A new Concussion/Brain Injury

  • Introduction to Concussion
  • Take all Concussions Seriously
  • Managing Symptoms
  • Information You May Miss
  • Signs, Symptoms and Pitfalls
  • Secondary Brain Injury
  • Repeat Concussion
  • Sports Related Concussion
  • Reporting Concussion
  • Living Alone – The Checklist
  • PCS – Post-Concussion Syndrome
  • References & Resources
  • Concussion – Further Reading

Introduction to concussion

In different countries across the world, medical communities have tended to use the word ‘concussion’ in a generalised way sometimes undermining the possible consequences.

Most people think of a concussion as being a head injury that has resulted in various short-term symptoms such as seeing stars briefly, headaches, nausea, and so on. Generally, these symptoms will clear in a day or two. If they do clear quickly, the concussion is not considered to be serious.

How long symptoms persist also depends on the person, whether they were intoxicated at the time, their age, the cause and severity of the injury, and general health conditions. These variables can mean that a concussion can last longer than a couple of days, but, if treated early under the supervision of a doctor, the symptoms can be alleviated.

Michael D. Lewis MD advises applying the ‘Omega-3 Protocol.’ He says, “…over 30% of concussions will lead to long-term, potentially permanent disability.” However, we would advocate that you speak to your doctor first because the inflammatory response also has beneficial effects that may not happen if you treat your head injury at the wrong time. 

Things are often further confused with the medical terms ‘Post Concussion Syndrome’ (PCS) and ‘Mild Traumatic Brain Injury’ (MTBI).

Take all Concussions Seriously

Every bang to the head should be taken seriously regardless of the label given as a diagnosis. A second blow happening in quick succession can lead to severe brain injury or disability.

The other thing to bear in mind is that many doctors, and even neurological specialist, believe that concussion symptoms, once cleared up, no longer pose any threat. Researchers are continuing to investigate this because it is a complex area.

The best thing to do with concussions, PCS, or mTBI, is to err on the side of caution.

You don’t need to lose consciousness to be diagnosed with a mild TBI, and the symptoms of this can be harrowing for those affected and can also last for several months, or even many, years.  

 
 

Managing symptoms

Always speak to your doctor before making any changes or trying supplements.

This is important because inflammation has evolutionary beneficial effects which prepare the brain for neuroplasticity and repair. 

While scientists are working on treatment they still don’t know if they should be aiming to treat brain injury through neuroprotection, or to prevent progression of the neuroinflammatory response. 

In general doctors will prescribe medications to help alleviate symptoms for the first two years. After this time it is considered safe to tackle the inflammation by using neuroprotective agents.

Please remember that just because some diagnostic labels indicate less severe trauma – this doesn’t mean the outcomes are.

Taking care of yourself early on can help you to overcome symptoms. Sometimes a brain injury will deplete vitamin and mineral reserves and you doctor will be able to test and monitor this for you.

A healthy diet will help to provide all the extra nutrition your brain needs to heal while one loaded with tans-fats, salt and empty calories is likely to exacerbate symptoms. Fruit and vegetables will also help to rebalance and support the gut microbiome as a brain injury can also deplete the good bacteria your tummy needs to manufacture neurochemicals to support your brain.

Fresh air, daylight and exercise are also crucial in rebuilding vitamin D reserves and helping your body rebalance your body, brain and crucially your sleep patterns.

Information you may miss

Whether in an emergency room or practice doctors are always very busy. They may not have the information you need for you to take away or have time to discuss all your concerns. So, what do you need to know?

Be aware of worsening symptoms:

Everyone needs to be aware of the signs of worsening symptoms as these may indicate a slow brain bleed or that further assessment is necessary. Symptoms may be subtle and may not appear until days or weeks after an injury.

For those people who live alone, please refer to the checklist for help.

For children please see the Child Brain Injury Trust factsheet.

Who to call for advice:

Start with your doctor. Print this to take with you – Brain Injury A Guide for General Practitioners – Click To Print / Download

Many countries have brain injury organisations you can call. The easiest way to find a group near you is to search on your browser. Type in ‘brain injury support group near me.’ If you have any problems, please contact us. We will be more than happy to assist.

