Victoria L. Dunckley M.D.

Mental Wealth

7 Myths About Concussions

Common misconceptions about diagnosis, occurrence and treatment of concussions

Posted Jun 09, 2016

From the NFL controversy to underreporting to more accurate diagnostic testing, concussion research has been making headlines lately.  Yet despite the public's growing awareness, misconceptions regarding these injuries are common. Today's post is by Linda Halabi on behalf of the concussion experts at Cerebrum Health Centers.

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Source: 9nong/fotolia

Myths About Concussions
A concussion is a mild traumatic brain injury that requires significant attention. After any injury that may have resulted in a jostle to the head, be sure to speak with a health care professional if you think there could be a chance of brain injury. It might be days or weeks before signs of concussion begin to appear, so be sure to monitor how you or the person who suffered an injury is feeling over time.

Although concussions are a relatively common injury, affecting about 128 people per 100,000 population in the United States yearly, common misconceptions about the occurrence, diagnosis, and treatment of concussions still exist.

Here’s a look at 7 common myths that may affect your understanding of concussions:

Myth #1 - You must experience loss of consciousness to sustain a concussion

Fact - Loss of consciousness is not the only indicator of concussion. In fact, loss of consciousness only occurs in a minority of cases. Before modern day medicine, loss of consciousness was one of the main signs used to identify concussions. However, we now know that there are a variety of other symptoms besides losing consciousness that are important indicators of a concussion. Headache, fatigue, nausea, light or noise sensitivity, balance problems, dizziness and ringing in the ears are common physical symptoms that can occur without loss of consciousness and may indicate the possibility of a concussion.

Myth #2 - Concussions only result from a direct blow to the head

Fact – A direct impact to the head is not required to sustain a concussion. A concussion is caused by force transmitted to the head which can occur without a direct blow to the head. For example, a fall or a blow to the neck, chest, or other region near the head can cause a whiplash effect on the brain which can lead to a concussion. Any sudden movement that causes the brain to bounce around or twist inside the skull can damage brain cells and cause head trauma.  

Myth #3 - Anyone who gets a concussion needs a CT scan or MRI immediately

Fact - Many concussions can’t be diagnosed with a CT scan or MRI test. Conventional CT and MRI scans almost always appear normal after concussions, even after repeated concussions. For cases when more severe injury to the brain is suspected, a CT scan can be used to identity intercranial clots that require neurosurgery but the frequency of this is very low (less than 1 percent). For patients that have passed a normal neurological examination and that show no post concussive symptoms except mild headache, it is reasonable to forgo CT scanning. A physician will likely start by conducting a neurological exam to evaluate vision, hearing, reflexes, memory, concentration, balance and coordination and will go from there.

Myth #4 - You need to wake someone with a concussion every 20 minutes.

Fact – On the contrary, rest is very important to the brains healing and recovery process. For at least the first 12 hours, someone should wake up the person suffering from a concussion every 2 or 3 hours to ask them a simple question and look for any changes in the way they look or act. Once a doctor has cleared the patient from this initial evaluation stage, you only need to check on them periodically. Getting plenty of sleep is actually one of the most important aspects of concussion treatment.

Myth #5 – All pain remedies and medications should be avoided if you have a concussion

Fact – Some worry that certain medications may mask the symptoms of concussion but gentle over the counter medications such as acetaminophen (Tylenol) can be safely used to treat pain. Aspirin, ibuprofen (such as Advil and Motrin), naproxen, and other non-steroidal anti-inflammatory drugs should not be used. Always talk to your health care professional before taking medications, especially when you are unsure of what to take for your condition and symptoms. Prescription medication may even be necessary to assist the brain’s recovery and may be prescribed by your doctor.

Myth #6 - Injury to the brain only occurs at the initial moment of impact

Fact - A concussion involves processes at the microscopic level of the brain. Chemical changes can occur for days, weeks, or even months after impact. In moderate and severe traumatic brain injuries, symptoms may be triggered by imbalances in the production of hormones required for the brain to function normally. After a concussion, the brain is also more susceptible to injury so it is critical to prevent any second concussions or other impacts to the brain during the healing process. In the days or weeks after a concussion, a minority of individuals may develop post concussive syndrome; symptoms include headache, fatigue, cognitive impairment, depression, irritability, dizziness, balance issues, and apathy. This is why it is critical to seek proper treatment of the concussion early on and to monitor changes in symptoms.

