The news has recently been filled with stories of the consequences of head trauma on athletes. This increased attention has been triggered by many reports of dementia, depression, and even suicide among former professional football players. There is no question but that athletes, current and former, deserve significant attention in this regard, since the effects of recurrent concussions are quite severe.

Frankly, concussion has been a “silent” and ignored epidemic for too many years. However, it is important for physicians and patients to realize that concussions and their myriad of consequences are not confined to athletes. Head injury is a very common problem in the general population. The two groups at highest risk for concussion are adolescents/young adults and older adults. The most common causes of concussion include car accidents, falls, and sports-related injuries. (See last week’s Medical Monday post, “A Concussionary Tale,” for a jolting account of what a concussion feels like.)

The word concussion itself is often confusing to people. Many physicians prefer the term “minor traumatic brain injury,” because it is more specific. Concussions come in different shapes and sizes, and despite what you may have heard, many concussions occur without any loss of consciousness. In its most mild form, a Grade 1 concussion is associated with no loss of consciousness and less than 15 minutes of confusion or feeling dazed. Many times, the immediate symptoms of concussion are ignored by the injured person because they are not considered that serious.

Even in mild injuries, however, the brain sustains trauma, and this leads to a cascade of chemical events in the brain that can cause longer-lasting symptoms. These “post-concussion” symptoms commonly include headache, confusion, memory problems, fatigue, insomnia, dizziness, and blurry vision. Many patients report that they feel as if they are “walking in a fog”—they feel “slower,” and concepts seem harder to grasp. Some patients do not even recall a head injury, because the trauma may have induced a transient amnesia for the event.

The good news is that in 85 percent of patients, these post-concussion symptoms eventually resolve. However, in 15 percent of cases, symptoms may be persistent and disabling.

The Best Treatment of Concussion Is Prevention

Of course we cannot expect the general population to walk around wearing helmets, but many steps can be taken to avoid concussion. These include wearing a seat belt, never driving under the influence of any alcohol, wearing helmets when riding a bicycle, and making sure to avoid falls.

If you have a relative or loved one with balance problems, it is imperative that you perform a home safety evaluation to ensure that the environment can be made safer for those prone to falling. This includes the installation of grab bars, non-slip mats, and the removal of tripping hazards. These small steps can prevent a major catastrophe.

If head trauma does occur, look for any signs of confusion, attention difficulties, or memory problems, as well as any personality changes or physical symptoms. If any of these are present, or if in doubt, please seek medical attention. Emergency evaluation should be sought if there is any nausea, vomiting, confusion, headache, or any loss of consciousness, since these may suggest bleeding within the skull. 

Prescription: Don’t Overtax the Brain

In my experience, the best treatment of post-concussion syndrome is time and rest. Most patients improve with time and patience. Like any injury in the body, the injured area should not be overtaxed. For the brain, overtaxing includes stress, exercise, and alcohol. Many patients will feel better after a concussion, only to have recurrence of all of their symptoms during a stressful workweek or when they have a few glasses of wine. Baby steps should be taken to see what the brain can handle—usually I have patients resume normal activities in slow, graduated steps, one week at a time. If they develop symptoms during the process, I have them go back to the activities of the previous week for another week or two.

Most people will find that it takes one to two months to feel “normal” again. It may take less or more time. Medications can be used to treat some of the symptoms, but I tend to avoid them, because masking the symptoms will often cause a patient to miss the cues that they should take a step back, and may hinder recovery if they allow patients to do more than they can handle. Of course, for those with persistent symptoms who need to return to their lives as best they can, a combination of medications and coping strategies is appropriate.