Finding other people to talk to:

There are many online support groups and forums. We recommend Traumatic Brain Injury Healing and Recovery Support Group; you can find them on Facebook.

No two brain injuries are the same, so if you do chat with other people to share experience, be mindful of comparing symptoms and outcomes. You will find that you share similarities with many people and talking about these can be useful as long as you bear in mind that your journey is particular to you. Read The Comparison Trap by Wendy Lustbader M.S.W.

Many factors influence recovery including age, health, diet and lifestyle. For example, two people of a similar age may find differences in their symptoms and outcomes because one may be sedentary and another a sports and health enthusiast. Many people find strength and feel supported, knowing they are not alone.

Every single brain injury is unique.

Understanding prognosis

Because every brain injury is unique, it can be difficult for doctors to predict outcomes. People want to know what to expect and can feel at a loss when answers are not readily available. Also, diagnosis may not always be clear to the patient or family, for example, a ‘mild’ traumatic brain injury does not indicate that the damage is not acute; the definition means that there was no loss of consciousness or that if apparent, it was minimal in length.

Any kind of concussion is classified as a head injury or traumatic brain injury (TBI); both are ABIs. 

Recovery outcomes are dependent on many factors adding to the difficulties clinicians have in giving a prognosis. Over the first months, your doctor or specialist will be able to provide a better indication of what to expect. Treatment and how immediately this starts will also make a difference. There is a six month ‘golden window’ of opportunity in which the injured brain is most able to recover spontaneously.

When symptoms and outcomes persist, speak to your doctor and ask about a referral to a neuropsychologist who will devise and guide a treatment plan.

There is a lot you can do to help yourself such as getting plenty of daylight and fresh air. See our ‘Positive Health’ section for more information.

Recovery is always on-going

The provision of inadequate information can persist. Sometimes people are still told that healing does not continue after two years. However, this opinion is very much outdated. The brain is capable of rewiring indefinitely after injury. It helps people to understand this at the onset because false expectations can have a psychological impact which can interfere with rehabilitation.

You may also hear that a brain injury is ‘for life’ and this can frighten some people and cause them to believe that how things are will never change. It is vital to get a perspective on this in the early stages. While the person may never regain the same level of skill they had previously, the brain is always rewiring and with patience, gentle feedback, support from a neuropsychologist or other experts, plus repetition of learning, people can and do overcome impairments.

Some functions are replaced by learning coping or compensatory strategies taught by a neurological specialist, usually a neurological occupational therapist. To start with, doing things differently to previously ingrained habits can be challenging for some people; however, as time passes, people start to realise the benefits of using new strategies. In many cases, skills will become ‘automatic’ and habitual again. The time it takes will depend on the severity of the injury and the level and quality of professional support and involvement of family and friends in the recovery process.

If you check out our ‘Partner Projects‘ page you will find a variety of recommended apps to use at various stages on the recovery journey. 

We have further strategies and tools you can use on our ‘Self-regulated Learning’ section.

The other common misconception is that brain injury permanently changes the personality. The core personality remains, and so intentions and motivations remain true to the character of a person. As these sponsoring intentions plus our reactions make their way through the damaged neurological circuits, they become broken and twisted, resulting in evident changes in behaviour. The same person is still inside, although damage to the frontal lobes affects how we use personality from an executive commands point of view and also affects how we are able to to appraise the emotional significance of events, analyse our environment and incoming information, and much more. 

Unfortunately, ignorance can also still persist. Some people are abandoned by their families because there is a belief that brain injury has caused them to become ‘retarded.’ Brain injury does not affect intelligence; it changes the way people can accomplish tasks with neurological damage. With help and support people can and do rewire their brains, and can eventually make significant improvements.

Brain injury is not a psychiatric illness either. There can be many changes in emotional response and control. However, these tend to balance back out, and in time, people regain their ability to manage their thoughts and feelings.

Brain injury can exacerbate previous personality tendencies and traits but will not cause a new personality to evolve. People rebalance themselves through learning about their brain injury and how it has affected them.

Pre-morbid conditions and existing mental health problems will affect post-brain injury outcomes. 

