THE TRUTH ABOUT CONCUSSION RECOVERY: WHY SOME HEAL FASTER THAN OTHERS
You’ve probably seen it before—one person gets a concussion and is back to normal in a week, while someone else is still struggling months or even years later. Same type of injury, completely different recovery timelines.
So what’s going on? Why do some people bounce back quickly while others feel stuck in an endless cycle of brain fog, dizziness, and headaches?
The answer isn’t simple, but it’s also not random either. In this article, we’re breaking down the key factors that influence concussion recovery—from brain metabolism to pre-existing conditions, and even genetics.
1. The Energy Crisis in the Brain
After a concussion, your brain enters an energy crisis. This impact disrupts normal cellular function, leading to a sudden and significant spike in energy demand.
“It was reported that there was a 30–46% increase in neuronal glycolytic rate about 30 min after injury”
For most people, this energy imbalance gradually resolves within a few weeks, allowing the brain to return to normal function. But in others, this process is delayed, keeping them in a prolonged state of brain fatigue, fog, and poor function.
Factors that can worsen this energy crisis:
Overexerting too soon – Trying to "push through it" before your brain has the fuel it needs
Poor sleep – Sleep is when your brain restores its energy balance
Nutrient deficiencies – The brain relies on key nutrients like omega-3s, magnesium, and B vitamins to heal
Reduced physical activity – Emerging research suggests that early, light physical activity (like walking) can actually speed up the resolution of this energy crisis
To learn more about the energy crisis that takes place following a concussion check out our blog entitled: WHAT ACTUALLY HAPPENS TO YOUR BRAIN DURING A CONCUSSION?
2. Blood Flow & Oxygen: The Recovery Bottleneck
During this energy crisis, the brain’s demand for oxygen sky rockets but cerebral blood flow takes a hit, dropping at the worst possible time. Blood carries oxygen so just when your brain is desperate for fuel, its supply gets cut off—making recovery even harder.
“Cerebral blood supply has been demonstrated to be reduced by up to 50%.”
Your brain’s ability to restore normal blood flow is a major factor in how quickly you recover.
Fast recovery: If blood flow returns to normal quickly, your brain can clear waste, deliver oxygen, and replenish energy levels efficiently.
Prolonged recovery: If blood flow remains dysregulated, recovery stalls. This can lead to ongoing headaches, brain fog, dizziness, and light sensitivity.
Some people may also experience autonomic nervous system dysfunction (dysautonomia) post-concussion, which affects blood flow regulation and contributes to exercise intolerance, heart rate issues, and lightheadedness.
What helps?
Light aerobic exercise (like walking or stationary cycling) can help restore normal blood flow
Blood pressure management
Hydration & electrolytes support proper circulation and brain function
To learn more about the how to restore blood flow to your brain following a concussion check out our blog entitled:
3. Pre-Existing Conditions & Brain Resilience
Not all brains are starting from the same baseline. Some people have underlying factors that make them more vulnerable to prolonged concussion recovery, and two of the most important concepts here are brain reserve and cognitive reserve.
Brain Reserve: How Much “Brain” You Have to Lose?
Brain reserve refers to the actual size of your brain and the number of neurons you have. Think of it as your brain’s structural resilience—the more neurons you start with, the more you can afford to lose before noticeable symptoms appear.
“Clinical symptoms of disease occur after a certain fixed pathological threshold has been met, which may vary per person because in individuals with more brain reserve, it will typically take longer before this threshold is met as there is more to lose.”
Imagine you and a friend both take a financial hit. If you have $100 and lose $2, you barely notice. But if you only have $10, losing $2 is a much bigger deal. Your brain reserve works the same way—the more you start with, the more buffer you have before symptoms appear.
This explains one reason as to why two people can experience the same concussion but have vastly different recoveries. Someone with low brain reserve might feel the effects immediately and severely, while someone with high brain reserve could sustain the same injury and hardly notice a difference—until they reach their personal threshold.
