Trauma that occurs to the head is always serious, especially because of the multitude of issues it can leave behind. It can result in a concussion (or mild traumatic brain injury) with acute symptoms such as headache and light sensitivity, which often resolve themselves over the course of a few days or weeks. However, these same post-concussive symptoms (and new ones) can develop and persist for months or even years after the initial injury—complicating the recovery process.
While each person will recuperate at their own pace, there are some incredibly important tips to consider in order to maximize the recovery for concussion and post-concussion syndrome patients.
1. Early diagnosis, intervention and education is key
Perhaps more than any other condition, early diagnosis and treatment after a mild traumatic brain injury is essential. The brain has just endured a physical shock as a result of the injury and reacts to its newfound state while simultaneously beginning the act of trying to repair itself. During this acute stage of the concussion, patients can experience the onset of specific symptoms such as headache, light and sound sensitivity, dizziness, and/or mood or cognitive changes—all of which can range from mild to severe. It can be a scary time facing these new and uncomfortable realities. In these moments, patients desperately need the support of medical professionals and concussion specialists to help ease the uncertainty.
This support can manifest as educational assistance, behavioral rehabilitation, outpatient resources, assistive devices, medications and more. Ultimately, doctors want to tap into the natural healing power of the brain and body in multiple ways in order to focus and accelerate the recovery.
In fact, evidence has shown that the development and severity of post-concussion symptoms are lessened when patients consult with a concussion specialist sooner. Similarly, acquiring treatment in the earliest stages after a concussion can help reduce the overall impairment in work, leisure and relational aspects of patients’ lives.1,2 This should encourage them to seek immediate assistance following a head injury.
2. Identify other risk factors for prolonged recovery
An extension of early diagnosis is the identification of additional risk factors that may influence the onset or duration of post-concussion syndrome. Some of the most important ones to look out for include:3
- Prior history of concussion
- History of regular headaches or migraine attacks
- Post-traumatic amnesia
- Dizziness or vertigo symptoms
- The presence of multiple symptoms due to the injury
- Depression or other emotional disorders
As a result, a comprehensive evaluation should be performed after the trauma in order to rule out any of these possible concerns. And while the existence of these issues do not automatically guarantee there will be a longer recovery period, they can give additional insight into specific patient experiences and ultimately allow for more effective care.
3. Total rest and isolation does more harm than good
In the past, people with a concussion were told to rest and become mainly inactive for several weeks following the concussion or until symptoms have subsided. However, this recommendation has changed recently because of evidence that “cocooning” behavior worsens physical symptoms such as photophobia and can also lead to anxiety, social isolation and depression.4
The Centers for Disease Control (CDC) now recommends that patients, including children, return to activities based on their individual symptom status instead of a singular mandate of extended rest. In fact, many are suggesting no more than 2 to 3 days of rest before slowly returning to non-sporting activities. Of course, each person presents a unique set of circumstances, which makes it important to work with a qualified healthcare provider to make this determination. But experts ultimately agree that concussion and post-concussive individuals should not go into total isolation for very long.
4. Increase participation in activities that do not worsen symptoms
Many people with concussion or post-concussion syndrome question when they can return to their normal activities and, as we mentioned, the answer is not very straight forward. However, we do know one thing: returning to normal activities should not make your symptoms worse. The medical community has recognized that complete isolation does not work for patients over the long haul, but, similarly, activities should not push them beyond their limits either.
For example, in athletes with concussion, it is recommended that a rest period of a few days is taken followed by gradual activity tolerance. As they meet certain physical and cognitive goals, they can continue to add more to their daily routine until they have fully reintegrated back into their regular activities.5 The key thing to remember is not to push it—your body will reveal its limitations, and it can simply take longer to get back to normal in your specific case.
5. If concussion symptoms persist, explore alternative diagnoses
What happens when concussion symptoms last longer than expected? Investigation from the medical care team may be required at this point in order to provide an expanded diagnosis beyond post-concussion syndrome. Even for those without the aforementioned risk factors prior to injury, the concussive blow and ensuing problems may have activated secondary processes and disorders that are now impacting the recovery process. Some of these include:6
Chronic headache or migraine
Even in the absence of a prior history of migraine, a serious head injury can lead to the development of chronic headaches or migraine attacks. And of course if patients have a genetic predisposition, they may be even more likely to be diagnosed with one of these disorders. The development of these problems may also partially explain the ongoing hypersensitivity symptoms that characterize both migraine-related conditions and post-concussion syndrome.
Chronic pain and fatigue
The mere presence of ongoing pain (particularly as a result of the head trauma) has been shown to lead to more sustained post-concussion symptoms. Deployed veterans may be particularly vulnerable to the development of chronic pain after a mild traumatic brain injury, but studies have suggested that more than half of civilian TBI patients also experience ongoing discomfort and irritation.7,8 Some experts have even suggested that specific neck-related pain may mimic post-concussive issues and/or contribute to or worsen post-concussion syndrome.6
Depression, PTSD and other emotional disorders
Since concussion injuries and post-concussion syndrome have a tremendous impact on a person’s physical quality of life, it is understandable that it can compromise their emotional well being too. In particular, post-traumatic stress disorder, depression, anxiety and panic disorders have been associated with prolonged physical symptoms and overall functioning.9,10 In addition, if patients are prescribed the isolationism of “cocoon therapy,” it can hasten these challenging emotional side effects and recovery can be further delayed.
