A few decades ago, “getting your bell rung” was just a part of playing sports and living an active lifestyle. Today, research into the long-term physical and psychological effects of concussions has shined a light on the danger of ignoring head injuries.
Dr. Dan Phillips, owner of MedAccess, spoke with Diana Pressey about the ins-and-outs of concussions. Concussion symptoms can include headaches, confusion, loss of memory, nausea and vomiting, dizziness, loss of consciousness or “seeing stars.”
Diana Pressey: What is a concussion, and what causes it?
Dr. Dan Phillips: A concussion … is a traumatic brain injury that affects your brain function. It is typically caused by a blow to the head. Now, that blow to the head can come in any form; you can be a football player or a contact sports player or involved in boxing or involved in a motor vehicle accident, but the bottom line is you take a sudden blow to the head that causes your brain to simply not function for a brief period of time.
Pressey: Are there any long-term effects?
Phillips: Yeah, and that’s the problem; that’s why concussions are getting so much press. When I was a high school athlete in the 70s, you got your bell rung, you got a concussion, you went back to play. That’s just the way things were, and that persisted, really, ‘til just the last few years. Now we’re realizing that there are long-term effects. People can have chronic loss of memory. You can have what we call post-traumatic headaches, which is, all of a sudden you get these headaches that are lasting for a long time. You can have vertigo, which is room-spinning dizziness, what we call post-traumatic vertigo. There’s something called post-concussion syndrome, where you get headaches and dizziness and thinking difficulties.
One of the concerns are repeated concussions, or repeated brain injuries over the life of a patient. Those are believed to cause cognitive impairment, almost like a dementia-type presentation, including depression and suicidality. And that’s come up recently: some very, very high-profile athletes, some former NFL players who’ve taken their own lives, (Aaron) Hernandez, the Boston Patriots star who was convicted of murder and hung himself in jail, subsequently found to have chronic traumatic encephalopathy, which is the result of repeated head injuries. Another thing we see is called second-impact syndrome, where someone goes back to contact sports and gets a second concussion before they really recover from the first one, and they end up with brain swelling, which can be fatal. So, yeah, there are some long-term effects which are very worrisome.
Pressey: What should someone do if they have or suspect they have a concussion? At what point should they see a doctor?
Phillips: If there’s a question of concussion, I think you should see a doctor right away. Certainly, if you had a head injury, and you’ve got symptoms of vomiting — particularly in adults — or there was a loss of consciousness that lasted more than 15, 20, 30 seconds, or a headache that’s getting worse instead of better, if there’s changes in behavior or if there’s confusion, clearly, the patient needs to be seen. In cases with athletes, if they had an episode where they can’t remember part of the game or they suffered a pretty big blow to the head, I think it’s appropriate to get checked.
Now, those patients don’t require CAT scans, for instance, in every case, and in fact, mild concussions are a clinical diagnosis. Someone comes in, says ‘I was playing basketball, I hit my head on the wall, I didn’t get knocked out, but I had this, this and this,’ that’s a clinical diagnosis, and typically the patient’s just watched, and after they’re cleared, then they can go back to sports.
Pressey: How do you treat a concussion?
Phillips: The mild concussions and moderate concussions are treated with rest. That person cannot or should not go back and risk another head injury. Severe concussions, sometimes, are observed in the hospital, but again, it’s observation. The big thing is getting them, ultimately, before they return to sports, to a concussion specialist, sometimes a neurologist or sports medicine specialist, who puts them through cognitive testing. For instance, a concussion specialist may see the patient when they’re having a concussion and do neurologic testing, then test them again, the same test, to prove them back to baseline normal before they release them to go back to sports. Sometimes, they recommend they don’t go back to contact sports.
Pressey: What about the old saying, “If you have a concussion, don’t fall asleep”? Is there validity in that?
Phillips: No, that’s the old way of thinking. Inevitably, we see that the child has bumped their head and it’s naptime, and you keep them awake, and now they really are cranky. So watch for, you know, if they go to sleep, are they arousable? If they’re neurologically intact, their speech isn’t slurred, and they’re not throwing up, then letting them rest and sleep and checking on them frequently is appropriate. But when you see patients with severe headaches, and they’re vomiting, those are the ones you need to get checked right away.
Pressey: How soon after getting a concussion can someone return to daily life and activities?
Phillips: It really, really depends on their return to normal neurologic function and the absence of symptoms; that’s the big thing. It varies based on the severity of the concussion.
Pressey: Is there anything that can be done to prevent a concussion?
Phillips: Besides not getting hit in the head? In contact sports, football players are being taught more and more not to spear (tackle) with the head, don’t use the head as a leading target. Head injury protection — good-quality helmets — if you’re riding a bicycle, you should have a helmet on all the time. If you’re playing rugby or other contact sports, you should have a head (guard). If you’re in contact sports, proper technique and avoiding spearing and using the head as a weapon, but inevitably, you’re gonna bump your head at some point, and then you’re at risk for concussion symptoms. All those who are not in contact sports, you’re at risk when you fall or you wreck your bike or something like that, so it’s really just general prevention and avoiding blows to the head.