Cognitive Reserve: How Sharp You Were to Begin With?
Cognitive reserve, on the other hand, refers to your actual cognitive abilities—because just having a big brain doesn’t necessarily mean you’re firing on all cylinders.
This reserve is shaped by lifetime experiences, including:
“The highest achieved educational level, occupation, physical activity, leisure activities, and social engagement. In fact a meta-analysis of 15 prospective cohort studies showed that dementia risk was reduced by 7% per year increase in education.”
Imagine you’ve heard the saying "use it or lose it," and this is exactly why some people can take a cognitive hit and still function at a high level, while others struggle with basic tasks. For example, someone who’s spent decades working in a mentally demanding job or engaging in learning-based activities has built a cognitive “safety net.” When they sustain a concussion, their cognitive decline may feel dramatic to them, but they might still be outperforming the average person.
That’s why some patients will report feeling slower, more forgetful, or mentally foggy, but when they take objective cognitive tests (like the Montreal Cognitive Assessment), they don’t score that poorly. This is where subjective cognitive impairment comes into play. If someone was once highly sharp and quick-witted, even a mild decline can feel devastating—whereas for someone who started off slower, that same decline might not even register.
Dr. Ted Carrick once put it best:
“Your level of dopey may not be my level of dopey.”
Meaning—if you’ve always been sharp, quick-witted, and high-performing, even a small decline in cognitive function will feel massive. But if someone was already struggling cognitively, that same decline might not even be noticeable.
Other Factors That Increase the Risk of Prolonged Recovery
Beyond brain and cognitive reserve, certain medical and personal history factors have been statistically linked to prolonged concussion recovery.
1. Prior Concussions
If you’ve had a concussion before, your risk of a longer recovery increases—and the more concussions you’ve had, the higher that risk climbs.
One prior concussion? You’re about 19% more likely to have a prolonged recovery compared to someone with no concussion history. (PMID: 36104148)
Two concussions? Your risk jumps to about 36% higher. (PMID: 36104148)
Three or more? Now your odds of an extended recovery are 50% higher than someone with no history of concussions. (PMID: 36104148)
Why does this happen? Every concussion disrupts the brain’s ability to recover efficiently, and if the brain hasn’t fully healed from a previous injury, the next one can compound the damage.
Think of it like rolling your ankle—the first time, it heals pretty well. But if you keep spraining it over and over, it becomes weaker, more unstable, and takes longer to bounce back each time. The brain works the same way. This is why athletes, military personnel, or anyone with a history of multiple head injuries need to be extra careful. The effects add up over time, making each concussion more difficult to recover from.
2. Higher Initial Symptom Severity
One of the biggest predictors of how long a concussion recovery will take is how bad you feel in the first few day safter the injury.
Mild to moderate symptoms? If your post-concussion symptom (PCS) score falls between 21-60, your risk of a prolonged recovery is nearly 2.5 times higher compared to someone with a lower symptom burden. (PMID: 36104148)
Severe symptoms? If your PCS score is above 60, your risk of an extended recovery is almost 3 times higher than someone with milder symptoms. (PMID: 36104148)
Why does this happen? The more intense your initial symptoms, the more likely your brain has sustained a greater level of metabolic disruption, inflammation, and blood flow dysregulation—all of which slow down healing.
Think of it like getting the wind knocked out of you. If it’s a minor hit, you might catch your breath and recover quickly. But if it’s a major blow, it takes longer to stabilize, and you feel the aftereffects for much longer. Takeaway being, how you feel in those first few days matters. If symptoms hit hard and don’t improve, it’s a sign that your brain is dealing with a heavier load—and your recovery may take longer.
3. Age
Age plays a role in concussion recovery, and research shows that older adolescents (15-18 years old) are at higher risk for prolonged recovery compared to younger teens.
Teens aged 15-18 are about 11% more likely to experience a longer recovery than their younger counterparts. (PMID: 36104148)
Why does this happen?