Labyrinthine concussion and other inner ear disorders
Not surprisingly, serious trauma to the head can mess with the inner ear given their relative physical proximity. In fact, a more refined diagnosis of labyrinthine concussion directly classifies these symptoms of hearing loss and tinnitus as a byproduct of injury to the inner ear. Similarly, inner-ear ruptures known as perilymph fistulas may be misdiagnosed as or even caused by a concussion.11 This can represent a linkage to the dizziness, vertigo and other vestibular dysfunction faced by some individuals.
With more than one-third of people with a traumatic brain injury reporting dry eye disease, patients cannot ignore it as a possible comorbid or co-occurring condition that is affecting their symptoms. In fact, given the important role of the eye in a multitude of neurological issues, eye sensitivity to the environment can lead to headaches, eye strain and photophobia, among other problems.
6. Treat the most burdensome symptoms
Whether patients are in the acute or persistent symptomatic phase of a head injury, it can feel like a long, hard road to getting better. In addition to identifying risk factors and other complicating disorders, taking measures to relieve the most burdensome symptoms can help ease the struggles for them. Here are some recommendations to consider.
Management of light sensitivity and photophobia
As previously noted, isolation therapy is not a good long-term solution for mild traumatic brain injuries. This can make light sensitivity a particularly challenging symptom to address because it means facing the light that causes pain; however, there are remedies that can make a difference. Among them, FL-41 glasses may be the most effective because their lenses are lighter than normal sunglasses and block certain colors of light that can aggravate photophobia.
Management of migraine and headache disorders
Post-concussion headaches and migraine attacks share many of the same physiological processes as traditional migraine with or without aura. This makes visiting with a headache specialist or neuro physical therapist a great first step for patients because those professionals can help identify the right mix of treatments—from typical migraine medications like triptans or CGRP drugs to behavioral modifications, rehabilitation and trigger management.
Management of dizziness and vertigo symptoms
For some, persistent dizziness and vertigo may be treated with an exercise-based physical therapy program called vestibular rehabilitation. The goal of this therapy is to help improve the all-too-common balance issues and motion-induced symptoms that affect post-concussion patients. In addition, prescription medications like antihistamines can help with these issues and anti-nausea drugs can improve some of the add-on complications of vertigo as well.
Management of cognitive issues
The goal of cognitive rehabilitation is to restore and maintain daily cognitive functioning and has shown to be beneficial in those with brain injuries. This type of treatment uses techniques to enhance memory, processing speed and attention as well as psychotherapy. While not necessarily the most burdening symptoms, these concerns can add up real fast and, when treated properly, can make the physical rehabilitation that much more effective.
If you are dealing with the consequences of a concussion or the ensuing post-concussion syndrome, we hope these tips give you a place to start. Each person responds differently to certain treatments and these may not all be relevant to or work for you, but you can feel confident that there is support available. We encourage you to speak with your medical team to see what can aid you in your recovery.
1Forrest RHJ, Henry JD, McGarry PJ, Marshall RN. Mild traumatic brain injury in New Zealand: factors influencing post-concussion symptom recovery time in a specialised concussion service. J Prim Health Care. 2018 Jun;10(2):159-166. doi: 10.1071/HC17071.
2Wade DT, King NS, Wenden FJ, Crawford S, Caldwell FE. Routine follow up after head injury: a second randomised controlled trial. J Neurol Neurosurg Psychiatry. 1998;65(2):177–183. doi:10.1136/jnnp.65.2.177.
3Scopaz KA, Hatzenbuehler JR. Risk modifiers for concussion and prolonged recovery. Sports Health. 2013;5(6):537–541. doi:10.1177/1941738112473059.
4Giza CC, Choe MC, Barlow KM. Determining If Rest Is Best After Concussion. JAMA Neurol. 2018 Apr 1;75(4):399-400. doi: 10.1001/jamaneurol.2018.0006.
5McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017 Jun;51(11):838-847. doi: 10.1136/bjsports-2017-097699. Epub 2017 Apr 26.
6Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012;4(2):147–154. doi:10.1177/1941738111433673.
7Stålnacke BM. Postconcussion symptoms in patients with injury-related chronic pain. Rehabil Res Pract. 2012;2012:528265. doi:10.1155/2012/528265.
8Irvine KA, Clark JD. Chronic Pain After Traumatic Brain Injury: Pathophysiology and Pain Mechanisms. Pain Med. 2018 Jul 1;19(7):1315-1333. doi: 10.1093/pm/pnx153.
9Lagarde E, Salmi LR, Holm LW, Contrand B, Masson F, Ribéreau-Gayon R, Laborey M, Cassidy JD. Association of symptoms following mild traumatic brain injury with posttraumatic stress disorder vs. postconcussion syndrome. JAMA Psychiatry. 2014 Sep;71(9):1032-40. doi: 10.1001/jamapsychiatry.2014.666.
10Oldenburg C, Lundin A, Edman G, et al Emotional reserve and prolonged post-concussive symptoms and disability: a Swedish prospective 1-year mild traumatic brain injury cohort study BMJ Open 2018;8:e020884. doi: 10.1136/bmjopen-2017-020884.
11Whitelaw AS, Young I A case of perilymphatic fistula in blunt head injury Emergency Medicine Journal 2005;22:921.
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