National Concussion Awareness Day, observed the third Friday in September, is intended to spotlight one of the most common — and often underestimated — brain injuries. A concussion, or mild traumatic brain injury (mTBI), may resolve quickly with proper treatment but can cause lasting damage if ignored.
According to the Centers for Disease Control and Prevention, 1.6 to 3.8 million Americans sustain a concussion each year, though actual numbers may be far higher due to underreporting.
Nearly half of all concussions result from unintentional falls, with a majority of those victims aged 65 or older. Other common causes of mTBIs include motor vehicle accidents, assaults, and sports or recreational activities. One in ten U.S. children or adolescents sustain a sports-related concussion every year.
Concussions occur when an outside force impacts the head or body hard enough to cause the brain to bounce or twist against the inside of the skull. The sudden movement stretches delicate nerve cells, leading to abrupt biochemical changes and the disruption of normal brain function. An uncomplicated concussion is rarely life-threatening, and resolves completely with proper treatment. But those who sustain more than one mTBI in their lifetime are at risk for permanent brain damage — impacting memory, mood, and learning.
You don’t have to be knocked out to have a concussion. Many people just feel dazed, disoriented, drowsy or even depressed. Headaches, nausea, and lightheadedness are also common. Symptoms usually resolve in less than two weeks, but may linger for up to a month. For reasons that are unclear, at least 30% of victims develop post-concussion syndrome — a constellation of persistent symptoms such as insomnia, impaired balance, and difficulty concentrating, that may take up to a year or more to resolve.
Individuals who sustain a second concussion before recovering from the first are at risk for second impact syndrome, a rare condition caused by severe swelling of the recently injured brain. An estimated 50% die; survivors suffer with permanent neurologic disabilities, including intellectual impairment or seizures. Athletes returning too early to their sport — especially football and hockey players — are especially vulnerable.
Repetitive mTBIs over many years can lead to chronic traumatic encephalopathy — a progressive brain disease most often seen in those playing contact sports. Victims can develop dementia, personality changes — even full-blown Parkinsonism. There is currently no treatment.
Risk factors for concussions include age (over 65 or under four); engaging in contact sports (such as basketball, soccer, and boxing); physically demanding jobs like construction, landscaping, or carpentry; and previous concussions.
If you jar or bump your head — with or without accompanying symptoms — call your primary care provider. Concussions are diagnosed by a physical exam and neurological testing, which includes vision, hearing, and problem-solving exams. Imaging tests like a CT scan or MRI may be recommended to check for serious complications, like bleeding into the brain.
The treatment for an uncomplicated concussion is rest. Most clinicians recommend 24 to 48 hours of little or no physical and mental activity — this means no television, computer, or cellphone use, and no reading, working, or studying. Acetaminophen may be taken for pain; aspirin or ibuprofen may cause bleeding and should be avoided. Under a health provider’s supervision, normal activities can slowly be resumed over the course of a week.
Sleep is an important part of recovery: It is a myth that an mTBI victim must be awakened every few hours. Instead, concerned caregivers can check occasionally for normal breathing or unusual restlessness if desired.
To prevent concussions, wear proper sport-specific headgear, helmets and mouthguards; avoid intense physical activity if you’re tired; declutter your home and workspace to avoid falls; and always wear seatbelts.
Call 911 or go to the emergency room if you sustain a head injury accompanied by loss of consciousness, confusion, vomiting, a worsening headache, or other severe symptoms.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.