A concussion is often described as a temporary brain injury. For many people, symptoms improve within several weeks. For others, headaches, dizziness, brain fog, sleep problems, and sensory sensitivity continue for months or even years.
One possible explanation involves central sensitization, a process in which the nervous system becomes increasingly reactive and begins amplifying pain and other sensory signals.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Robert Bashuk of the Concussion Center in Atlanta about concussion as a possible nociplastic disorder, the brain’s metabolic response to injury, and why early treatment may help prevent persistent symptoms.
A Concussion Is a Traumatic Brain Injury
A concussion is considered a mild traumatic brain injury.
It can result from a direct blow to the head, but the head does not have to strike anything. An impact to the neck or body can transmit enough force to the brain to cause an injury.
That force may stretch or shear nerve cells and trigger changes involving brain chemicals, blood flow, cellular energy, and inflammation.
Symptoms may appear immediately, but they can also develop over several hours or days.
A person does not have to lose consciousness, see stars, or have an abnormal brain scan to suffer a concussion.
The Brain Experiences an Energy Crisis
Immediately after a concussion, the brain experiences a burst of abnormal electrical activity.
This period of excitation is followed by reduced neuronal activity and a temporary energy deficit. Dr. Bashuk explained that concussion may interfere with mitochondria, the structures that help cells produce energy.
This can lead to a reduction in ATP, the energy source used by brain cells.
The metabolic recovery process may take several weeks, even when the person begins feeling better sooner.
Dr. Bashuk compared this to a broken bone. The pain may improve before the fracture has fully healed. In the same way, concussion symptoms may decrease before the brain’s cellular energy system has returned to normal.
That difference is especially important when deciding when an athlete should return to a sport where another impact is possible.
What Are Persistent Post-Concussion Symptoms?
Persistent post-concussion symptoms occur when problems continue beyond the typical early recovery period.
Symptoms may include:
- Headaches
- Neck pain
- Dizziness
- Brain fog
- Memory problems
- Difficulty concentrating
- Irritability
- Anxiety
- Fatigue
- Insomnia
- Exercise intolerance
- Light and sound sensitivity
- Numbness or tingling
Dr. Bashuk explained that many people recover within a few weeks, while a meaningful percentage develop longer-lasting problems.
The question is why an acute injury becomes chronic for some patients.
What Is Nociplastic Pain?
Pain is commonly divided into three categories.
Nociceptive pain occurs when tissue is injured or threatened. Touching a hot surface, stepping on glass, or suffering a cut are familiar examples.
Neuropathic pain comes from injury or disease affecting a nerve. Shingles, diabetic neuropathy, and a pinched spinal nerve may cause this type of pain.
Nociplastic pain is different.
It involves altered pain processing even when there is no clear ongoing tissue injury or damaged nerve explaining the severity and persistence of the symptoms.
The pain is real, but the nervous system may be amplifying it beyond what would be expected from the original injury.
How Central Sensitization Develops
Central sensitization occurs when the brain and spinal cord become increasingly sensitive to pain or sensory information.
A harmful stimulus normally triggers a protective response. The nervous system detects the danger, creates pain, and encourages the person to move away or protect the injured area.
That system is useful in the short term.
However, prolonged pain and inflammation may change how the central nervous system processes signals. The nervous system can become hyperexcitable and continue producing pain even when the original source has healed or become less significant.
Dr. Bashuk used the example of a person with a herniated disc. The disc may be treated surgically, but the patient continues experiencing pain because the nervous system has learned and reinforced the pain response.
He believes a similar process may help explain why some concussion symptoms become persistent.
When Normal Sensations Become Overwhelming
Central sensitization may produce several types of abnormal sensitivity.
Hyperalgesia occurs when a painful stimulus causes much more pain than would normally be expected.
Allodynia occurs when something that is usually harmless becomes painful. For example, warm shower water may hurt when it touches sunburned skin.
Global sensory hypersensitivity may affect several senses at once.
After a concussion, a person may become extremely sensitive to:
- Bright lights
- Normal household sounds
- Strong smells
- Certain foods
- Medication
- Movement
- Touch
- Busy environments
A patient may need to sit in a dark room or wear sunglasses indoors because ordinary lighting feels unbearable.
These reactions are not necessarily exaggerations. They may reflect changes in how the nervous system processes sensory signals.
The Role of Neuroinflammation
Inflammation is part of the brain’s response to injury.
When nerve cells are stretched or damaged, substances may leak into areas where they do not belong. The brain’s immune cells, called microglia, then activate to remove damaged material and support healing.
In a healthy recovery, those cells eventually return to a resting state.
In some cases, they may remain activated and continue producing inflammation.
Persistent neuroinflammation may contribute to headaches, insomnia, brain fog, irritability, memory problems, and sensitivity to light and sound.
Dr. Bashuk connected prolonged microglial activity with central sensitization and persistent post-concussion symptoms.
Why Sleep Is So Important
The brain has a waste-removal system known as the glymphatic system.
This system helps clear metabolic waste and cellular debris, with much of that work occurring during deep sleep.
A concussion may interfere with glymphatic function while also making sleep more difficult.
That creates a harmful cycle:
Poor sleep reduces the brain’s ability to clear waste. Waste and inflammation build up. Headaches, irritability, and brain fog worsen. Those symptoms then make it even harder to sleep.
Anyone who has stayed awake for an extended period understands some of these effects. Sleep deprivation alone can produce poor concentration, fatigue, irritability, and cognitive slowing.
After a concussion, those effects may be even more significant.
Why Complete Rest May Delay Recovery
One of the most persistent concussion myths is that patients should remain inactive until every symptom disappears.
Dr. Bashuk strongly challenged that approach.
He explained that prolonged “cocooning,” such as remaining in a dark room and avoiding nearly all activity, is no longer considered the best strategy for many patients.
Instead, he supports a brief period of relative rest followed by medically guided, subsymptom aerobic exercise.
Tests such as the Buffalo Concussion Treadmill Test or Buffalo Concussion Bike Test may help determine how much exercise a patient can tolerate safely.
The goal is not to push through severe symptoms. It is to gradually restore activity without significantly worsening the patient’s condition.
Exercise after a concussion should be based on medical guidance and the individual patient’s symptoms and health.
Migraine, Whiplash, and Concussion May Overlap
Dr. Bashuk noted that concussion, migraine, and whiplash often produce similar symptoms.
Each may involve:
- Headache
- Neck pain
- Light sensitivity
- Sound sensitivity
- Dizziness
- Sleep problems
- Anxiety
- Brain fog
- Difficulty concentrating
These conditions may also involve inflammation, central sensitization, and changes in pain processing.
Recognizing those shared mechanisms may help providers understand why one patient develops chronic headaches while another experiences widespread pain, sensory sensitivity, or persistent neck symptoms.
Early Treatment May Interrupt the Cycle
Dr. Bashuk’s central message was that concussion care should begin with a sense of urgency.
The purpose is not to frighten patients. It is to identify and treat problems before inflammation, disrupted sleep, pain, and sensory sensitivity become reinforced.
Early care may involve:
- Medically guided aerobic exercise
- Headache treatment
- Sleep management
- Vestibular rehabilitation
- Eye-movement therapy
- Cervical evaluation and treatment
- Education about expected recovery
- Mental health support
- Nutrition and hydration guidance
No single treatment is right for every patient.
However, telling someone only to rest and wait may overlook opportunities to address problems while they are still developing.
A concussion is a real brain injury, but persistent symptoms are not inevitable. Early recognition, education, and coordinated treatment may give the nervous system a better opportunity to recover before an acute injury becomes a chronic condition.
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