after a trigger, but some symptoms may increase hours/days later. Keep an Activity & Symptom Log. 

For Example: 

• Gardening outside from 1:00 pm - 4:00 pm 

… difficulty sleeping and a massive headache the next morning 

• Went to the Costo 

… significant increase in headache beginning while at the store and continuing to increase on the way home

Once you have a log of your activities and symptoms, you can begin to find the patterns and identify your personal triggers. 

In the gardening example, the triggers may be sunlight, heat, and/or physical activity (e.g., bending down and standing up). Next time you garden, plan ahead and try to mitigate these triggers by wearing sunglasses and/or a hat, taking frequent breaks inside, and bringing a chair to sit down in instead of standing or kneeling. 

In the Costo example, the triggers may be background noise (e.g., people talking or music playing), fluorescent lighting, or trying to remember a long grocery list in your head. Next time you take a trip to Costo, plan ahead and try to mitigate these triggers by wearing a hat to shield your eyes from the fluorescent lights, wearing earplugs, and writing everything down in a grocery list organized by section in the store. 

The ultimate goal early in concussion recovery is to reduce significant symptoms such as headaches. When one is in a state of high pain and intense headache they are unable to complete daily activities (understandably so!). This is disruptive to one's life, and is also counterproductive to recovery. Once you understand your triggers, you will be able to hopefully reduce the frequency and intensity of your headaches, allowing the brain more time to heal your concussive injury.

Hannah Beach MS CCC-SLP

Helping Family Members with Concussion

When someone has a broken leg, it’s pretty obvious how we can be helpful.  We can drive them places, open doors for them, carry their groceries, etc.  Concussion is a different kind of injury.  It is known as “the invisible injury” because it is not externally obvious to others.  There’s no cast, no crutches, and it doesn’t even show up on a CT scan. The individual often struggles with thinking, overstimulation, and fatigue, among other things.  Sometimes people aren’t sure what they can do to help. The answers may vary, depending on the individual, but here are some general tips for how to help someone you know who has had a concussion.  

1. Ask if they would like you to go with them to an appointment. Sometimes people become very overwhelmed by the large amount of information they are presented with, and having another set of eyes and ears may be helpful.

2. Gain their attention and make sure they are looking at you before you speak to them. If possible, let them finish what they were doing.  Dividing their attention between two things will likely be unsuccessful.  Also understand that it may take the person a minute to switch gears from what they were doing before.

3. Text them instructions or important information so that they can process it when they are able to focus, rather than telling them in passing or when they cannot write it down.

4. Provide assistance, but try not to take all responsibility away from the person.  For instance, it is okay to remind the person of their appointments, but if they are able to schedule them and check their calendar, this is something they should continue to do. It will be good for their brain to have to pay attention to such things.

5. Try not to take it personally if they are wanting more alone time or need a break from a conversation. This is very common, as people with concussions often become quickly overloaded and symptomatic. After a while it may be difficult for them to process what you are saying.

6. Offer to bring them a meal or something else that might make their life a little easier.  Many people with concussions are very busy with medical appointments when they aren’t working, which can make it difficult to find the time to cook.

At the Colorado Concussion Clinic, we understand that mild traumatic brain injuries impact not only those who are injured, but those with whom they are closest.  There can be frustration on both sides, even if there is a lot of love.  You may feel just as overwhelmed as your partner if all of a sudden you are working full time and taking on a majority of the household responsibilities.  It can be helpful to see a therapist to address any feelings you may be having and learn effective coping and communication strategies.  If your loved one who is injured is open to it, it may also be helpful for you to ask their providers questions about their symptoms or treatment plan.  Having a deeper understanding of the injury may help you help not only your loved one, but you as well.

- Ramya Shyam, MS CCC-SLP

“Jot That Down” - Thoughts about note-taking following a head injury

One of the things I hear frequently when I meet a new patient is, “All of a sudden I have to write everything down.  I used to just remember things and now I’m totally overwhelmed.  It’s SO frustrating!”

