Hello friends – I haven’t posted much on this forum but I wanted to share a (relative) success story for those of you still struggling with post-concussion syndrome.

It’s been a year now since my concussion and I have recently managed to functionally recover from PCS – by functional recovery I mean that I no longer suffer from the most disabling symptoms including constant headache, light sensitivity and the crippling PCS fatigue. I have been free of these symptoms for over a month now. Although I have improved significantly cognitively – I can remember new people I met a few weeks ago again, my visuospatial ability and cognitive ability still aren’t as good as they used to be pre-concussion but that’s a minor complaint.

So what lead to my breakthrough in recovery?

Two things: seeing a competent behavioural optometrist who specialized in neuro-optometry and taking the buffalo protocol seriously.

I had previously been to a ‘concussion clinic’ that gave me 3 basic eye exercises (pencil-push-ups etc) that I did for half an hour every day for over a month but which did not help (in fact one of them, a gaze-fixating exercise where you shake your head severely exacerbated my PCS at one point) any of my visual problems.

About 3 months ago I went to a behavioural optometrist with the intention of trying prismatic glasses (I got the inspiration from Eliot Clark’s book on his PCS experience) and he not only gave me prism glasses but also real visual-therapy exercises that I noticed made a notable difference in my symptoms in as little as 2 weeks. For example, I used to have blurred vision when looking at moving objects (e.g. scrolling text) – it turned out that the speed at which I could focus/accommodate my vision was more than 2x slower than normal and the behavioural optometrist gave me exercises that gave me noticeable results in the symptom whereas the concussion clinic guys didn’t even touch on that symptom or its cause. I still have the blurred vision on looking at moving objects but it has significantly improved. I continued to have convergence insufficiency which has now completely resolved and several other main problems which I won’t go into the details of but you get the idea: visual and vestibular problems are fixable and you need to see competent people that can help you with these.

The other thing I did which I believe was just as, if not more, helpful than the behavioural optometrist was taking the buffalo protocol seriously. I know the buffalo protocol was effective because I had dramatic improvements in my worst symptom – crippling fatigue – before I even saw the optometrist and I noticed rapid improvement in the weeks following starting the buffalo protocol.

I had tried regular aerobic exercise – jogging – in the past with no significant improvement in my symptoms. What convinced me to give it another go was reading this scientific article about PCS: I can't post links but google "Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging" for the article

To make a complicated article overly simple the idea is that a key pathophysiological aspect of PCS is dysfunctional regulation of cerebral blood-flow. This dysfunctional autoregulation of blood flow in the brain is what causes the exercise intolerance seen in pretty much everyone with PCS. And the idea is that the brain can learn to functionally regulate blood-flow again in response to chronic, graded exercise.

Now when I had previously attempted exercise in the past I had only done light-jogging about 20 minutes a day. In the beginning even light-jogging would exacerbate my symptoms (I’d get a headache while jogging) but after 2-3 weeks of jogging everyday I could jog at a slow pace without exacerbation of symptoms. However, I noticed no improvement in my PCS symptoms and stopped. What I never bothered to do back then because I had never read about the buffalo protocol (I was simply advised that ‘exercise can help with PCS recovery’) was to increase the intensity of my exercise, i.e. to do activity at a higher and higher heart-rate.

It’s not enough to get used to doing a light-jog without exacerbating PCS symptoms. You must be able to get to maximum capacity at close to 100% heart-rate like a normal person without getting symptoms. Or at least that’s the goal.

The Buffalo protocol is basically gradually increasing your heart-rate while running on a tread-mill.

I practiced an exercise regimen of jogging outside at faster paces and adding multiple, short bursts of sprints, 20-30 minutes a day, every-day.

I was sprinting within a week of starting the regimen and at first I would get very severe symptoms: the first 3-5 days of sprinting gave me splitting headaches that would last for many hours after exercise.

But I persisted (taking a days break every 2-3 days in the beginning).

And after about 3 weeks I began to notice something:

The symptoms that I would get after intense exercise became less severe. The headaches decreased in severity and soon lasted for an hour or two rather than all-day. And as this was happening I noticed my crippling fatigue getting better and the brain fog lifting. A month before I started the Buffalo protocol I needed a nap after walking to town for shopping and a month after I could do a normal day like I used to be able to before my concussion again.

I am at the point now where I can exercise intensely at maximum capacity (sprinting with breaks for 20 mins) and only get a mild headache that lasts 30 minutes at most. And I have only mild residual visual problems.

But the resting headaches are gone, the fatigue is gone, the fog is gone. I have been a functional human being for over a month now.

The scientific article I linked to is also what the Cognitive FX centre base their treatment programme on but I managed to almost resolve my PCS on my own by simply running outside for a month and seeing a competent optometrist that charged me 1/10 of what Cognitive FX do. This after like 9 months of suffering from unremitting post-concussion syndrome that just didn’t get better on its own.

I encourage anyone with post-concussion syndrome to give the Buffalo protocol a serious attempt for at least a few weeks until you can do intense exercise and to see a competent vestibular therapist and/or behavioural optometrist.