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Stress and Lack of Sleep Can Cause Concussion-Like Symptoms, Study Shows

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Key Takeaways

  • Concussion symptoms can be mimicked by preexisting conditions, such as stress and lack of sleep.
  • Athletes most likely to report concussion-related symptoms after not having suffered a recent head injury also report trouble sleeping and mental health disorders, such as ADHD and depression.
  • The findings could help to make diagnostic tools more precise, and encourage individualized treatment and care.

Many people may be going through life experiencing concussion-like symptoms—like headaches, fatigue, and difficulty concentrating—without ever suffering an injury.

In a new study, researchers found between 11% and 27% of college athletes with no history of recent concussions actually reported symptoms that met the criteria for post-concussion syndrome (PCS). Three factors were most likely to predict PCS-like symptoms: stress, lack of sleep, and existing mental health problems.

Researchers, as part of the Concussion Assessment, Research and Education (CARE) Consortium, established by the National Collegiate Athletic Association (NCAA) and U.S. Department of Defense, concluded that although the aches and pains following a concussion can help clinicians decide a treatment plan, it can be hard to disentangle what's caused by the concussion and what isn't for the individual.

"Clinicians should consider both injury-related factors, as well as non-injury-related factors—like mental health history and sleep—in evaluating an athlete following a concussion," lead author of the study Jaclyn Caccese, PhD, an assistant professor at The Ohio State University College of Medicine, tells Verywell.

The research was commissioned to inform on concussion effects and recovery in student-athletes at colleges, universities, and military service academies. The findings were published in the journal Sports Medicine in January.

What This Means for You

If you or someone you know has recently suffered a concussion, it could help to receive an official diagnosis from a doctor. On the other hand, if you or someone you know suffered a concussion more than a month ago, but still feel like they are experiencing symptoms, it is important to sort out preexisting conditions and concussion-related symptoms with a medical health professional.

The Findings

To shed light on how to best diagnose and treat the immediate and reeling effects of a concussion, participants completed a diagnostic survey.

Over 12,000 military service academy cadets and 18,548 NCAA student-athletes responded to the Sport Concussion Assessment Tool, third edition (SCAT3), which helps medical professionals diagnose concussion through screening for memory, balance, delayed recall, among other concussion symptoms. Demographic and family medical history data were also collected.

Researchers sought to sort out athletes' medical histories pre-concussion to evaluate how they affected post-concussion symptoms, if at all.

With no recently reported concussion, 17.8% of male cadets and 27.6% of female cadets, while 11.4% of male student-athletes and 20% of female student-athletes, all reported PCS-qualifying symptoms.

The data could serve to predict which individuals who haven't experienced a recent concussion are most likely to report PCS-like symptoms. "Concussion symptoms are non-specific, and many things can mimic concussion-like symptoms," Caccese says.

In both groups, sleep problems, previous migraines, and pre-existing psychiatric disorders were strong predictors of symptoms. More specifically, cadets struggled especially when they were having academic problems or were in their first year at the academy. For NCAA student-athletes, disorders such as ADHD or depression most often predicted PCS symptoms.

The findings may encourage increasing diagnostic tools' specificity, Caccese said in a press release. The research also highlights the need to treat patients and athletes dealing with head trauma in the context of their personal medical histories. For athletes, the tool can determine when they are allowed to hop back in the game.

"Because concussion symptoms are non-specific, evaluating someone long after a concussion, and asking them to self-report their symptoms at that time, and then attributing those symptoms to the remote injury can easily result in misdiagnosis," Cacesse says.

Individualizing Care

Caccese's research focuses on "the short- and long-term effects of repetitive head impacts in sports and sport-related concussion," so being able to study those effects depends greatly on the clinician's ability to diagnose the athlete.

"Concussion diagnosis remains a clinical decision informed by a physical exam and potentially a battery of objective tests," Caccese says. "Symptom reporting is still one of the best methods for identifying concussion. Unfortunately, concussion symptoms are non-specific, and many things can mimic concussion-like symptoms."

Some symptoms commonly reported in association with concussions, according to the Centers for Disease Control and Prevention, include:

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness, or double or blurry vision
  • Bothered by light or noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Confusion, or concentration or memory problems
  • Just not “feeling right,” or “feeling down”
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Article Sources
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  1. Caccese J, Iverson G, Hunzinger K, et al. Factors associated with symptom reporting in U.S. service academy cadets and NCAA student athletes without concussion: Findings from the CARE ConsortiumSports Med. 2021. doi:10.1007/s40279-020-01415-4

  2. Ohio State News. Lack of Sleep, Stress Can Lead to Symptoms Resembling Concussion. Updated January 22, 2021.

  3. Centers for Disease Control and Prevention. Concussion Signs and Symptoms. Updated February 12, 2019.