All You Need to Know About Concussions

There isn’t any specific medicine to treat concussions but over-the-counter pain relievers and sometimes medicines for sleep or anxiety can help.

By Eva Briggs

Mild traumatic brain injuries, also known as concussions, occur anytime of the year. However, as kids return to school and sports this fall, I’ll be seeing more head injuries at the urgent care.

There is no one universal definition of concussion. Most definitions state that a concussion is caused by direct or indirect force to the brain, producing neurologic symptoms, not explained by some other cause.

So first, the direct injury to the head, face or neck must occur shortly before the onset of symptoms. The neurologic symptoms usually start right after the injury, but can evolve over minutes to hours.

Symptoms can be physical, cognitive (thinking and reasoning), emotional or behavioral.

Physical symptoms include blurred vision, dizziness, fatigue, headache, lightheadedness, sensitivity to noise and light, nausea, numbness and tingling, ringing ears and vomiting.

Cognitive symptoms include confusion, amnesia, trouble concentrating or memory, disorientation, feeling slow or foggy, trouble focusing, loss of consciousness and slurred speech.

Examples of emotional and behavioral symptoms include sleep disturbances, drowsiness, anxiety, cleanness, irritability, sadness, and personality changes.

Concussion arises from forces that disrupt nerve cell membranes. This allows potassium to flow out of the cells into the extracellular space, and also permits increases in calcium and certain amino acids to leak out of brain cells. As the body attempts to restore balance, blood flow to the brain may decrease. These disruptions can persist for several weeks. During this time the brain has increased susceptibility to damage from any further injury.

Because these changes occur at the microscopic level, imaging test like CAT scan or MRI are not needed, and indeed don’t show abnormalities.

Medical providers only order these tests when symptoms suggest structural damage to the brain. Most children who have a concussion do not need a CAT scan, which exposes the brain to unnecessary radiation with its potential long-term consequences.

Recovery from concussion can take days, a few weeks or even months. Some patients’ symptoms resolve within 72 hours. Most adults recover in about two weeks and children take one to three months. But for some people concussion symptoms persist longer.

Unfortunately, there is no way to predict which patients will have a prolonged recovery. Loss of consciousness and amnesia, and other symptoms are not clearly associated with the length of time it takes to get better. In general, the more severe the initial symptoms, and a history of prior concussion, portend slower recovery. Symptoms of fatigue, early onset headache, amnesia, disorientation, also are associated with prolonged recovery.

After an initial evaluation, concussion patients can return home with a responsible caretaker when medically stable and have access to follow-up medical care. The first stage of recovery is cognitive rest for 24 to 48 hours. This translates to avoiding activities that require attention or concentration: text messaging, video games, television, computer use and schoolwork.

Patients also require physical rest for 24 to 48 hours, avoiding any activity that makes their symptoms worse: aerobic exercise, weightlifting, and household chores.

Treatments that can help include sunglasses for light sensitivity, earplugs or noise-canceling headphones for sound sensitivity. Medicines such as over-the-counter pain relievers and sometimes medicines for sleep or anxiety, can help. There isn’t any specific medicine to treat concussions.

After the initial period of rest, patients can slowly transition back to school, exercise and other activities. The patient’s family, caregivers, medical provider and school personnel all need to work together plan a gradual return to activity.

Some measures to prevent concussion include the use of protective gear. Helmets and mouth guards reduce overall head and dental injuries, but it’s not clear how much they reduce the risk of concussion. Adhering to the sports safety rules, discouraging excessively aggressive playing styles, and early recognition of symptoms are important. Most states now have laws requiring concussion education for coaches, athletes and their parents. After a possible concussion, athletes should resume play only after cleared by a licensed medical professional.

Eva Briggs is a medical doctor who works at two urgent care centers (Central Square and Fulton) operated by Oswego Health.