HBOT studied for persistent post-concussive symptoms in athletes, military veterans, and civilians. Protocol pressure appears to be a major determinant of outcome.
HBOT Hub — http://localhost:3003/conditions/concussion · Printed October 11, 2026 · Neurological · Sports medicine · Military
GRADE Evidence Rating
Quality: ModerateWeak recommendation
Same evidence base as TBI (Boussi-Gross, Tal, Harch). Response rates 60–80% in Efrati Lab trials.
Overview
HBOT for post-concussion syndrome has been studied in both sports medicine and military contexts. Results are mixed: Department of Defense trials (2010s) failed to show benefit, but subsequent civilian trials with longer protocols and 2.0 ATA (vs 1.5 ATA DoD) showed significant improvement. Protocol design appears to be a major variable.
How HBOT Works
Mechanisms overlap with TBI generally — angiogenesis in persistently hypoperfused brain regions, reduced neuroinflammation, improved mitochondrial function, and HIF-1α-driven repair signalling. SPECT imaging in post-concussive patients consistently shows regional hypoperfusion that normalises with HBOT in responders.
Clinical Protocol
Typical protocol
40 sessions at 2.0 ATA, 90 minutes each
Evidence level
Mixed RCTs — Protocol-dependent
FDA / regulatory status
Not FDA-approved
Civilian/Efrati-protocol PCS treatment: 40 sessions at 2.0 ATA over 8 weeks, with pre- and post-course cognitive and functional assessment. Dod-protocol: 40 sessions at 1.5 ATA (less consistently effective).
Cautions & Considerations
Protocol pressure matters — 2.0 ATA has stronger evidence than 1.5 ATA.
Off-label and typically cash-pay.
Not a substitute for standard concussion management.
Response variable; not all patients benefit.
Key Research
Harch et al. 2012
Wolf et al. 2012 (negative DoD trial)
Hadanny et al. 2020
Harch et al. 2017 (veterans)
Indexed studies
Hyperbaric Oxygen Therapy Can Improve Post-Concussion Syndrome Years After Mild Traumatic Brain Injury (2013, Level 2, 1.5 ATA) — PMID 23441039
Hyperbaric Oxygen May Induce Angiogenesis in Patients with Prolonged Post-Concussion Syndrome (2017, Level 2, 2 ATA) — PMID 28234660
Questions to Ask Your Doctor
Am I a candidate for HBOT for this condition given my medical history and current treatments?
What pressure (ATA) and session count would you recommend, and why?
Is treatment at this centre UHMS-accredited? What is the chamber type (monoplace or multiplace)?
What is the expected response rate and typical timeline for improvement?
What are the specific contraindications and side-effect risks in my case?
What is the expected cost and insurance coverage status?
What alternative or complementary treatments should I consider?