Let’s take a minute to analyze the situation and put things in perspective.  Normally, you have a routine which may involve work, typical household chores, family obligations, etc.  But now you’ve been hurt - maybe due to a fall, a sports injury, or a car crash.  You’re not feeling like yourself, you’re tired and scared, and all of a sudden tasks are piling up.  In addition to your usual responsibilities, you may be dealing with any or all of the following:

• Physical symptoms: headaches, dizziness, nausea, sleep disturbance, etc.

• Emotional symptoms: sadness, fear, anxiety, trauma, etc.

• Medical appointments happening at different times on different days

• Insurance companies

• Work issues

• Not having a car

• Being unable to perform household chores

When we think of it that way, it’s a lot!  You’ve had several things added to your plate, and it’s hard to juggle and remember everything that needs to be done.

It’s wonderful to be able to rely on your spontaneous memory - to not have to use a calendar, to not have to take notes every time you talk to someone, or to not have to check your notes 5 times a day to make sure you aren’t missing something.  Truthfully, though, this is what you have to do following a concussion.  My goal is to help you be at peace with this...to understand that writing things down is actually good.  It means that on some level you are recognizing that something isn’t working and you are problem solving that issue.  None of us need to be perfect.  What we need to be able to do is identify problems and solve them.  

Also, you need some free space in that precious brain to process the information that is coming at you throughout the day.  Putting appointments, reminders, and other information in your calendar is the perfect way to free up valuable brain space.  

Some of you may wonder, “Will I always have to do this?”  The answer is, probably not to the same degree.  Once you are feeling better, the appointments slow down, and you get back to your normal routine, your spontaneous memory will likely work much better.  Still, is it the worst thing in the world to use a calendar or to take notes during an appointment?  Life is busy, and as we get older we tend to have more on our minds.  For example, even though I pick my child up from school at the same time every day, I still set an alarm because I’m human and sometimes I can get caught up in what I’m doing...writing a blog post for instance.  Setting the alarm puts my mind at ease and allows me to focus on the task at hand without constantly checking the time.   

Writing information down allows us to focus, think better, and sometimes even process the information we are hearing.  At CCC, we encourage this sort of thing!

- Ramya Shyam, MS CCC-SLP

How Does Impaired Hearing Impact Cognition?

Did you know that hearing impairment is a common symptom after sustaining a concussion?  Many people are aware of post-concussive symptoms such as headaches, dizziness, or memory loss, but are less familiar with the possibility of hearing impairment.  Some people experience hearing loss while others may experience symptoms such as difficulty processing auditory information, ringing in the ears, or sensitivity to noise.  It varies significantly by person, but these symptoms can sometimes have a profound effect on your life. 

You might be surprised to learn that even mild hearing impairment can impact a person’s life and daily functioning.  In fact, research shows that even mild hearing impairment is associated with a faster rate of cognitive decline as well as an increased risk of dementia.  In this blog, we’re going to discuss several examples of different areas of cognition that are directly impacted by a hearing impairment in addition to some tips to help you alleviate these challenges.  

First, it is important to mention that if you are concerned that your hearing has changed in any way since your concussion, it will benefit you to:

1. Make an appointment with a certified audiologist for a hearing evaluation.  

2. Follow the audiologist’s recommendations.  There are many treatment options such as amplification technology (e.g., hearing aids, amplified telephones) or aural rehabilitation that may include auditory training, counseling, or learning strategies to help you hear better in situations you have more trouble.

Now, here’s where we dive into some of the specific areas of cognition that are often affected:

Hearing impairment can directly impact your ability to pay attention and concentrate on information you are listening to.  This is because your brain has to work extra hard to decode and understand the information.  This may cause you to experience cognitive overload and fatigue, both of which make it difficult to pay attention.  

So, what are a few ways you can improve your attention in these situations? 

