A concussion is a physical injury to the head resulting in altered mental function, with expectation of recovery within 2–3 weeks. In a significant minority of cases the symptoms persist longer, thereby comprising a symptom complex commonly referred to as the “post concussion syndrome”, that is, one or more somatic (for example, headaches, dizziness), cognitive (for example, poor concentration, memory), or behavioural/affective (for example, irritability, mood swings) symptoms. Unfortunately, the referral of a patient with the possibility of post concussion syndrome to a busy neurology outpatient clinic can precipitate an inward sigh of reluctant resignation in even the most diligent neurologist or neurosurgeon. We know we are in for a potentially lengthy consultation—long on symptoms and short on signs. Moreover, the process can be convoluted and meandering, as unrewarding for the patient as it is unsatisfying for the clinician.

It is important to acknowledge at the outset that there is a dearth of evidence-based knowledge of the underlying pathogenesis, and even less of the best management of post concussive symptoms. Thus, much of the information and advice in this article is empirical and based on expert and personal experience.