Q&A: Concussions

By Madeleine Castellanos, M.D.

Concussions are serious head injuries that often go unreported or undiagnosed but have significant cognitive and overall health consequences for individuals.  Here Dr. Castellanos answers some questions related to concussion identification and treatment.

Q:  What exactly is a concussion, and can I have one without realizing it?

A:  A concussion is a type of traumatic brain injury (TBI) caused by a quick movement of the head, often-times hitting another object.  This rapid movement causes the brain to collide against the inside of the skull enough to produce a type of bruising or inflammation.  It could be from a direct hit such as in football or a blow to the head.  But even a small fender-bender that results in whiplash or a fall can result in a mild-to-moderate concussion.  They are much more common than you think and often go unrecognized.

Q:  What symptoms should I look out for to see if I have a concussion?

A:  Even though a loss of consciousness is a good indicator of a concussion, there are many other milder symptoms that should be cause for concern as indicators of a concussion.  Most people are familiar with the physical symptoms of a concussion – headache, sensitivity to light or noise, fatigue, blurry vision, balance problems, nausea, or fatigue.  But there may also be cognitive issues such as difficulty concentrating, easily fatigued by reading or using a technological device, difficulty remembering new information, or not being able to process things as quickly.  There can be disturbances in sleep such as an increased need for sleep, or restless sleep and/or difficulty falling asleep.  Finally, mood issues can also be a symptom of concussion including anxiety, agitation, irritation, sadness, and even quickly moving from one emotion to another.  Symptoms vary from person to person depending on the area of the brain affected, as well as the severity of the concussion.

Q:  Who is at risk for a concussion?

A:  Those individuals who participate in contact sports such as football, soccer, lacrosse, and hockey are at high risk for concussion, and athletes may have multiple concussions over the years.  Skiers and even those riding bikes are at risk, regardless of age. Protective equipment does not necessarily help since the injury is caused by the brain hitting the inside of the skull, not a direct hit to the outside of the skull itself.  The elderly are particularly at risk for concussions for two reasons:  First, as brain size decreases with age, there is more space between the brain and the skull.  With this increased distance, any concussion would be more pronounced.  Also, elderly persons are at higher risk for falls, which could include a head injury and/or whiplash culminating in a concussion.  A very common cause of concussion that often goes unnoticed is a car accident.  Even small fender-benders that result in whiplash can cause enough force to bruise the brain against the skull and cause a concussion.  If treatment for a concussion does not continue until there is complete recovery, then that person is also at risk for re-injury.

Q:  If I don’t get treatment for it, will my body heal itself after a concussion?

A:  Although the body is designed to heal itself, the central nervous system cannot resolve inflammation as easily as the rest of the body.  Once there is inflammation in the brain, it tends to simmer for quite some time, delaying the healing process.  The inflammation and symptoms of concussion can continue after the initial injury for months or even years without proper treatment.

Q:  Are there long-term consequences to my health if I get a concussion?

A:  About 20% or more of patients who experience a concussion go on to develop chronic issues as a result of head trauma, called post-concussion syndrome, in which symptoms persist for longer than 6 weeks.  In some cases, symptoms can persist for weeks, months, or even years.  The more concussions a person has, the greater the chance of developing post-concussion syndrome, and the damage can accumulate with repeated injury.  This long-lasting inflammation can result in greater activation of the stress response cycle, and impairment of gastric motility and immune barrier of the intestines and the brain. It may even result in emotional dysregulation or in debilitating sensory disturbances such as inability to tolerate loud places or busy patterns.  Some patients may also develop learning difficulties, personality changes, and other cognitive deficits.  Any number of neurological symptoms may become permanent as well including loss of taste or smell, ringing in the ears, motion sickness, or mood disorders.

Q:  What type of doctor should I see if I think I may have had a concussion?

A:  There are neurologists who specialize in head trauma, TBI and concussion.  If you suspect that you have had a concussion, or  have a history of contact sports, falls, motor vehicle accidents, or other activities that jar the head and you have any symptoms – even mild changes in ability to concentrate, mood changes, or a decreased ability to tolerate sounds, busy environments, or bright lights – you should be evaluated by a concussion specialist.  If you are experiencing significant symptoms impairing your ability to work, study, or interact with other people, you should seek out a specialty clinic that includes a multidisciplinary team of neurologists, neuropsychologists, physical therapists, occupational therapists, and speech pathologists.

Q:  What are some current treatments for concussion?

A:  The treatment for a concussion will depend on the severity of symptoms a person is experiencing.  Initially, a person will require more rest and will not be able to take on the same workload that they did before the concussion.  Rest includes additional sleep as well as limiting screen time including phones, computers, and television exposure.  Once it’s been determined that there is no structural damage such as bleeding, rest needs to be paired with gentle activity to encourage good blood flow to the brain and stimulation of different brain areas to support healing.  Gentle exercise that does not risk re-injury such as walking or rhythmic movements can be very helpful.  A stationary bicycle and swimming can also be excellent forms of gentle exercise which increase blood flow and coordination.  Treatments must be tailored to the symptoms a person is experiencing.  Examples of treatments include balance therapy, vision therapy and neuro-optometric rehabilitation, occupational therapy, physical therapy, and cognitive behavioral therapy to name a few.  The goal is to avoid medications whenever possible since the system is more sensitive to these after a concussion.  In the case of severe concussion or TBI, it may be necessary to use anti-seizure medications for a short period of time.

Q:  Are there nutritional or therapeutic treatments for concussion?

A:  There are several natural treatments for concussion that assist with decreasing inflammation in the central nervous system, thereby allowing healing to proceed faster.  These include high doses of good quality fish oils to help improve blood flow to the brain as well as provide the building blocks for healing cells of the central nervous system.   Micronized progesterone (bio-identical), and small doses of lithium orotate can help decrease the exaggerated inflammatory response in the brain.  N-acetyl cysteine may also be helpful for many people to decrease overstimulation of the brain.  Overall, a person’s nutrient status should be optimal, especially for levels of magnesium, zinc, copper, B vitamins, Vitamin D3, and antioxidants.  Hyperbaric oxygen treatments can be very helpful for the treatment of concussion and TBI because it supports the energy centers of the cell, which accelerates healing.  Acupuncture has also been shown to be helpful for mobilizing energy to accelerate healing of concussion and decrease pain.

Concussions are often overlooked or their impact minimized, which can discourage a person from seeking treatment or fully continuing treatment until they have completely healed.  Treatment for concussion should begin early, be tailored to a person’s symptoms, and be continued far beyond the acute stage of injury.  Recognition and early action are paramount in helping to restore an individual’s health and level of functioning.

Madeleine Castellanos, MD is a functional medicine physician with a specialty in psychiatry, practicing for over 10 years in New York City and South Florida.  She is trained in the Bredesen Protocol to reverse cognitive decline and uses a systems-based approach to help patients reduce inflammation, improve metabolism, reduce physical and mood symptoms, and improve overall health.