• Modify your environment by reducing background noise or moving into a less distracting location

• Sit or stand near the speaker 

• Consider using amplification technology (e.g., conference microphones, amplified telephone)

Hearing impairment can impact your memory.  When our patients have trouble staying focused while listening, they often experience difficulty remembering the information they hear.  This is because attention is a foundational skill that is necessary for the formation of memories.  And, when concentrating and listening become so effortful, people often experience decreased memory. 

So, what are some things you can do to improve your memory?  

• Continue to practice and master the attention strategies mentioned above 

• Ask people to repeat what they said 

• Take a moment to stop and briefly summarize what you heard in your own words 

• Take notes that you can refer to later 

Hearing impairment can impact your ability to engage in effective communication with others.  As you can imagine, if you have trouble paying attention or remembering details you hear, it will be difficult to follow along during conversations, especially when there are multiple people speaking.  You might even feel like other people are mumbling because it is difficult to understand them.  If you miss important details, this can easily lead to a miscommunication.  And, after socializing, you may feel cognitively exhausted because of all the extra effort you used to listen and stay engaged. 

What types of strategies can help you improve your communication in these situations?

• Face the person you’re talking to so you can use both auditory and visual cues (reading lips) to help with understanding.

• Advocate for yourself ahead of time. Let people know about your hearing impairment.  Ask them to speak a little louder, slower, and only one person at a time.

• Ask questions to clarify that you understood. 

By addressing your hearing impairment with a full audiological evaluation and following through with the recommendations for treatment, you can improve your ability to concentrate, remember the details, communicate effectively with others, and your overall quality of life.  

And, if you are having any difficulty implementing the strategies outlined above or are looking for additional cognitive support, the licensed cognitive therapists at the Colorado Concussion Clinic are here to support you! 

- Mari Gottlieb, MA CCC-SLP

Four Ways to Manage Fatigue From a Cognitive Perspective

Fatigue is one of the most common symptoms our patients report after they experience a concussion.  It can reveal itself physically, cognitively, or even emotionally.  Our group of speech language pathologists at the Colorado Concussion Clinic often work with our patients to manage each type using a holistic and individualized approach to cognitive therapy.  While there are many different ways to treat fatigue, here are four ways we might address it in therapy with you:

#1:

First, it is important to understand your triggers for fatigue (e.g., loud noises, poor sleep quality, etc.) and the type of fatigue you experience depending on the activity you complete.  We may recommend you begin logging or tracking your fatigue levels during the day to help increase your awareness.  For example, you might find that some activities are emotionally or physically fatiguing, or both.  Our goal is to help you tune into this and pay attention to the way each activity makes you feel.  Having this level of insight can help you adjust your schedule to better suit your needs.

#2:

We recommend creating consistent routines to follow during the day to help conserve your energy.  Doing so will decrease the need to make decisions throughout the day, which often takes more time and energy than expected.  We’ll help you identify routine tasks and create a consistent schedule for these throughout your week.   Following a routine will also improve your ability to focus and remember to complete those tasks. 

#3:

Next, we may teach you how to strategically plan your day based on the information we learn through your fatigue log while also helping you maintain your routines. We often recommend that you complete tasks in a specific way to conserve your energy such as – planning a rest break before and after your physical therapy appointments, or completing a cognitively challenging task in the morning when you have the most energy.  Our intention is to teach you how to plan your day to maximize your energy and manage your symptoms proactively. 

#4:

Finally, to improve your energy levels and reduce fatigue, it is always important to prioritize activities that promote overall wellness and a healthy brain, especially after sustaining a concussion.  To manage this from a cognitive perspective, we may help you develop goals for your sleep or exercise routines, or help you start incorporating stress management techniques into your day.  We all know how easy it is to forget even the simplest things that are good for us, like maintaining a good sleep schedule or prioritizing your mental health.  And after a concussion, these things may feel like more of a challenge.  Our goal is to guide and support you in reaching your goals, and help you feel more like yourself as soon as possible! 

- Mari Gottlieb, MA CCC-SLP