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Review
. 2025 Jan 17;15(1):33.
doi: 10.3390/jpm15010033.

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms

Jon L Pertab  1 , Tricia L Merkley  2 , Holly Winiarski  3 , Kelly M J Cramond  4 , Alex J Cramond  4
Affiliations
Review

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms

Jon L Pertab et al. J Pers Med. .

Abstract

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system-the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients.

Keywords: autonomic nervous system dysfunction; behavioral interventions; concussion rehabilitation; mild traumatic brain injury; persisting symptoms post-concussion.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A simplified graphical representation of factors that may be impacting autonomic nervous system functioning pre-injury and post-injury for a specific individual.
Figure 2
Figure 2
A simplified depiction of circadian rhythm hormones that impact sleep and daytime energy levels.
See this image and copyright information in PMC

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