Alternative approaches

There are two main approaches to managing symptoms, pharmacological and natural, and it is worth spending time giving some thought to your personal preferences and also taking the time to do some research and to speak to your doctor. 

Try to find a doctor who has experience in brain injury and will support you in the best way. Ask them about their experience as some doctors will have different levels of knowledge to others. Laura has kindly shared her experience about why you should be precautious. Because a brain injury can affect the way the whole body functions, there are benefits to working with a functional practitioner.

While many people find relief with medications, many others have strong reactions following brain injury or may develop sensitivity over time. Symptoms may worsen, or there may be strong side effects as a result of using prescription drugs to relieve physical outcomes. It is essential to work closely with a prescribing physician and to discuss long-term approaches to your health.

Over the last ten years or so there has been a lot more research into supplements that support the brain and while many neurological experts prefer to stick with medicine, there are some who will support your interest in doing what you can to help yourself.

It is essential that you speak with your doctor before taking any supplement. Some may have contra-indications to prescribed medicine and some you may not need at all. 

Finding the balance

Advice about rest and activity following a brain injury can vary depending on the source. While doctors used to advise that people take complete rest, the current consensus is to find a balance between light activities and rest.

Depending on the severity of the injury, reactions and needs can vary.  Overstimulation can increase feelings of being overwhelmed and can also exacerbate emotional responses such as anger, irritability and frustration. For many people, making this connection between feedback from others and understanding their own emotions and feelings is difficult.  Many people feel a pressure try to get back to their everyday routine but should always err on the side of caution as doing too much can worsen the inflammatory response.

It is essential to listen to the guidance of your neurological expert or doctor.

If you have problems with maintaining attention, you may need to find activities that are outside of your usual comfort zone. All forms of art and craft are known to be therapeutic.  If physical injuries allow, taking gentle walks in the fresh air, listening to guided meditations/practising mindfulness, or yoga/tai chi are all beneficial.

Unexpected changes

The effects of a brain injury ripple out and touch everyone. The changes can vary on a spectrum from minor to extremely severe across all aspects of health and life.  There is now more understanding about the emotional and psychological repercussions on everyone, and it is essential that wherever possible, the family are included in the therapeutic process.

The experience of living life after brain injury can vary enormously and very often will depend on the quality of care the injured person receives. The more a family are included, the less likely they are to become frustrated or to walk away.

A brain injury can have a significant impact on family income, career, relationship dynamics and intimacy, and also on established roles, responsibilities and hierarchy within the home. Adapting to these changes can be difficult and may cause anguish and fear. Sometimes these worries need to be put on the back burner because there are more immediate needs to attend. It is vital to give these matters your practical attention as soon as you can.

When we are educated about something, we feel more able to manage it. Do all the research you can do so that you know what to expect. Encourage wider family and friends to read any pertinent information you find. Many people drift away because they don’t know how to help or be supportive. Allow people to learn, and they are much more likely to maintain relationships. Let them know what you need and talk about what you understand. By sharing knowledge and information from the many sources available, including neuro specialists, websites like this one, and support organisations and groups, you can better manage expectations and outcomes.

Change can be catastrophic and tragic, affecting every part of daily living. Ambiguous grief is commonplace, and feelings of emotional loss can be prevalent seeping into everything you try and do. Grief can affect everyone and can be overwhelming. Acknowledging what has happened and getting to the point of acceptance early on can make a big difference to the way anyone manages the outcomes of brain injury.

Many brain injuries are ‘invisible’ because there are no visual clues of disability. Very often, people do look physically well and yet will be struggling with a myriad of complications and change without having the cognitive functionality they need to deal with it – or explain it. Despite appearances, there will be functional loss and cognitive impairment. The degree to which someone is affected will depend on the severity of their injury. All brain injuries are acute, and everyone needs support and understanding.

Struggling to get help

Problems with getting help after a head injury are very common, especially for those diagnosed with concussion or mild traumatic brain injury. 

Something not commonly known is that these aren’t the only people who ‘slip through the net’ and sometimes fail to set medical support. The terms, ‘mild,’ ‘moderate,’ and ‘severe’ indicate the length of time someone was unconscious for rather than being reflective of outcomes and symptoms. The ‘walking wounded’ categorised as ‘severe’ can also fail to be referred for neurological assessment.

