Concussions can profoundly affect mental health

Dear Doctor: There is a new movie just released called Concussion with Will Smith. What is a concussion?

A concussion is a type of traumatic brain injury. Concussions are the most common type of traumatic brain injury. The cause is a temporary disruption in the way your brain functions. Most commonly they come from direct trauma to the head, but they may also be a result of excess trauma or shaking to the head and/or upper body.

Concussions usually produce loss of consciousness, but not always. In cases of head and upper-body trauma that do not result in loss of consciousness, concussions can still occur and often the victim is unaware that they have a concussion. That is why it is so important to have processes in place to have people, including athletes, carefully examined after significant trauma.

The movie Concussion portrays a doctor who was one of the first to make the connection of head trauma and concussions to adverse health effects in professional football players. Currently there is multi-million-dollar litigation brought against the NFL by 5,000+ players for health effects they have suffered related to concussions.

Why should I care about concussions?

Concussions are becoming more and more common in contact physical athletics involving all ages, children to adult professionals. A recent government report estimates that over four million sports-related concussions occur in the United States annually.

Concussions are also the most common type of traumatic brain injury seen in persons over the age of 65 secondary to falls. Concussions are also commonly seen after motor vehicle accidents. Concussions can have profound mental health implications.

What causes concussions?

A concussion is the result of a violent blow to the head. The brain is slammed against the skull and injured. One of the things that make concussions difficult to diagnose is that the brain has no pain receptors, so often the signs and symptoms of a concussion will come on minutes to hours after the concussion. Additionally, as mentioned earlier, one does not have to lose consciousness to get a concussion.

How is a concussion diagnosed? 

Any type of injury to the head should be evaluated by a physician. At that time, the physician may perform a physical neurologic examination that checks your vision, hearing, balance, strength, coordination, reflexes, and thinking skills such as memory, attention and ability to process information. The doctor may also order special imaging studies such as CT scans and MRI evaluations.

Some of the signs and symptoms of a concussion are:

• A severe, constant headache
• Personality changes and increased irritability
• Interference with sleep
• Mood changes and/or depressed feelings
• Strange sensations of taste and smell
• A feeling of pressure in the head
• A feeling of profound confusion or feeling like one is “in a fog”
• Temporary loss of consciousness
• Inability to remember the traumatic event
• “Seeing stars”
• Dizziness
• Nausea
• Vomiting
• Concentration difficulties
• Memory difficulties in general
• Ringing in the ears
• Slurred speech
• Irritability

Remember, it is vitally important to see a physician after any head injury.

How are concussions prevented?

It is very important to wear the proper athletic protective equipment. Always wear a seatbelt. Also, it is important to reduce the impediments and risks for falls at home.

Some parents have removed children from sports where the risk of concussion is high. As a result, some schools have had to join together to field enough players for a full team. In addition, some schools are eliminating traumatic sports programs like football.

How are concussions treated?

The prime treatment for concussion is rest. Rest also includes limiting activities that require mental concentration and concentrated thinking including, but limited to: watching TV; playing video games; concentrated reading, typing or texting; and focused, intense schoolwork or job duties.

Your doctor may recommend shortened workdays or school days, taking breaks during the day, or reduced workloads or work assignments while you recover.

The time needed to recover from a concussion involves many factors including age, medical conditions, medications being taken, and number of previous concussions.

With every subsequent concussion, the ability to recover becomes less and less, and studies have indicated that repeated concussions can cause long-term cognitive, memory and mental function changes. Generally speaking, the rest period for the first concussion is approximately two weeks. During this time it is important to get plenty of sleep.

Sometimes recurrent headaches can last several weeks to months. For a headache, doctors may recommend acetaminophen (Tylenol, others). Do not take ibuprofen (Advil, Motrin IB, others) and aspirin as they increase the risk of bleeding.

All post-concussion recovery programs should be supervised by a physician. Most people recover completely from concussions. Follow your doctor’s advice closely. A doctor will let you know when it is safe to return to normal activities, especially sports or physically or mentally demanding jobs.

Action steps 

• Any head injury, even if the person does not lose consciousness, should be evaluated by a physician.
• Always wear a seat belt.
• Make sure your environment is safe and remove risks for falls.
• Always wear the appropriate protective head gear in athletics.
• If you have been diagnosed with a concussion, do not return to work or school or athletic activities until cleared by your doctor.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.