In his editorial King (Reference King2003) gave an excellent overview of the post-concussion syndrome, an area of neuropsychology and psychiatry that is fraught with difficulty and controversy. King pointed out that both biological and psychological factors are at play in post-concussion syndrome. Of great importance was his integration of time since injury into a model and outlining ‘windows of vulnerability’ for the development of symptoms. It is likely that most clinicians treating patients with post-concussion syndrome will find this model of real value for understanding and possibly preventing some of the difficulties resulting from the syndrome.

King rightly pointed out the need for studies investigating treatment and management of post-concussion syndrome. New and future research findings now need to be incorporated into King's model. For example, Ponsford et al (Reference Ponsford, Willmott and Rothwell2002) in a randomised controlled trial found that the provision 1 week post-injury of an information booklet to patients who suffered a mild head injury reduced anxiety and reporting of ongoing problems at 3 months post-injury. Against a background of ‘windows of vulnerability’ for the development and maintenance of symptoms, providing written information to patients in addition to the early interventions reviewed by King can further improve outcome in post-concussion syndrome.

A recent example identifying a potential lack of evidence for an intervention perhaps also needs mentioning. De Kruijk et al (Reference De Kruijk, Leffers and Meerhof2002) investigated the effect of bed rest on outcome following mild traumatic brain injury. Bed rest has been recommended as an intervention to improve outcome following head injury; however, the effectiveness of this intervention has not been investigated. De Kruijk and colleagues did not find significant differences in outcome between their bed rest and no bed rest groups at 3 months post injury. However, they concluded that bed rest might have some palliative effect during the initial weeks following injury.

New and future research findings on management, integrated into King's model, can potentially enhance the prevention of chronic symptomatology developing in post-concussion syndrome. This might also inform our understanding of cases where post-concussion symptoms persist beyond 1 year following injury.