Until protocols are put in place for everyone it is up to the patient and their family to be assertive when symptoms and the cognitive/executive effects continue to problematic more than one month post injury. For those with severe difficulties urgent attention should be sought. If your emergency department gave you information or guidelines to return to them these should be followed; otherwise visit your doctor and discuss getting a referral for neurological assessment. 

Signs, symptoms and pitfalls

There are several essential things you need to understand, including possible pitfalls following trauma.

If you live alone and have sustained a head injury please see the checklist.

Signs and Symptoms

Physical and Sensory Problems:

  • Persistent headaches
  • Feelings of dizziness
  • Nausea/vomiting
  • Visual disturbances – blurred or double vision, dislike of bright lights
  • Being easily upset by loud noises

Sleep disturbances:

  • Altered sleep patterns
  • Fatigue
  • Insomnia

Behavioural and Mood Changes:

  • Feeling irritable
  • Easily angered
  • Feeling frustrated or impatient
  • Restlessness
  • Impulsivity and self-control problems
  • Feeling depressed, tearful or anxious

Cognitive Problems:

  • Feeling confused
  • Difficulties with attention and concentration
  • Memory problems
  • Difficulties with problem solving
  • Taking longer to think
  • Difficulty understanding others meaning or instructions

 

No two brain injuries are the same, which means that the effects of brain injuries vary greatly from person to person. The signs can be subtle or misunderstood by anyone without experience.

If you suspect a traumatic or acquired brain injury, it is essential to immediately contact the injured person’s doctor or go to the accident and emergency department at your nearest hospital.

As well as the severity and type of injury, the age and general health of a person, and many other factors, can have an impact on how well they recover. Diet and lifestyle influence healing and it is recommended you speak to your doctor or a nutritionist about things you can do to help yourself. Also, we have a ‘Positive Health’ section to support your understanding of how your lifestyle choices can support healing.

Children

We recommend getting in touch with the Child Brain Injury Trust or another specialised organisation if your child has been hurt.

Children’s brains are more ‘plastic’ and better able to rewire. However, this knowledge mustn’t set an expectation. A child can struggle into adulthood, and they need careful observation and support throughout their educational years.

Watch out for hormonal changes or imbalance. Damage to the pituitary gland can be a contributing factor in depression. Children and young adults are also more susceptible to mental health problems when they are under pressure sitting tests and exams.

It is essential to listen to children and to help them describe their struggles. Sometimes children stop telling adults how they feel because they don’t think they are understood.

Possible pitfalls to be aware of:

  • Staff levels in many emergency rooms are more skeletal during the weekend. These shortages can exacerbate problems with being given a diagnosis, assessment, advice or treatment. If you are in any doubt about a diagnosis, worsening symptoms or the information provided, either see your GP or return to the A&E department
  • Emergency medical personal and general practitioners don’t always have specialised knowledge of brain injury. If you are concerned, ask to see a neurological specialist or, if one is not on duty, ask for a referral appointment
  • A neurological specialist may not be available to see you (or a loved one), and this can result in people with head injuries not being referred for a CT or MRI scan. Concussions do not show up on a CT scan – although technology is improving. Do not allow CT results to dictate diagnosis without being very clear about what to expect from them
  • Some brain injuries are overlooked or not given priority when other injuries take precedence. Voice your concerns if symptoms develop or persist.
  • Even when there is a diagnosis of the initial injury or insult, it is highly likely that no information or treatment will be given. Ask for information and also the name of any local brain injury organisation. If symptoms persist for more than a few weeks, ask for a referral from your GP so that you can speak to a neurological specialist, such as a neuropsychologist. It is best to address a brain injury as early on as possible
  • If a brain injury is considered to be a concussion or ‘mild’ traumatic brain injury you might struggle to get medical support. Be prepared to be assertive if symptoms persist for longer than 3 months
  • You may not be given information to take home with you or a follow-up appointment and may worry about assessing what to do next. If symptoms worsen, you should seek urgent medical help. If symptoms persist but don’t get worse speak to your doctor
  • What to do if symptoms persist or become worse

Secondary brain injury

While the science about the disruption to the physiological processes in the brain following trauma is complex, what we need to be aware of and to understand, is reasonably straightforward.  This knowledge is critical to how well someone will recover following head trauma.

