The Peter Attia Drive

Concussions and head trauma: symptoms, treatment, and recovery | Micky Collins, Ph.D.

Mon Jul 24 2023

concussionstreatmentrecoverysymptomsmanagement

Description

The episode discusses the definition, diagnosis, signs, and symptoms of concussions. Risk factors that make individuals more susceptible to concussions or experience more severe ones are explored. Quick treatment and recovery from concussions are emphasized, including for children, adults, and the elderly population. The use of hyperbaric oxygen and synthetic ketones as treatments for concussion is discussed. The conversation leaves the host feeling optimistic about the prognosis for people with concussions.

Insights

Concussion is a treatable injury

Concussion is a treatable injury, and full recovery to baseline is possible. Effective management of concussion can prevent long-term problems.

Different types of concussions

There are six different types of concussions, each with different symptoms, risk factors, therapeutic techniques, and outcomes. The more types of concussions a patient has, the more difficult it is to treat.

Vestibular problems and their impact

Vestibular problems can cause dizziness, fogginess, environmental sensitivity, and avoidance of exercise or busy environments. They often kick off other symptoms like migraines and anxiety.

Importance of early intervention

Early intervention within weeks of an injury can lead to faster recovery from concussions. Quick access to treatment within seven days predicts better outcomes for concussion patients.

Long-term effects and research

The natural history of untreated concussions is not well understood, and there is ongoing research on the long-term outcomes for patients. Certain risk factors, personality types, and biomechanics can contribute to prolonged symptoms after a concussion.

Seeking specialty care

Specialty concussion clinics are better equipped to manage concussions than general pediatricians. Access to concussion clinics has improved over the years, including through telemedicine options. Seeking specialty care within a week of injury can lead to quicker outcomes for concussion recovery.

Recognizing symptoms and seeking care

Symptoms of a head injury can include dizziness, fogginess, fatigue, light sensitivity, noise sensitivity, headache, difficulties following or staying asleep, nausea, car sickness, difficulty in busy environments, and cognitive issues. If symptoms are severe and not improving, it is important to see a healthcare professional.

Treatment options

Vestibular problems can be treated with the right physical therapy and approach. Patients should be encouraged to be more active and challenge themselves. Medications like sertraline, wellbutrin, lexepro, eschatol, or prima can be used depending on the specific profile of the nervous system problem.

Concussion in older adults

Concussion in older adults is an understudied area but can be treated with positive outcomes. The aging population is more susceptible to falls due to factors such as brain atrophy, less motor control, and reduced protection of the brain inside the skull.

Training concussion specialists

There are approximately 15 to 20 fellowship programs in the US for training concussion specialists. Neurologists may not have specific training in concussions, so it's important to see a specialist.

Summary

Transcript

Introduction

00:11 - 07:10

The Drive podcast focuses on translating the science of longevity into accessible content.

Understanding Concussions

06:54 - 19:26

Concussion is caused by the brain shifting inside the skull due to acceleration or deceleration forces.
Stretching of the neuron membrane leads to leakage of potassium and influx of calcium, causing energy supply issues.
Different systems in the brain can be decompensated following concussion, leading to different types of concussions.
No biomarker currently exists for diagnosing concussion.
Concussion is an injury at the cellular level without structural changes in the brain.
There is currently no biomarker to measure this type of injury.
The brain's demand for glycolysis increases after a concussion to actively pump potassium back into neurons.
The entry of calcium into cells during a concussion causes vasoconstriction and decreased cerebral functioning.
Concussion affects different systems and pathways in the brain, rather than specific regions.
Preexisting risk factors can determine the severity and type of concussion symptoms experienced.
Girls are more likely to have concussions than boys, and hormonal influences play a role.
Recovery from an initial concussion leaves individuals vulnerable to subsequent concussions with less force causing more serious outcomes.
Concussion is a treatable injury, and full recovery to baseline is possible.

Managing Concussions

19:03 - 25:44

Recovering from an initial injury makes a person more vulnerable to serious outcomes from less force.
Concussion is a treatable injury if managed effectively and fully treated.
Managing concussion effectively can prevent long-term problems.
Kids playing sports is healthy, but effective management of concussion is crucial.
Proper assessment and tools are necessary for managing concussion effectively.
Dizziness is six times more predictive of longer recovery than loss of consciousness.
Symptoms of injury predict poor outcome better than signs of injury.
Playing through a concussion prolongs recovery time significantly.
Educating parents about the symptoms and risks of playing through a concussion is important.

Types of Concussions and Recovery

25:21 - 31:59

There are six different types of concussions: cognitive, vestibular, ocular, migraine, anxiety, and neck.
Each type of concussion has different symptoms, risk factors, therapeutic techniques, and outcomes.
The more types of concussions a patient has, the more difficult it is to treat.
Adolescent brains take the longest to recover from concussion compared to college athletes and professional athletes.
There is an age relationship in concussion recovery.
Research is being done on hormonal influences in women's concussions.
The menstrual cycle can change after a head injury.
Misinformation about concussion can lead to poor outcomes and mistreatment of the injury.
Quick access to treatment within seven days predicts better outcomes for concussion patients.

Case Study: Vestibular Problems

31:29 - 37:48

Vestibular problems can cause dizziness, fogginess, environmental sensitivity, and avoidance of exercise or busy environments.
The same pathways in the brain that control the vestibular system also mediate the sympathetic nervous system response.
Patients with concussions often experience fight or flight responses due to sympathetic nervous system arousal.
Avoidance of certain environments triggers both the vestibular problem and the fight or flight response.
Migraines can be triggered by stress, lack of sleep, and inconsistent exercise patterns.
Migraines can also feed back through the vestibular pathways and ocular pathways causing additional problems.
Migraines can be caused by inconsistent sleep and exercise.
A vestibular problem can lead to anxiety, which then becomes a migraine problem.
Migraines can also cause problems in the vestibular and ocular pathways.