Myth #7 - Older people are more susceptible to concussions

Fact - Children are actually more likely to suffer traumatic brain injury than adults and their symptoms can be longer lasting and more severe. The young brain more susceptible to concussion than the adult brain and may require more time to recover. Children especially may not show symptoms of concussion until months or even years after the initial trauma occurs. This makes it especially important to monitor people with head injuries for a long period of time.

Concussions are a big deal and should be taken seriously. If you or a loved one have experienced any head trauma or injuries that may have resulted in a concussion, speak with your doctor. Getting concussion treatment early, taking time to heal, and avoiding future head trauma can lessen the impacts of concussion and lead to a healthier overall recovery.

Dr. Dunckley’s notes:  Two points I'd like to add. The first is that following recovery from a concussion, a doctor cannot absolutely “rule out” that the child does not have any repercussions from the injury. Injuries may cause subtle changes that can’t necessarily be picked up by neuropsychological testing, physical exam, or even a brain scan, especially if you don’t have baseline testing prior to the injury--though the inexpensive balance test mentioned above holds promise to improving accuracy. Also, every concussion makes the brain more vulnerable the next time the child gets hit. Traumatic injuries are cumulative, so several minor injuries can create a tipping point from which the brain struggles to fully recover.  Parents sometimes report, “The doctor said he’s fine,” – after the child has already sustained 2 or 3 concussions and is back playing football. The child might not show any obvious signs now, but he is forever more vulnerable to future brain impairment with each injury.

The second is that that standard precautions following a concussion dictate that the child should physically and mentally rest, avoid excess sensory stimulation (bright lights, loud noise, etc.), and avoid visually stimulating screen-time such as video games, computer use, texting, etc.  Parents often report that the doctor ordered “no screen-time,” but in the same breath admit, “I tried, but I couldn’t keep him off his phone/video game/iPad.” 

This is the brain we’re talking about here! Take devices away and out of the house; most kids simply can’t resist if devices are around, especially if they’ve got suddenly got a lot of time on their hands. Handle a child’s brain with extreme care, and keep the child away from screens – including school-related screens. The healing process itself can cause inflammation and damage, so the more quiet and rest the brain gets as it’s healing the better. One study showed that children with concussions who did not heed the standard rest recommendations took twice as long to get better. 

For more on how an extended break from electronics can rest, heal, and resynchronize a child's nervous system, see Reset Your Child's Brain

References

Arbogast, Kristy B., Allison E. Curry, Melissa R. Pfeiffer, Mark R. Zonfrillo, Juliet Haarbauer-Krupa, Matthew J. Breiding, Victor G. Coronado, and Christina L. Master. “Point of Health Care Entry for Youth With Concussion Within a Large Pediatric Care Network.” JAMA Pediatrics, May 31, 2016.

Brown, Naomi J., Rebekah C. Mannix, Michael J. O’Brien, David Gostine, Michael W. Collins, and William P. Meehan. “Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms.” Pediatrics, January 6, 2014. 

Campellone MD, JV (July 27, 2014). “Concussion – Adults – Discharge”. U.S. National Library of Medicine. MedlinePlus Medical Encyclopedia. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000126.htm

Goble DJ, Manyak KA, Abdenour TE, Rauh MJ, Baweja HA. "An Initial Evaluation of BTrackS™ Balance Plate and Sports Balance Software for Concussion Diagnosis." International Journal of Sports Physical Therapy, 2016

National Institute of Neurological Disorders and Stroke (NINDS) (February 11, 2016). “Traumatic Brain Injury: Hope Through Research”. Retrieved from http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm

Ropper MD, A, & Gorson MD, K (January 11, 2007). “Concussion”. The New England Journal of Medicine. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMcp064645

Tator MD, CH (July 22, 2013). “Concussions and their consequences: current diagnosis, management and prevention”. Canadian Medical Association Journal. Retrieved from http://www.cmaj.ca/content/185/11/975.full