A diagnosis of concussion or mild traumatic brain injury can be confusing because of “a continuing lack of unity regarding mTBI definitions.[1]”

Not all concussions will result in a biochemical cascade. Where concussion symptoms clear up after a couple of weeks or 3 months at the most, it will be more likely that the body has dealt with the inflammatory response. When symptoms persist, you need to take action under the advice of your doctor.

Neuroinflammation is a complex process and certainly has some evolutionary beneficial affects that actually prepare the brain for neuroplasticity and repair, something we all want and need, but, it can also have deleterious effects that none of us want to suffer. No one wants the rewiring stage to be delayed but, while the jury is still out, the best advice you can follow is that which your doctor or specialist provides.

Following the ‘primary injury‘ to the brain, the force or blow causing concussion and brain injury, a cascade of biochemical events happen including damage to the blood-brain barrier leading to inflammation and cellular damage. Excitotoxicity leads to further axonal damage, mitochondrial dysfunction, oxidative stress as well as also adding to apoptosis and necrosis.

Studies have shown that this cascade can continue for 16 to 17 years post-injury[2] and without doubt, adds to the difficulties people have with overcoming symptoms and improving cognitive and executive functioning. Unaddressed this cascade works much like an on-switch, with each event causing a vicious circle of non-abating problems.

There are ways to get this ‘on switch‘ to turn back off and the information on this site is based around how to do this using nutrition, lifestyle changes, and other important interventions.

Laboratory studies show that people who have high levels of micronutrient reserves recover more quickly from a brain injury. Further studies also show that brain injury depletes reserves and that a diet supplemented with micronutrients improves recovery.[3] 

There is also evidence from a “case series of three patients with severe TBIs who were aggressively treated with vitamin D3, progesterone, omega-3 fatty acids and enteral glutamine for up to six weeks, termed nutraceutical augmentation for traumatic brain injury (NATBI), with very favourable outcomes” to show this treatment reverses coma and improves clinical outcomes in patients with severe traumatic brain injuries.[4]

There is a rapid growth in the science behind supplements as researchers work for a way to tackle the lack of treatments for brain injury.[5,] One of the reasons for this is because brain injury commonly causes sensitivity to prescription medications.

While there are several natural products studied for their therapeutic effects following brain injury, Nigella Sativa, commonly known as black cumin or used as black seed oil, is of particular interest to many scientists.

The NCBI (National Center for Biotechnology Information) said:

 “Due to its miraculous power of healing, N. sativa has got the place among the top-ranked evidence-based herbal medicines.”

Nigella sativa, extensively researched as a neuroprotective agent and now used in clinical practice, has shown beneficial effects in a range of psychological and neurological disorders – including brain injury outcomes.[6]

Among these are benefits in:

  • Anxiety
  • Depression
  • Epilepsy
  • Inflammation
  • Memory Impairment
  • Neurotoxicity
  • Neurodegeneration
  • Pain management

Historically, mainly due to a lack of specialised knowledge, doctors treat individual symptoms without relating these to the cause – i.e. brain injury and the biochemical response. While many people do find improvements, they can become reliant on medications designed for short-term use. Many others develop further symptoms and notice that prescription medications are not helping at all, leading to worries and fears about recovery. Added stressors feed the biochemical cascade making things worse rather than better.

We have created a series of video tutorials which describe the biochemical cascade.

References:

[1] ACRM Methodological Issues and Research Recommendations
for Prognosis After Mild Traumatic Brain Injury:
Results of the International Collaboration on Mild
Traumatic Brain Injury Prognosis 

[2] PubMed Inflammation after trauma: microglial activation and traumatic brain injury

[3] NeuroSpectrum360 Micronutrients For Brain Recovery: Canadian Centre for Behavioral Neuroscience

[4] Edorium Journals Matthews LR, Danner OK, Ahmed YA, Dennis-Griggs DM, Frederick A, Clark C, Moore R, DuMornay W, Childs EW, Wilson KL. Combination therapy with vitamin d3, progesterone, omega 3-fatty acids and glutamine reverses coma and improves clinical outcomes in patients with severe traumatic brain injuries: A case series. International Journal of Case Reports and Images 2012;4(3):143–149.