Treatment for Vestibular Problems

37:21 - 44:13

Vestibular problems can amplify anxiety and lead to a vicious cycle.
Some patients may have ocular motor problems without vestibular issues or migraines.
Retraining the ocular system through PT can help with ocular motor problems.
Vestibular problems often kick off other symptoms like migraines and anxiety.
Exercise, nutrition, and sleep can contribute to recovery from vestibular injuries.
Early intervention within weeks of an injury can lead to faster recovery.
A patient was given detailed vestibular exercises to do every morning and evening.
The patient also received a workout program to train the vestibular system and increase the parasympathetic nervous system.
The exercise program also helps treat migraines.
The patient will walk for 45 minutes in the morning and do a rigorous workout in the afternoon for about 45 minutes to an hour each day until their next appointment in four weeks.
Specific exercises include Russian twists, planks with head turns, lateral shuffles, burpees, etc., depending on the type of vestibular problem.
The patient is advised to regulate their sleep schedule, avoid napping, and expose themselves to busy environments regularly.
Behavioral treatment is preferred over medication initially, but there are medications available if needed.
Different medications like sertraline, wellbutrin, effects, lexapro, eschatol, prima can be used depending on the specific profile of the nervous system problem.

Medications and Follow-up

49:29 - 55:54

Different medications can be used to treat the vestibular system and nervous system problems associated with concussions, such as sertraline, wellbutrin, lexepro, eschatol, or prima.
Regular follow-up appointments are necessary to ensure compliance and address any secondary problems that may arise.
Concussions can lead to hypogonadism in male patients due to the impact on the pituitary gland.
A rampant sympathetic nervous system can affect various bodily organs and functions, including hormone influences, temperature regulation, and migraine.
Hyperbaric oxygen therapy is not recommended for concussion treatment as there is no empirical evidence supporting its effectiveness.
The opportunity cost of hyperbaric chamber treatments should be considered in terms of time investment and potential alternative health-improving activities.
There is no compelling data suggesting that hyperbaric treatments immediately after an injury would have a significant impact on outcomes.
Rumination should be avoided during concussion treatment, making hyperbaric chamber sessions less desirable.
The use of synthetic ketones prior to an injury may have theoretical benefits in ameliorating symptoms by providing an alternative energy source.

Epidemiology and Long-Term Effects

55:36 - 1:02:43

The highest risk of concussion in terms of lifetime incidents is found in equestrian sports, with 90% of equestrians experiencing concussions.
Boxing is also a common sport where concussions occur, but research in this area has been limited due to underreporting.
There are an estimated 1.8 to 3.6 million concussions per year in sports and recreation in the United States alone.
The natural history of untreated concussions is not well understood, as there is a lack of research on the long-term outcomes for patients.
Certain risk factors, personality types, and biomechanics can contribute to patients experiencing prolonged symptoms after a concussion.
Research has shown some relative increases in anxiety among individuals who have sustained multiple concussions, but there is no clear link between concussions and dementia or other neurodegenerative illnesses.
A controlled study is currently being conducted to examine the prevalence of neurodegenerative issues in patients with repetitive head injuries compared to those without such injuries.
The results from this study and others like it will provide more clarity on the relationship between concussions and long-term brain health.
CTE (chronic traumatic encephalopathy) may be the result of accumulated sub-concussive injuries rather than major concussions, but further research is needed to confirm this hypothesis.

Understanding CTE and Seeking Treatment

1:02:18 - 1:08:41

There is no definitive scientific statement on the issues surrounding sub-concussive injuries and CTE.
Patients who believe they have CTE can improve with treatment, which highlights the importance of awareness and access to treatments.
Patients with untreated concussions can experience high anxiety, suicidal thoughts, and a decline in their overall well-being.
Increased awareness without a solution can lead to hysteria and devastating outcomes for patients.
Specialty concussion clinics are better equipped to manage concussions than general pediatricians.
Access to concussion clinics has improved over the years, including through telemedicine options.
Some top programs in the country for concussion management include ANOVA in Washington, D.C., Boston Children's Hospital, clinics in Houston and Phoenix, and various programs in California.
Seeking specialty care within a week of injury can lead to quicker outcomes for concussion recovery.

Recognizing Symptoms and Seeking Care

1:08:12 - 1:14:28

Seeking specialty care within a week of a head injury leads to quicker outcomes.
If you feel fine after a head injury and have no symptoms, it may not be necessary to get evaluated.
Symptoms of a head injury can include dizziness, fogginess, fatigue, light sensitivity, noise sensitivity, headache, difficulties following or staying asleep, nausea, car sickness, difficulty in busy environments, and cognitive issues.
If symptoms are severe and not improving, it is important to see a healthcare professional.
For weekend warriors or those who may hit their head again soon, getting checked out is recommended.
There is no compelling data suggesting that the APOE4 genotype increases susceptibility to concussion or traumatic brain injury.
The aging population is more susceptible to falls due to factors such as brain atrophy, less motor control, and reduced protection of the brain inside the skull.
Concussion in older adults is an understudied area but can be treated with positive outcomes.
A case example of an older adult with a fall resulting in facial fracture and concussion was discussed.

Conclusion

1:14:06 - 1:20:21

Vestibular problems can be treated with the right physical therapy and approach
Patients should be encouraged to be more active and challenge themselves
Funding for concussion research is available from various sources including NIH, NFL, and the Chuck Knoll Foundation
Neurologists may not have specific training in concussions, so it's important to see a specialist
There are approximately 15 to 20 fellowship programs in the US for training concussion specialists