Brain Development: The adolescent brain is still maturing, meaning it’s more vulnerable to injury and takes longer to recover.
Hormonal Changes: Fluctuations in hormones like cortisol and growth factors can impact brain healing and inflammation.
Increased Stress Response: Older teens often face higher academic, social, and athletic demands, which can exacerbate symptoms and slow recovery.
Think of it like recovering from a muscle injury. A younger child, whose body is more adaptable, might heal quickly, while an older teen, with more physical stress and greater physiological demands, takes longer to fully recover. The same concept applies to the brain.
4. ADHD & Anxiety Disorders
Pre-existing conditions like ADHD and anxiety don’t just impact daily life—they can also make concussion recovery take longer.
ADHD increases the risk of prolonged recovery by about 14% compared to individuals without ADHD. (PMID: 36104148)
Anxiety disorders increase the risk of extended recovery even more—by approximately 47%. (PMID: 36104148)
Why does this happen?
ADHD affects dopamine regulation, which plays a key role in cognitive function, focus, and emotional regulation. When the brain is already struggling to process information efficiently, a concussion can make symptoms feel even more overwhelming.
Anxiety increases cortisol (the stress hormone), which has been shown to heighten concussion symptoms and prolong recovery. When the nervous system is in a constant state of fight-or-flight, the brain has a harder time shifting into recovery mode.
Patients with ADHD or anxiety may need a more structured and individualized recovery plan, including cognitive pacing, stress-reduction strategies, and targeted therapy to help avoid prolonged symptoms. Managing these underlying conditions can make a significant difference in how quickly and smoothly concussion recovery progresses.
This is why concussion treatment should never be one-size-fits-all—it has to be tailored to the individual.
4. Inflammation & Immune Response
After a concussion, your brain activates an immune response, releasing inflammatory molecules to help with repair. But in some cases, this inflammation doesn’t shut off properly, leading to persistent brain fog, fatigue, and mood changes.
What can contribute to high inflammation?
Poor gut health – The gut and brain are closely connected, and post-concussion gut issues can increase inflammation
Diet – Highly processed, inflammatory foods (like sugar and seed oils) can worsen symptoms
Lack of sleep – Sleep is crucial for clearing out brain inflammation
How to reduce post-concussion inflammation:
Anti-inflammatory diet – Focus on omega-3s, antioxidants, and whole foods
Good gut health – Probiotics and fiber-rich foods can help regulate the immune response
Prioritize deep sleep – Your brain clears out inflammation during deep sleep cycles
5. Genetics & Individual Variability
Some people are just genetically wired for slower brain recovery due to differences in brain metabolism, inflammation response, and neuroplasticity.
For example, variations in the ApoE4 gene have been linked to worse outcomes after brain injuries because it affects how well the brain clears out waste and repairs itself.
While we can’t change our genes, we can optimize the things that influence them—like nutrition, lifestyle, and targeted rehab.
Final Thoughts
At the end of the day, concussion recovery isn’t just about the initial hit—it’s about everything that happens afterward.
Fast recoveries tend to happen when:
✔ Blood flow returns to normal quickly
✔ The brain’s energy crisis resolves efficiently
✔ Inflammation is well-regulated
✔ The person doesn’t have pre-existing vulnerabilities
Prolonged recoveries happen when:
❌ The brain stays in an energy crisis
❌ Blood flow remains dysregulated
❌ Inflammation lingers and disrupts function
❌ Pre-existing conditions complicate healing
If you’re still struggling with post-concussion symptoms, it’s not just bad luck—there are real reasons behind it, and more importantly, real solutions. If you’re tired of feeling stuck, let’s figure out why and get you back on track.
Download my free Concussion Recovery Guide – A step-by-step breakdown of what to do and what to avoid to support healing.
Schedule a free consultation – If you’re still dealing with symptoms, let’s chat. I’ll listen to your story, assess your situation, and see if I can help—or point you in the direction of someone who can.