[5] PubMed Stuck at the bench: Potential natural neuroprotective compounds for concussion

[6] Science Direct Nigella sativa L and thymoquinone as neuroprotective antioxidants

Repeat concussion

While everyone should take extra care with their brain pre and post-injury the risk of a second injury or ‘repeat concussion’ is most common in sports where players are at higher risk of head injury and whiplash movements. 

The biochemical cascade can be delayed by days or weeks following a minor concussion, so a person may not be immediately aware of how seriously they are hurt. Repeat concussions are likely to increase the severity of each injury. The advice to ‘sit it out’ is crucial to avoid a more severe brain injury. Disability and loss of life are genuine dangers for people returning to play before a concussion has had the time to heal completely.

Studies have shown that muscle mass in the neck can reduce the severity of a concussion, which is why girls are more prone to a sports-related injury. Studies have also shown that athletes with highly nutritious diets, and therefore reasonable reserves of micronutrients, are more likely to recover in a shorter period. It is important not to think that you are at less risk if you have focused on building muscle mass and have included supplements or a healthy diet as part of your daily routine. Although these interventions have been shown to help – they don’t prevent a concussion from occurring.

Further Resources:

UKABIF – Concussion and sports related brain injury 

Sports related concussion

Multiple concussions, as frequently happen in many areas of sport, are however extremely dangerous, and everyone needs to be aware of these dangers – preferably in advance.

Current advice calls for sitting it out, rather than returning to play. No game or activity is ever worth the risk – multiple or repeat concussions can lead to severe disability.

If you have the time, it is worth taking a look at the story of Josh Olsen on YouTube. Josh suffered multiple concussions, which resulted in ‘second impact syndrome.’ He spent almost a month in a coma and had to have numerous life-saving surgeries.

The story is shared to help educate others and to help people to understand just how serious a ‘concussion’ can be.

There are multiple causes of concussion, and everyone needs to be aware of the dangers. We all need to be keenly aware of the dangers, especially in respect of little ones and elderly seniors who will be less conscious or aware of activities to avoid.

 

The best way to limit the severity of outcomes of a head injury is to take safety precautions. Wear a helmet, use a seatbelt and in all activities think safety first. And, whatever you do, never use a mobile while driving or even think about driving while tired or after consuming alcohol or drugs.

Another danger is ice; a lot of older adults slip and fall on slippery winter surfaces because they forget that they don’t have the same core strength or balance that they used to have. It is always essential to make sure older relatives and neighbours are safe during the winter.

Reporting concussion

Most people know that they, or others, shouldn’t be left alone for 24 hours following a head injury. However, what most people are unsure of is whether or not to report a head injury or concussion to a doctor or hospital. The advice is to get it noted on your medical record so that if your symptoms worsen and you are unable to describe why or what is wrong, someone else knows.

A lot of indecisiveness starts with cultural understandings which tell us that we should feel better after a bang on the head in 24 to 48 hours. Because of this, a lot of people don’t report a concussion at all – and there are further psychological pressures that can come into play.

Some people will feel they don’t want to be a nuisance; some will think that reporting a concussion might stop them from doing the things they want to do.

Whatever is going on, it is crucial, as above, to take all concussions seriously. There is no sense of loss of face for those who report concussions and feel better quickly. It is always better and safer to err on the side of caution and to make sure that medically someone is aware of an event that could change your immediate or even longer life and health.

Information is often inadequate and may not be given. Everyone needs to be aware of how serious a head injury can be. What you don’t want is to wind up months later being unable to return to work or school and to have no record of why or what the instigating cause was.

Go and see someone. Take it on the chin and be sensible and responsible for your health.

A new brain injury – living alone

The Checklist

Are you alone with brain injury?

The following checklists will help you to understand if you should seek further help and support.

