CONDITIONS

What Is Concussions and Common Head Injuries

Concussions and common head injuries are especially concerning as they influence one of the most vital organs of the body –the brain. This is the organ that makes us who we are. Our personality, emotions, and critical thinking are all located within the brain. As a result, injuries to the brain can be devastating for both the person who has sustained the injury, as well as for their family.


Brain injuries can be classified in two categories: traumatic brain injuries and acquired brain injuries.

  • Traumatic brain injuries are an injury to the brain, which is caused by an external force after birth. Acquired brain injuries include all types of traumatic brain injuries, and also brain injuries caused after birth by stroke and loss of oxygen to the brain (hypoxic brain injury).
  • Acquired brain injuries, however, do not include degenerative brain conditions like Alzheimer’s Disease or Parkinson’s Disease.

Traumatic brain injuries include:

  • Concussions. Concussions, which are also known as mild traumatic brain injuries, occur with a traumatic event that alters the way your brain functions. According to the Mayo Clinic, these effects are usually temporary, but can include: headaches, problems with concentration, memory, balance, and coordination. Concussions can occur from a “blow to the head,” a fall, or when the body or head is violently shaken. Often times, a person may temporarily lose consciousness after the traumatic event. Concussions are especially common in those who participate in contact sports, like football. Although concussions do damage the brain, the vast majority of patients with concussions recover fully. Those who do not recover completely may suffer from various other complications, which include epilepsy (seizures), post-concussion syndrome (concussion symptoms that last for weeks to months), chronic headaches, and vertigo (feeling of spinning or imbalance).
  • Contusions. Contusions result from direct impact on the brain, which causes a bruise or bleeding within or on the brain. Large contusions may need to be surgically removed.
  • Coup-contrecoup. This type of injury occurs when there is brain damage at the site of impact as well as at the opposite side due to the brain making contact within the side of the skull secondary to momentum of the initial trauma.
  • Diffuse axonal. These injuries occur with strong rotational or acceleration forces, which can occur in car accidents or in a patient with shaken baby syndrome. Diffuse axonal injury results in tears within the brain as it lags behind the quick movement of the skull. The extensive nerve tearing causes various chemicals to be released within the brain that eventually cause more damage to the brain. Diffuse axonal injury can cause temporary or permanent damage and even coma and death.
  • Penetrating injury. Occurs when a bullet, knife, or other object enters the skull and injury the brain, often times forcing hair, bone, or other debris inside the skull/brain as well. Firearms are the single most common cause of death from traumatic brain injury.

Acquired brain injuries occur after, or secondary to, strokes, tumors, hypoxia (decreased levels of oxygen), anoxia (lack of oxygen), toxins, degenerative diseases, near drownings, and other conditions not necessarily caused by external forces.

What Causes Concussions and Common Head Injuries

Concussions and other common head injuries are caused by trauma. As the various mechanisms described above deliver mechanical forces and energy to the skull, it is eventually transmitted to the brain.

When the cells of the brain, called neurons, are disrupted by this energy, the delicate connections are damaged. As a result, there are leaked neurotransmitters that cause the brain to become overly active (which may cause a seizure). In addition, these injuries cause significant swelling due to fluid leaking from blood vessels and the neurons themselves leaking their contents. As the brain is located within a fixed volume space (the skull), swelling and the resultant increase in pressure further damages brain structures. Furthermore, these injuries can cause significant bleeding, which further increases pressure within the brain and skull and disrupts oxygen and nutrients from supplying the delicate brain tissue. Unlike many other tissues within the body, the brain does not recover from damage as effectively. As a result, there may be permanent neurological deficits, such as mood changes, personality changes, decreases in strength, decreases in sensation, and many other symptoms.

Risk Factors For Concussions and Common Head Injuries

Risk factors for concussions and other head injuries include:

  • Participation in contact sports, such as football, hockey, soccer, rugby, boxing, and others. Risk is further increased if proper protective gear is not worn.
  • Involvement in a motor vehicle collision
  • Involvement in a pedestrian or bicycle accident
  • Being a soldier in combat
  • Being a victim of physical abuse
  • Falling, which is particularly common in the young and the elderly
  • Having had a previous head injury or concussion

Diagnosing Concussions and Common Head Injuries

A diagnosis of concussion or other brain injury will likely start with a visit to your primary care physician, who will obtain a thorough medical history and then perform a physical examination, which will include a detailed neurological exam. During the neurological exam, he or she will assess your hearing, vision, strength, sensation, balance, coordination, memory, concentration, and reflexes.

