Persistent Concussion Symptoms: A Closer Look at the Common Risk Factors

| By Dr. Jennifer Hunnicutt

While most individuals recover quickly, a significant number of patients experience prolonged symptoms, leading to substantial healthcare costs.

Concussions are becoming increasingly common and concerning, especially among youth and adolescents. In Ontario, the rate of medically diagnosed concussions is notable at 1% of the population per year. 

While most individuals recover quickly (<14 days), a significant number of patients experience prolonged symptoms, leading to substantial healthcare costs. Patients are considered to have prolonged post-concussion symptoms (PPCS) if symptoms last beyond 3 months. 

Study Insights

A recent study (Scott et. al, 2023) from researchers representing a broad range of medical institutions in Ontario aimed to identify factors that might predict whether a patient with a concussion will experience prolonged symptoms. 

The study researchers analyzed data from 293 patients aged ≥16 years, focusing on two groups: those with acute concussions (symptoms for ≤ 14 days) and those with PPCS (symptoms lasting ≥ 90 days). It is important to note that these patients were not athletes, but rather representative of the general population.  

The study looked at four specific risk factors that relate to severity of concussions: 

  • Sex
  • History of mental health disorders
  • History of headaches/migraines
  • History of past concussions

Key Findings

Contrary to the hypotheses of the researchers, they found no significant differences between the acute concussion and PPCS groups in sex, history of mental health disorders, history of headaches/migraines, or history past concussions. 

Other Sub-Findings 

There were differences in certain demographic variables between the patient groups. For example, patients with PPCS were older and more likely to have been injured in transportation-related incidents, such as car accidents. They were also more likely to live outside Metropolitan areas (in the case of this study, Metropolitan Toronto. 

Both groups had a higher proportion of females, aligning with other research indicating that females are at a higher risk of experiencing persistent symptoms post-concussion.

Patients with PPCS were more symptomatic across cognitive, emotional, somatic, and fatigue categories (using the SCAT5 concussion evaluation tool).

Limitations of the Research Study

There are a few limitations of this study that are worth noting. First, it was a relatively small sample size for this type of study. Next, it was cross-sectional, meaning it only captured a snapshot of data at one specific time. However, it should be noted that this study was conducted during the COVID-19 pandemic. Because of this, the researchers acknowledge that this situation may have altered results (i.e., less people participating in work or physical activities that are associated with risk of concussion). 

Implications for Concussion Clinics and Healthcare Providers

Given the study’s findings, and regardless of the limitations, healthcare providers and concussion clinics may need to think outside the box when it comes to care for patients with PPCS. They should be aware that the risk factors for prolonged symptoms may extend beyond the commonly accepted ones. A more comprehensive approach to evaluating and treating concussion patients, considering factors such as age, injury mechanism, and geographic location, is essential.


HEADCHECK Pro and HEADCHECK Hub includes options for automated symptom evaluations with patients meaning that concussion clinics and healthcare providers can easily maintain a constant connection with patients experiencing PPCS.

Contact us to learn more today!


Scott OFT, Bubna M, Boyko E, Hunt C, Kristman VL, Gargaro J, Khodadadi M, Chandra T, Kabir US, Kenrick-Rochon S, Cowle S, Burke MJ, Zabjek KF, Dosaj A, Mushtaque A, Baker AJ, Bayley MT; CONNECT; Tartaglia MC. Characterizing the profiles of patients with acute concussion versus prolonged post-concussion symptoms in Ontario. Sci Rep. 2023 Oct 20;13(1):17955. doi: 10.1038/s41598-023-44095-6. PMID: 37863954; PMCID: PMC10589269.

Dr. Jennifer Hunnicutt

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