Head Pain and Injuries: Concussion

A popular and important topic in sports medicine are head pain and injuries or concussions.  A concussion is a type of traumatic brain injury that is caused by a hit to the head or body that results in the brain moving rapidly back and forth.   This sudden movement causes the brain to “bounce around” inside the skull. This can then result in damage to the brain cells, as well as creating chemical changes in the brain itself.  There may or may not be associated loss of consciousness.

Concussion Signs and Symptoms

There is a myriad of different signs and symptoms that one can have while suffering from a concussion. It is possible that these may be subtle and may not be obvious immediately. Signs and symptoms generally show up soon after the injury, however.

Here is a list of common concussion signs:

• Difficulty recalling events prior to or after a hit or fall
• Appearing dazed or stunned
• Confused about the score, their assignment or position during a game
• Answering questions slowly
• Changes in personality, mood, or behavior.  
• Moving in a clumsy manner

Here is a list of common concussion symptoms:

• Headache or “pressure” in the head
• Feelings of nausea or vomiting
• Dizziness or feeling of being off-balance.  
• Blurry vision
• Light and noise sensitivity
• Feeling “foggy” or sluggish
• Difficulty concentrating on tasks
• Feeling forgetful or having memory problems
• Feeling confused, nervous, or anxious
• Feeling more emotional
• Difficulty falling or staying asleep
• Overall not feeling well

Dangerous Signs and Symptoms of a Head Injury

In rare cases, there are more serious injuries that could occur after a blow to the body or head.  Carefully evaluation for signs of an intracranial hemorrhage, or a bleed inside the head, is important.  In these cases, the blood can collect alongside the brain causing a hematoma which may put pressure on the brain against the skull.  If this is suspected based on the signs and symptoms, one needs to go to the emergency room right away or call 911. 

These signs and symptoms of head injury can include:

• Asymmetric pupils, one larger than the other
• Inability to be aroused or woken up
• Progressive worsening headache that does not go away
• Slurring of speech
• Focal weakness in the extremities or decreased coordination
• Repeated vomiting, convulsions, or seizures.  
• Loss of consciousness.  Even a brief episode of loss of consciousness should be taken seriously and evaluated by a doctor immediately. 

How Are Concussions Diagnosed?

If a head injury happens while playing sports, a coach or athletic trainer may be the first person to do an evaluation.  Along with looking for the signs and symptoms of concussion, there are a few simple tests a trained person can perform which help make an informed decision on the sideline.  An athlete who has a confirmed head injury must stop playing and be cleared by a doctor prior to returning to play.

After the injury, there are neurocognitive concussion tests taken via computer programs that try to assess the brain’s function by measuring processing speed, attention, and memory.  It is best to compare testing after the injury with the person’s baseline test results done before an injury occurs. These tests can be a helpful way to monitor how someone is recovering. 

Imaging such as CT scan or MRI is not routinely needed for concussion management.  They are sometimes done in the acute period to rule out an intracranial bleed or cranial fracture. 

Concussion Treatment and Recovery

Concussions are self-resolving but it takes some time for this to happen.  Each concussion and each person is unique so recovery times can vary from a few days to weeks, or even a few months.  It’s important to find a balance between doing too much and doing too little and recovery should be customized based on symptoms. 

• Rest: Rest is important initially and one should take it easy for the first few days after the injury during the time when symptoms are most severe.  It is best to avoid mentally draining activities. Avoid all physical activity, especially ones that could put one at risk for another head injury.  Try to get a good night’s sleep and nap liberally during the day as needed.
• Light activity:  non-strenuous activity can be started as the symptoms are starting to improve.  Return to school or work gradually. If symptoms do not worsen during an activity then slowly adding more activities is ok.  If symptoms worsen then it is necessary to cut back on that activity until it is tolerated. Continue to avoid all sports and any activities that could lead to another head injury.
• Moderate activity:  If symptoms are nearly gone then most activities can be restarted.  It is important to still avoid sports and any activities that could lead to another head injury.  If symptoms recur with activity, then break for a few minutes or longer and try a less strenuous version of the activity.
• Regular activity:  If all symptoms are gone the return to all activities, except sports.  For sports, a doctor will coordinate a gradual return to play protocol with the coach or athletic trainer.  Athletes will need medical clearance to return to full sports competition.

Factors that might delay recovery include:

• History of previous concussion or brain injury
• Neurological or mental health disorders
• Learning difficulties
• Family and social stressors. 

Head Injury Tips and Prevention

It is more likely to get a concussion if there is a history of a previous one.   Some tips for concussion prevention include:

• For youth sports teams, be aware of any rules on tackling (football) or heading the ball (soccer) that are in place to reduce concussions.

• Wear a helmet for activities such as skiing, snowboarding, biking, skateboarding, or riding a scooter.  Helmets are not preventative for a concussion but will hopefully help to protect against skull fracture or serious brain injury.
• Encourage people to never ignore symptoms after a head injury, no matter how insignificant it may seem.  Advise them to stop the sport or activity and get medical attention right away.

Stephen S. Chen, MD- Sports Medicine Doctor can help you evaluate and treat your hear pain and injury or concussion. Contact us using our phone number 925-934-3536 or email us at stephen.chen@eastbaysportsdoc.com to book an appointment.