If you have sustained any kind of head injury it is possible that you will not understand the severity of your condition. Symptoms of a TBI may not appear until days or weeks following the injury. You may be confused about why you feel poorly and might be waiting to feel better. You may look fine and not recognise that you are acting differently.

You may be reliant on people telling you what to do and not realise they may not know.

It is also possible that the severity of your symptoms may not have been fully understood at any initial assessment by a medical professional(s). If you have a responsible adult or family member who will be able to assist you, please ask them to give you their full support.

If you are that friend or family member, and someone has shared this with you and they have asked you for your support, then please give it unconditionally and without questions. It is really easy for the people around us to mistake the symptoms of our brain injuries for ‘normal’ stresses within the personality, especially post-trauma.

Give a yes or no answer to the following questions:

  1. Are you alone with brain injury?
  2. Have you been dismissed by doctors?
  3. Have you been told that things will improve on their own?
  4. Do you get confused easily?
  5. Have you lost some memory?
  6. Does life seem different?
  7. Do you have problems with daily routines?
  8. Do you believe your brain now works differently?

If the answer to any of these questions is ‘yes’ then you need help.

Print out and check the guide below for further signs of brain injury. Take the information to your doctor.

Brain Injury A Guide for General Practitioners – Click To Print / Download

Post Concussion Syndrome(PCS)

While the jury is still out about why any concussion should last more than three months, some scientists and specialists are beginning to put the pieces of the puzzle together.

Most people diagnosed with PCS are only too aware of the symptoms and cognitive problems that plague them and just don’t seem to go away. People can become weary worrying about returning to work or education.

Symptoms can vary from one person to the next, and some can be apparent in other mental health issues making diagnosis even more problematic. If you suspect that you or someone you know has PCS, don’t rely on self-diagnosis from reading lists of symptoms, go and speak to a doctor and if necessary ask for a referral to a brain injury specialist.

PCS is generally the diagnosis given when the symptoms of concussion or a head injury last for months or even years after the initial injury.

While conventional CAT and MRI scans don’t show the microscopic damage in concussion or whiplash injuries, a Magnetoencephalography (MEG) scan will.

Although not yet used clinically as an aid to diagnosis, MEG scans will very likely become the top-ranking scanner in the future. Being able to ‘see’ the damage and knowing what is happening can bring a huge relief to people, especially those who don’t have any evidence other than their symptoms and outcomes to support why they are suffering so much.

What complicates diagnosis?

A lot of things! The things to be wary of are accusations of malingering and also of trying to get more compensation from a legal claim. Don’t let doctors write-you-off and be tenacious in getting the help you need.

It is highly likely that in the near future insurance companies and lawyers will insist on MEG scans to rule out the minority of unscrupulous people who actually undermine the seriousness of PCS for those who are genuinely struggling and whose lives have been turned upside down.

Things to consider

There are a number of pre-existing social, life and health issues that could be behind PCS. 

In fact, these pre-existing conditions could explain a variety of prolonged symptoms following any severity of brain injury and are worth considering because it turns out there is possibly a lot we can do to help ourselves.

Let’s go back to MEG for a moment. MEG measures brain wave activity as well as being able to take pictures of areas of injury and over-activity as the brain works harder to perform the same tasks. MEG shows differences in executive functioning between mTBI, PTSD and mental disorders. A five-minute MEG scan gives 100% predictability of concussion diagnosis.

Scientists behind this work are aware of how the flow of energy throughout the body can be disrupted by a brain injury.

Incorrect and ineffective treatments extend suffering, and it is also recognised that while concussion symptoms resolve in around 70 to 80% of cases, it isn’t fully understood why it isn’t this way for everyone.

The role of previous history

We are all different in many ways, and these diversities could be at the root of PCS.

It is thought that pre-existing conditions affecting recovery could include diet, age, lifestyle, fitness, the health of your gut microbiome, vitamin and mineral reserves and levels, particularly vitamins B12 and D, sleep quality, underlying psychological or psychiatric conditions, personality type/attitudes and general mental health, medications and health issues, alcohol or substance misuse, level of education achieved and even genetics and epigenetics could be factors that cause a predisposition to prolonged recovery.

