The Long Term Consequences of Concussion

A concussion is a temporary disturbance in brain function that follows an impact to the head. They are common in contact sports and the issue of concussion is sport has become a hot public health issue in recent years. They can follow any head injury, not just in sports. The main symptoms of a concussion include headaches, nausea, vomiting, dizziness, slurred speech, a temporary loss of memory (especially of the events leading to the concussion) and inability to focus. Only about 10% of concussions lead to a loss of consciousness. Most of those who have a concussion recover relatively quickly with most recovering within several days to a couple of weeks. About 1 in 10 people who have a concussion may experience persistent symptoms for months and sometimes, years. When the symptoms of the concussion persist beyond three months, then they may be diagnosed as having persistent post-concussion symptoms. The seriousness of concussions has led the World Health Organization to classify concussion as a critical public health issue.

Previous advice on the treatment of a concussion was complete rest, but this has changed in recent years. Complete rest in the day after the concussion is still advised, however it is now encouraged that low-intensity exercise is undertaken over the following days. This might include walking, easy jogging or an exercise cycle. Gentle mental stimulation (such as work or study) is also recommended over the following days. While those with a concussion recover at different rates, the amount of physical and mental activity should be gradually increased and be guided by the symptoms.

Persistent post-concussion symptoms can vary substantially between individuals but generally the symptoms include headaches, light or noise sensitivity, balance problems, sleep disturbances, anxiety and depression. Fatigue, both mental and physical, is very common in those with the persistent post-concussion symptoms, and this can have a significant impact on quality of life.

A lot more is known about the immediate and short-term management of concussion but less is known about the management of the long-term issues. Effective treatment of the persistent symptoms includes early psychological support. Apart from the psychological support which has been shown to be effective there is no definitive treatment for the long-term consequences of concussion. The symptoms of each individual will be managed as they appear and addressed by the treating physician as each individual will manifest a different set of symptoms. Medication may be needed for the headache symptoms. Physical therapy may be needed to help address the balance issues. Gentle exercise is encouraged to help the fatigue and conditioning. There is no medication that is available to help the cognitive and memory issues, so cognitive and behavioural therapy from a psychologist is often used. Psychotherapy and medication can be used to assist the anxiety and depression issues. Gentle aerobic exercise has been shown to be important to facilitate the recovery from these long-term symptoms. There can also be psychological impacts on the partner and family around the person with the concussion and these may need to be addressed if needed.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.