In addition to the history and physical, he or she will then utilize any of the following tools to arrive at a diagnosis:

A CT scan also uses x-rays to generate an image, but it has several advantages compared to the simple x-rays. It will show the precise location, shape, and size of masses, blood collections, and other abnormalities. In order to obtain even sharper images, some patients are asked to drink or receive IV contrast. This contrast makes some tissues appear brighter, which makes the images and the structures more apparent and easier to discern. Allergies to contrast medium may cause hives, flushing, shortness of breath, and low blood pressure. If you have had a reaction to contrast before, you should inform your physician. In addition to masses (such as cancers), it can show enlarged lymph nodes, which may have cancer cells. Many patients will also have CT scans of the chest, abdomen, brain, and extremities as traumatic brain injuries often occur in the setting of other injuries. A CT scan may also be used to obtain biopsies of masses or cancers or drain collections that lie deep within or nearby other vital structures, which is termed CT guided needle biopsy.

A magnetic resonance imaging (MRI) study also provides detailed soft tissue “pictures.” As opposed to CT scans, which utilizes x-rays, MRIs use magnetic radio waves to generate images. MRIs are particularly useful for imaging the brain and spinal cord. Gadolinium, a contrast, is often used to produce even better MRI images. A specific MRI scan called an MRA uses contrast to assess blood vessels, which may be supplying nutrients to the cancerous tissue.

As head injuries may worsen very quickly and can evolve over many hours, your physician may elect to have you admitted to the hospital for a period of observation. During this time, the medical team will perform regular neurological examinations and ensure your condition does not deteriorate. Once deemed stable, you will likely be discharged under the care of your family and advised to follow-up as an outpatient.

Symptoms of Concussions and Common Head Injuries

Symptoms of a concussion and other common head injuries include:

  • Headache
  • Dizziness
  • Nausea
  • Loss of memory, or amnesia
  • Loss of coordination, known as ataxia
  • Loss of vision
  • Bleeding
  • Vomiting
  • Seizures
  • Ringing in the ears, known as tinnitus
  • Slurred speech
  • Fatigue, or lethargy

Prognosis

Prognosis refers to the likely course of a disease or ailment. To determine the prognosis of a concussion and other common head injuries, a definitive diagnosis is required. Once a diagnosis is confirmed, your physician can determine your individual prognosis based upon your condition as well as your baseline medical condition and functioning.

A simple concussion treated with adequate rest will usually lead to full recovery. In addition, small brain bruises or bleeds that are treated quickly, also have a promising prognosis. Extensive head injury that is not treated promptly carries a very poor prognosis as the brain controls many vital functions for life, such as heart rate, blood pressure, and breathing.

Living With Concussions and Common Head Injuries

People with concussions and other common head injuries not only face physical challenges, but also mental and emotional challenges. It is important to understand your illness and treatment as it can make you feel more in control. Taking care of your emotional health is also vital. Family and friends can be an important source of support for you during this challenging time. Previously simple tasks may prove much more difficult or impossible following brain injury. Thus, support from loved ones may prove critical for day-to-day activities and enjoyment.

In addition, it is helpful to consider the following:

  • Explore all treatment options. Educate yourself on potential treatment methods and ask your doctor questions. Be sure to seek out reliable sources both online and in print. See the resources section for sources of information on brain cancer.
  • Weigh the benefits and risks of each treatment options. Ask yourself what the aim of your treatment should be, and what you wish to accomplish as you live with the disease.

Screening

The U.S. Preventive Services Task Force (USPSTF) is an excellent source of information regarding screening of various medical conditions. However, the USPSTF does not currently recommend any type of screening for concussions or other common head injuries.

Prevention

Unfortunately, there is no guaranteed preventative method to stop concussions and other common head injuries from developing. However, the earlier these conditions are diagnosed, the better. Brain injuries are often very time sensitive and the earlier they are treated, the higher the likelihood of ideal outcomes.

To minimize the chance of a concussion and other head injuries, it is recommended that you:

  • Wear protective gear during sports and other recreational activities
  • Buckle your seatbelt
  • Make your home safe with adequate lighting and your floors free from anything that may cause you to trip or fall
  • Exercise regularly to maintain muscle mass, coordination, and balance

If you experience any general signs of concussions and other common head injuries (Please see above), contact your physician immediately.

Common Treatment

The treatment of concussions and other common head injuries depends upon the diagnosis.

For concussions, the primary treatment is rest. It is vital that you avoid physical exertion as well as mentally stimulating tasks, such as critical thinking and activities such as video games. Your physician may also recommend a shortened work or school day and regular breaks to rest during your day. Slowly you can begin to increase your physical and mental tasks until you return to your baseline. For headaches, it may be useful to take acetaminophen (Tylenol). It is generally recommended to avoid other pain relievers, such as aspirin and ibuprofen, as they may increase your risk of bleeding. If your concussion occurred secondary to sport activity, seek the advice of your physician to determine a safe time period for returning to the sport. Growing evidence supports that a second concussion can cause much worse damage than the initial concussion. Further, multiple concussions may lead to cumulative, long-lasting mental impairment.

