Can Lyme Disease Cause Persistent Post-Concussion Symptoms?

When concussion symptoms persist
Could Lyme disease be a contributing factor?
Lessons from a chronic PCS study

Persistent post-concussion syndrome (PCS) can include headaches, dizziness, fatigue, irritability, and difficulty concentrating long after a traumatic brain injury. Researchers at the Azzolino Clinic questioned whether some patients with chronic PCS might also have undiagnosed Lyme disease contributing to their ongoing symptoms.

Researchers at the Azzolino Clinic in San Francisco, California identified an alarming number of individuals suffering from post-concussion syndrome who were refractory to care and had serologically tested positive for Lyme disease. Their observations raised an important clinical question: could some persistent post-concussion symptoms be related to an ongoing, previously unrecognized tick-borne infection?

Why Lyme Disease and Post-Concussion Syndrome Can Look Similar

Lyme disease and post-concussion syndrome share many overlapping symptoms, including headaches, dizziness, fatigue, irritability, brain fog, memory problems, and difficulty concentrating. This overlap can make diagnosis challenging, particularly when symptoms persist long after the original injury.

For additional discussion of cognitive symptoms, see brain fog and Lyme disease.

“Furthermore, we have witnessed a dramatic improvement in function and reduction in disability following treatment of these patients,” writes Azzolino and colleagues.

The authors, based on their observations, wondered: What is the prevalence of Lyme disease and co-infections in PCS patients, specifically in those who are still symptomatic at least 1 year after their traumatic brain injury?

And could symptoms be due to an “ongoing undiagnosed and untreated Lyme disease or associated co-infection?”

Azzolino and colleagues identified 217 PCS patients who did not respond to TBI treatment and had tested positive for Lyme disease by IgM Western blot using IGeneX laboratory.

[bctt tweet=”Study looks at the prevalence of Lyme disease in patients with post-concussion syndrome, who do not respond to treatment.” username=”DrDanielCameron”]

Study Findings

To be included in the study, patients had to have at least one PCS symptom (e.g., headache, irritability, dizziness, vertigo, difficulty concentrating) for more than one year and a negative brain computed tomography (CT) or magnetic resonance imaging (MRI) scan.

Participants were excluded if they had previously tested positive for Lyme disease and/or co-infections, had received two weeks of antibiotics since the date of injury, had been diagnosed with a primary neurological illness (e.g., seizure disorder or multiple sclerosis), or had post-stroke syndrome.

Out of the 217 patients, “38% had a positive Western blot IGeneX IgM.”

These findings raised the possibility that Lyme disease may be an overlooked contributor in some patients with persistent post-concussion symptoms.

“There was a statistically significant relationship of a positive Western blot IGeneX IgM predicting chronic PCS,” writes Azzolino.

“It is likely that [antibiotic treatment for Lyme disease] could also alleviate symptoms such as cognitive disturbances, dizziness, and fatigue,” writes Azzolino.

Additionally, “Given the cost of interventions for PCS, the diagnosis and treatment of co-morbid infections could prove to have a significant impact on the standard of care of PCS.”

Clinical Perspective

Patients with persistent post-concussion syndrome often report symptoms that overlap with neurologic Lyme disease, including headaches, dizziness, fatigue, cognitive difficulties, and impaired concentration. While this study does not establish causation, it raises important questions regarding the role of tick-borne infections in selected patients whose symptoms remain unexplained despite standard concussion care.

For additional discussion of persistent symptoms, see persistent Lyme disease symptoms.

Frequently Asked Questions

Can Lyme disease cause symptoms similar to post-concussion syndrome?

Yes. Lyme disease may cause headaches, dizziness, fatigue, brain fog, memory problems, and difficulty concentrating, which can overlap with symptoms reported in post-concussion syndrome.

What did this study find?

The study reported that 38% of chronic post-concussion syndrome patients in the cohort had a positive IGeneX IgM Western blot. The authors suggested that additional research is needed to better understand this association.

Can treating Lyme disease improve persistent post-concussion symptoms?

The authors proposed that treatment of Lyme disease could potentially improve symptoms such as fatigue, dizziness, and cognitive dysfunction in some patients. However, additional studies are needed.

Did the study prove Lyme disease caused post-concussion syndrome?

No. The study identified an association but did not establish that Lyme disease caused persistent post-concussion symptoms.

Clinical Takeaway

This study raises the possibility that some patients with persistent post-concussion syndrome symptoms may also have undiagnosed Lyme disease or tick-borne co-infections. However, the findings should be interpreted cautiously because the study relied on a positive IGeneX IgM Western blot without confirmatory IgG testing.

Persistent headaches, dizziness, fatigue, and cognitive symptoms following concussion may warrant a broader evaluation when recovery does not follow the expected course.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention