Concussion-related Frequently Asked Questions
Perhaps you’re a parent or a coach of youth athletes and concerned about concussion, Traumatic Brain Injuries (TBI), post-concussion treatment, cognitive testing and more, leaving you confused and dizzy with more questions than answers. The Concussion Management Clinic is here to help.
Let’s start with some basics. These frequently asked questions related to concussion may have the answer you are looking for. If not, please contact us for further assistance or to set up an appointment for evaluation and/or treatment.
What is a concussion
A concussion is a temporary alteration in awareness or consciousness as a result of a blow to the head. You do not have to lose consciousness in order to experience a concussion. A concussion involves changes in the chemistry of the brain. The chemical changes in the brain last longer than the symptoms so your doctor will recommend that you rest and avoid contact sports for at least a week.
All important aspects of human function are regulated in some way by the brain. A concussion causes a disruption of these regulatory functions, and the patient experiences the concussion in the abdomen (nausea), the heart (irregular heart function), the liver (changes in the metabolism of medications) and the vestibular system (dizziness). Our treatment, for those with prolonged symptoms, is aimed at restoring the regulatory functions of the brain through carefully monitored exercise.
What are typical concussion symptoms?
At the time of the injury and for a short while afterward people experience a variety of symptoms. The most common are: Headache, dizziness, ringing in the ears, sensitivity to light or noise, upset stomach, and vomiting. Almost everyone with a concussion will experience memory disturbance. For example, you might have some memory lapses before or during the event that caused the concussion. You are also likely to have difficulty retaining new information.
Some of the symptoms described above will last only an hour or two and others may last longer, up to a week or more. In addition, people with a concussion may develop new symptoms once they go home from the Emergency Room or doctor’s office. Many concussed individuals report trouble getting to sleep or staying asleep. Some also have trouble with irritability. Another delayed symptom is poor concentration, especially for reading.
When will I recover from concussion symptoms?
Most people find that the symptoms of concussion are gone within a few days. However the chemical changes in the brain do not return to normal for at least a week and during this time it is important not to experience another blow to the head.
In some cases symptoms will last longer than a few days. If symptoms persist for a week or more you should go to your doctor or a concussion clinic for further evaluation. In rare cases a person can have symptoms that persist for three or more weeks and this is called “post concussion syndrome”. Post concussion syndrome should definitely be treated by a knowledgeable health care practitioner. If untreated, post concussion syndrome can lead to difficulties at work or school, not to mention considerable discomfort to the person with the symptoms.
What should I watch out for?
Concussions generally do not cause permanent damage. However, in rare instances a concussion can lead to a bleed within the tissue that surrounds the brain. This can be life threatening so it is important that the person with a concussion be watched by others. Important signs of an internal bleed are:
- headache that appears to be getting worse
- continuing to vomit, even after you have returned home
- increased drowsiness or dizziness
- increased confusion
In simple terms, if your symptoms appear to get worse, go to an emergency department in your local hospital immediately.
Is there treatment for concussion?
During the first week or until symptoms are gone, doctors recommend rest. To date, no one has found a medication that can help cure a concussion. However, your doctor may prescribe medications for some symptoms such as headache.
If symptoms persist beyond one week, and especially, beyond three weeks, it is wise to seek treatment from your doctor or a specialized concussion clinic. There are various treatments for some of the persistent symptoms of concussion. There are also treatments available for some of the problems that occasionally accompany post concussion syndrome, such as depression.
Who should I see for follow up care and treatment?
It is important that you inform your primary care doctor about your concussion. You may wish to discuss with your doctor whether you need the specialized services of a concussion clinic. Some people with concussions may choose to seek services from the concussion clinic directly. The Concussion Management Clinic is located within UBMD Orthopaedics & Sports Medicine, at the University at Buffalo School of Medicine and Biomedical Sciences. It is also held at our Niagara Falls location in the Summit Healthplex. Contact us for locations and more information.
What is post concussion syndrome?