Well educated people with a healthy diet and lifestyle are more likely to have neuroprotective qualities existent in the brain. New research published in the Journal of Neurology shows that people with higher levels of education will fare better.

Why do any of these have an impact on how well anyone will recover from a brain injury? Generally, difficulties with recovery stem from the ‘secondary injury.‘ For example, if your gut microbiome and brain environment are already compromised by a poor diet and other factors, the inflammatory response following a brain injury significantly alters the gut microbiota weakening the immune system and damaging biological communication systems such as the central and enteric nervous systems making a recovery harder.

There is a view that poor recovery is entirely due to doing too much too soon and while over-doing it in the early days and weeks can certainly play an aggravating part, it is far from being the only culprit responsible for prolonged symptoms and cognitive changes.

More research

While much more research is needed, another underlying factor could be the poor responses people have to the secondary injury or biochemical cascade. 

All of the pre-existing conditions mentioned above can affect the delicate balances in biological functionality. The health of the gut microbiome, adrenals/hormone balance and immune system can all affect how well and how quickly we recover from inflammatory responses to injury and trauma. Those who have suffered previous trauma or a prior brain injury may already have a weakened system.

What can you do?

When the whole world seems out of control, people can struggle to keep going mentally and emotionally.

Not knowing what is wrong or why things are happening to you can add to the burden of health and cognitive issues following concussion or mTBI.

When we know the causes of our struggles, we can begin to address them. It is well documented that lifestyle changes can reverse biological damage. If we can get the body back to health, we stand a greater chance of getting the brain back to health.

The health of your brain environment is crucial to recovery and is dependent on your overall physical health, so when you read that exercise and fresh air are beneficial following a brain injury, it is worth taking notice of and making the appropriate changes.

Sleep is also a crucial factor in how well the brain will recover so if you are having problems it is essential to seek help and deal with these as early on as possible.

The health of your brain environment is also a key factor in rewiring your brain and plasticity.

Change your diet,  and include prebiotics and probiotics and avoid foods that worsen inflammation.

If you are post two years speak to your doctor about Introducing scientifically proven neuroprotectors such as black seed oil and omega-3.

Talk to your doctor about medications as the injured brain is much more sensitive to prescription drugs.

Learn everything you can about healing your brain. A lot of public literature focuses on problems rather than solutions. Recovery from a brain injury involves educating yourself and understanding as much as you can about the causes underlying your problems. When you know what is behind the things you are struggling with, you are empowered to make the best changes you can.

Treatments such as cognitive behavioural, physical, balance, exertion and vision therapy and neuro-optometric rehab can all play a part. Speak to your doctor or specialist about other things that can help.

Resources:

For the families and friends who are looking for help and information following a recent trauma involving a loved one, there is useful information on Headway about what to expect and answers many worries and questions.

You will also find the information about what happens to the injured brain useful as this describes the secondary injury/biochemical cascade – in more detail.

It is vital to read ‘A New Brain Injury‘ – especially if you are the one who has been directly affected and aren’t getting any medical help or other support.

References:

National Neuro Trauma Society – Primary and Secondary Brain Injury

Choosing Wisely Canada – CT scans for adults with head injuries

NCBI – The Neurometabolic Cascade of Concussion

NCBI – Stuck at the bench: Potential natural neuroprotective compounds for concussion

Original research paper Assessment of dietary adequacy for important brain micronutrients in patients presenting to a traumatic brain injury clinic for evaluation
Terry Wahls1, Linda Rubenstein2, Michael Hall3, Linda Snetselaar4

PMR Archives – Methodological issues and research recommendations for prognosis after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.

NCBI – Concussion is confusing us all

Preventing concussion

Get a Heads Up: Keeping Safe from Brain Injury

Recommended further reading :

Mail Online – (March 2018) Rest after a concussion could be bad for children

CDC – Recovery from concussion

Complete Concussion Management – Rest or physical activity after concussion

SportsMD.com – Second Impact Syndrome

Sage Journals – Reporting Skill: The Missing Ingredient in Concussion Reporting Intention Assessment

Medscape – CTE Prevalence High…and Not Just in Athletes