Lasting effects after mild concussions

Abnormal brain structural patterns persist months after clinical symptoms had resolved from a mild concussion researchers found at the Lovelace Biomedical and Environmental Research Institute in Albuquerque, N.M.

Dr. Mayer and colleagues examined the underlying pathophysiology of mild traumatic brain injury through changes in gray matter diffusion and atrophy during the semiacute stage and found evidence that structural changes persist long past the improvement in neuropsychological tests. In a study that involved 50 participants, 26 patients showed evidence of increased cortical gray matter anisotropic diffusion 4 months post injury.

See full study

Traumatic-Triggered Migraines vs Concussions

Family history of migraines is a precursor to headaches in children and as per studies cited bellow, head trauma and concussions may increase the length of headaches and complicate treatment. The question is: are Traumatic-Triggered Migraines (TTM’s) different than headaches as a concussive characteristic? and should they be treated differently? The case study referenced by Lords, Q reported in Sports Health Multidisciplinary App.(Traumatic Migraine Versus Concussion: A Case Report.)   presented a different look at their diagnosis and treatment approach.  This report instead of actually  separating them apart it may be pointing out how related they are or that one is part of the other. Headaches post injury may be more or less severe, longer lasting and have a genetic component but should be dealt with in the contest of brain injury. The word “Concussion” can at this time, after it became a popular word in sports, complicate how we deal with it. Because concussions have the sports connotation is easy to fall into the trap of making us follow the light path others have taken and skip important steps toward treatment. In the brain injury world, per say, I can relate to the stance of wanting to distance ourselves from what the word “concussion” is becoming and try to separate its components, such as headaches, and give it another name as it clearly happens in the cited article. For example in this study the author seem to attempt to separate the diagnosis between what a concussion is and what traumatic related headaches or migraines are. Headaches and migraines most times are components of a concussion were its nature, historic and genetic component challenges current diagnosis and treatment methods.

Have you dealt with headaches and/or migraines pre and post injury? Can you separate them and what approaches have you tried with or without success?

Click for referenced studies here…

Headache medications may worsen headaches after concussions

There are many instances in which athletes present with chronic headaches post concussion. Some of them with history of migraines trigger an aggressive approach from some pediatricians. Family history of migraines, for example, increases the possibility of developing migraines and that may trigger a closer look at the benefits of headache medication. In most instants analgesics are indicated but in some times overuse of pain medication may cause the syndrome to worsen. Dr. Geoffrey Heyer, MD reports in his study presented as an abstract, here referenced, headache medications may worsen headaches after concussions and may cause chronification of a headache syndrome.

Have you had any experience in this regard? Anecdotes? How did it resolve?

Source reference: Heyer G, et al “Analgesic overuse contributes to chronic post –traumatic headaches in adolescent concussion patients: CNS 2013; Abstract 113

Group baseline test administration is less reliable than individual assessments study shows

by Alex Gometz, DPT, CIC

A recent study finds group approaches to baselines are less reliable. This study is a cohort comparison evaluating the differences in results in skills assessed during neurocognitive baseline testing in groups of athletes versus individualized approaches. Decreased performance was demonstrated in the group setting, in which test takers scored significantly lower on verbal memory and exhibited a greater rate of invalid baselines.

The above referenced study brings to lite the importance of a sound clinical evaluation by healthcare professionals who are most appropriate to make the best use of current evaluating tools. It is, or it should be, common knowledge that a baseline test is important to guiding post injury recovery, and for it to be true it has to be done correctly in conjunction with any other tools available. In many instances, the focus has been on the test performed rather than the clinician’s ability to administer it for best results.

It makes sense therefore to stay away from group assessments due to the expected lack of individualization of the assessment and therefore increased chance of inaccuracies. A study may not have been needed to make that point. It is obvious that the less attention to detail the less accuracy of the information collected.

Head injuries may happen in different environments and when they happen in sports setting they shouldn’t take a lighter approach at any stage weather it is a baseline or management post injury. There may be more benefits realized when left to health care professionals with experience and licensed to deal with the assessment and rehabilitation of brain injury from the beginning to end of the process.

See copy of the study referenced…