For the other traumatic brain injuries, initial treatment is aimed at preventing secondary injury. Primary injury refers to the initial brain damage due to the traumatic event. Secondary injury refers to the swelling, bleeding, and other effects due to the primary injury. Although the primary injury can usually not be reversed, treatment is geared towards patient stabilization and prevention/limiting of secondary injury.

In the event of a serious head injury, upon arrival to the hospital, the medical staff will provide supportive care and then consult general surgeons and neurosurgeons to assess the need for surgery. If the patient is deemed appropriate for surgery, the patient will quickly be sent to the operating room. Possible surgical interventions for traumatic brain injuries include craniotomy (a surgical approach to gain access into the skull and brain) to drain fluid around the brain or hematomas (collections of blood). The craniotomy may also allow the surgeon to remove debris, such as bullets, knifes, or other objects that penetrated the skull. Often times if swelling is a concern, a drain may be left in place to allow fluid and blood to drain outside the skull and to avoid the development of high pressure within the skull.

If the patient is not considered a surgical candidate, he or she will likely be transferred to the intensive care unit (ICU) for careful observation and medical treatment. Possible treatments in the ICU include tracheal intubation (in which the patient’s airway is secured with a breathing tube to help them breathe), medications to preserve adequate blood pressure (these are referred to as vasopressors and may include norepinephrine, milrinone, and vasopressin), and medications aimed at preventing or terminating seizures, known as anticonvulsants. Examples of these anti-seizure medications are benzodiazepines (such as midazolam and lorazepam), barbituates (such as phenobarbital), carboxamides (such as carbamazepine), fatty acids (such as valproic acids), and fructose derivatives (such as topiramate). Powerful steroids, such as dexamethasone, may also be given to patients to decrease swelling.

Complementary and Alternative Treatment

As the definitive treatment for concussions and other head injuries include rest, medications, and surgery, patients should seek traditional Western medicine care in the event of head injury, and are discourage to only seek alternative treatments. However, there are a number of helpful complementary treatments that can be very helpful—make sure to get your physician’s approval, to be safe.


Load up on antioxidants. Eat a healthy diet rich in whole foods, abundant protein, with lots of fruits and vegetables, especially those that have lots of antioxidants. Specifically load up on blueberries during the two weeks following the injury. Why? Blueberries contain potent antioxidants that help strengthen blood vessel walls, both in your body and in your brain. Supplement the fruits’ antioxidant power by taking up to 3,000 mg of vitamin C, which helps reduce the oxidative stress in the brain associated with trauma from head injury.


Drink LOTS of fluids. Make sure you keep your body very well hydrated, because this helps the brain to heal more quickly. So how much should you drink? A LOT! It is recommended, in the critical two weeks after sustaining a head injury, that you drink one ounce of fluid (water is best) per two pounds of body weight. This means that someone who weights 120 pounds should drink 60 ounces of over the course of each day during that critical time.


Take arnica (Arnica montana). You are likely familiar with arnica cream, used for sore muscles, sprains and bruises. But arnica also comes in the form of homeopathic pellets, which can help hasten healing of bruised brain tissue. Place three homeopathic arnica 30c pellets (available at health stores and online) under your tongue within 15 minutes of the trauma or as soon as you can get them. Continue this dosage every hour for the rest of the day, reducing frequency on the second, third, and fourth days to three doses — one in the morning, one at lunch and one in the evening.


Dose up on fish oil. General recommendation for most people is to take one to two grams daily of high-potency fish oil, but it is recommended that for those that have sustained a head injury, which they take up to four grams as quickly post-injury, and continue to take four grams daily for up to seven days post-injury. Recent studies have demonstrated that taking high-potency fish oil that contains a large amount of omega-2 fatty acids EPA and DHA can assist in healing concussions, and also help decrease brain inflammation. Note: if there is evidence of bleeding in your brain, do not take fish oil.

When To Contact A Doctor

If you are experiencing any of the signs or symptoms of concussions and other common head injuries, you should seek medical attention as soon as possible. The earlier a diagnosis can be made, the earlier treatment can begin, which generally leads to improved outcomes and better prognosis.

Questions For Your Doctor

Your medical team may consist of several healthcare professionals, including your primary care physician, a neurologist, and a neurosurgeon.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • How far advanced is my concussion and common head injuries?
  • What are my options for treatment?
  • What is my prognosis?
  • What treatment would you recommend, and why?
  • What are the possible side effects?
  • Does my insurance cover these treatments?
  • What changes will I need to make in my day-to-day life?
  • Is there anything else I should know about my concussion or head injury?

Resources

Other useful resources to help you learn about concussions and other common head injuries can be found at:

The Brain Injury Association of America

The Brain Trauma Foundation