Cause and prognosis of persistent symptoms

• The cause of longer-term symptoms in people with minor head injury is not yet known, but there is little evidence to suggest a neurological basis. The minor symptoms described are consistent with expert opinion from a review article [Alves et al, 1993].
• Most people who have persistent symptoms recover within 3 months, but about 8% have symptoms for at least a year, and sometimes symptoms are permanent. Up to 14% of people are disabled and can not work due to persistent symptoms [Binder, 1997].
• Hypopituitarism can result from a traumatic brain injury (particularly a severe injury) and is estimated to occur in 15–25% of survivors [Ghigo et al, 2005; Agha and Thompson, 2006; Klose et al, 2007].

Psychological intervention

• The recommendation for provision of psychological interventions (including reassurance, information provision, and advice) is based on expert opinion in a review article [King, 2003].
• This is supported by evidence from a placebo-controlled trial (n = 218) that showed that intervention in the form of reassurance and education given within the first few weeks of minor head injury significantly improves post-concussion symptoms. In the study there was significantly less social disability (p = 0.01) and less severe post-concussion symptoms (p = 0.02) at follow up 6 months after injury in the active intervention group [Wade et al, 1998].