There is some disagreement among health care professionals as to what exactly constitutes post concussion syndrome. In a review of the literature we attempted to provide a definition that made sense to our patients and our colleagues. We suggested that post concussion syndrome is characterized by symptoms of concussion persisting for a period of at least six weeks.
The symptoms of concussion do not normally last beyond two weeks. When symptoms do persist it suggests that the metabolic changes of concussion have not been corrected. This persistence of symptoms is called post concussion syndrome. We suggested a six week period of persisting symptoms to be conservative but we actually start to treat people for post concussion syndrome as early as three weeks post injury. The most common persisting symptoms are fatigue, headache, reduced memory and/or depression.
There is some argument whether there is such a thing as post concussion syndrome. Some researchers and some health care practitioners assume as fact that most people recover from concussion and those that do not have other issues such as a desire to be seen as ill, or perhaps have depression. This disagreement over post concussion syndrome is possible because the brain is so difficult to examine while the person is still alive and it is hard to prove that subtle changes in behavior or thinking patterns are the result of changes in the brain. However, more recent research finding support that persistent symptoms are associated with specific changes in brain function and physiologic changes such as heart rate variability.
How do we treat post concussion syndrome?
The most common treatment for post concussion syndrome is medication. Neurologists and family doctors often prescribe anti-depressants. There is some limited research evidence that anti-depressants do help, at least with symptoms of depression. Some physicians prescribe so called “memory drugs”, which appear to have some benefit for those with Alzheimer’s disease, but are of unknown value to those with post concussion syndrome. Neuropsychologists generally provide the most comprehensive treatment by teaching patients with post concussion syndrome about their disorder, and offering suggestions for adapting to specific issues of fatigue, concentration difficulties and depression.
The treatment approach used at the UBMD Orthopaedics & Sports Medicine/University at Buffalo Concussion Management Clinic is based on a view of post concussion syndrome as a systemic problem rather than just a problem with the brain. All important aspects of human function are regulated in some way by the brain. A concussion causes a disruption of these regulatory functions and the patient experiences the concussion in the abdomen (nausea), the heart (irregular heart function), the liver (changes in the metabolism of medications) and the vestibular system (dizziness). Our treatment, therefore, is aimed at restoring the regulatory functions of the brain through carefully monitored exercise. Exercise has been shown to improve people who suffer from depression. Exercise has also been shown to reduce the effects of aging on brain function and increase longevity.
When athletes are assessed for readiness to return to play after concussion they are put through an exercise routine to see if raising blood pressure and heart rate will bring on concussion symptoms. If concussion symptoms reappear then the athlete is not considered safe to return to the sport. Generally athletes who are not ready to return to their sport are told to go home and rest or are prescribed medications. Our approach is to evaluate the level of exercise that produced symptoms (called the threshold) and then prescribe a monitored exercise program that is sub threshold (and therefore does not bring on symptoms). Our approach has been very beneficial for our patients and we are now conducting research on this approach that will help further identify how and why this treatment approach works.
What makes your concussion treatment methods so effective?
We are a pioneering group that uses a scientifically-validated exercise-based protocol to evaluate concussions and to treat post-concussion syndrome. Our method is now the recognized standard in concussion treatment. We also have computerized cognitive testing to help decide when athletes are ready to return to play.
Our concussion treatment program is unique and the most comprehensive in Western New York. Using a multidisciplinary approach it is based on cutting-edge research developed at the University at Buffalo by John Leddy, M.D. and Barry Willer, Ph.D. Patients will see both a physician and a neuropsychologist. Neuropsychologists specialize in brain and behavior relationships, and they help to assess and manage concussions. This treatment approach is based on a view of post-concussion syndrome as a whole body problem rather than just a problem with the brain. In addition, many patients will take a computer test that measures memory and concentration. Athletes can also take the test before the season to establish a baseline (baseline testing) to serve as a comparison to any future tests.
Is our clinic just for athletes?
We have used controlled exercise as a treatment for post concussion syndrome with athletes and it was very effective. We have also used the approach with non-athletes and it has worked as long as the individual is prepared to improve their health through exercise.