C. Munro Cullum, Ph.D.Psychiatry
Nyaz Didehbani, Ph.D.Psychiatry
Concussion care and awareness have come a long way in the past two decades. Gone are the days when a wobbly football player would just “shake off” a collision and trot back to the huddle.
Today, if a player exhibits symptoms of a concussion, they’re more likely to be ushered to the sideline and examined. In most cases, their helmet is taken away so they cannot reenter the game. And before an athlete can return to play, he or she is required to complete modern concussion protocols, which involve a multistep and typically multiday process that often includes physical and cognitive testing in addition to assessment of symptoms.
With increased awareness, of course, has come added scrutiny – not to mention confusion and misinformation. Some parents have chosen to keep their kids from participating in sports over concussion concerns. Unfortunately, lack of sports involvement could deprive the child of much-needed physical activity and social development opportunities.
As clinical neuropsychologists specializing in concussion care, we are determined to share the most accurate, up-to-date information we have about concussions and the research surrounding them. With that in mind, we wanted to clear up a few persistent myths about concussions and the care they require.
1. MYTH: If someone sustains a concussion, don’t let them fall asleep; wake them every few hours.
REALITY: Some rest is good for the brain after a concussion – but not too much.
Unless there are focal neurologic signs (such as differences in pupil size) or evidence of a more severe brain injury (e.g., prolonged loss of consciousness, seizure, etc.), most patients with concussion benefit from sleep. Many years ago, there was a fear that patients who fall asleep after a concussion were at risk of slipping into a coma, but research has shown that’s not the case for most concussions. When in doubt, consult a health care professional.
2. MYTH: If you’re not “knocked out,” it’s not a concussion.
REALITY: About 90% of concussions don’t result in loss of consciousness.
Concussion refers to a temporary disruption of normal brain function, but most often this is reflected in specific symptoms and not loss of consciousness (LOC) per se. Common symptoms of a concussion include:
- Headache or “pressure” in the head
- Nausea/vomiting
- Balance problems or dizziness
- Double or blurry vision
- Sensitivity to light or noise
- Feeling sluggish, hazy, foggy, or groggy
- Concentration or memory problems
- Confusion
3. MYTH: If you hit your head today but don’t have symptoms until tomorrow, it’s not a concussion.
Reality: Some patients won’t experience symptoms until the next day.
Most concussions are associated with an acute onset of symptoms, but there is a subset of patients who may develop a headache or other post-concussive symptoms the next day. That’s why symptom monitoring and reporting are key following a concussion.
4. MYTH: Concussions will lead to chronic traumatic encephalopathy (CTE).
REALITY: CTE is a rare neuropathologic condition, and its association to concussions is unclear.
CTE is not a clinical diagnosis, so we do not know what, if any, symptoms are related to the underlying pathology that is found in an autopsy in CTE. Although CTE has been found in the brains of some individuals who have had a history of repetitive head hits, it has also been found in others with no such history.
At this point, we don’t know why CTE develops in some people and not others nor what all its risk factors are. More research is needed to address these questions.
5. MYTH: You have to hit your head to have a concussion.
REALITY: A concussion can be sustained whenever there is a sudden, significant jolt to the brain.
A hit to the torso, or any hit causing rapid acceleration/deceleration of the brain in the skull can result in concussion. So, not every concussion is from a hit to the head. You can also get a concussion from a hit to the torso if your brain is jostled enough.
6. MYTH: You can return to play as soon as you feel OK after a concussion.
REALITY: Athletes should complete a multistep process to be cleared for play.
When a concussion is suspected or diagnosed, the athlete should be removed from play until he or she is evaluated and cleared by a health care professional experienced in dealing with a concussion.
All 50 states now have laws requiring removal from play of a teen athlete after a suspected concussion, and schools are mandated to follow specific protocols before allowing the injured athlete back into full-speed competition.
7. MYTH: A concussion isn’t an actual brain injury.
REALITY: Brain injuries vary in severity, and a concussion is a mild brain injury.
Severe brain injuries are associated with greater symptoms (for example, loss of consciousness, post-traumatic amnesia, etc.), functional impairment, and worse outcomes. Although concussion symptoms aren’t typically severe, they are brain injuries.
8. MYTH: You always “see stars” if you suffer a concussion.
REALITY: No two concussions are alike.
While some people have reported “seeing stars,” and while various visual disturbances can occur after a concussion, there are a number of other symptoms that can occur. You don’t necessarily see stars.
9. MYTH: Most people who sustain more than one concussion develop dementia.
REALITY: The risk for dementia following even more serious brain injuries is not high overall.
No two brains or people are alike, but the vast majority of people who sustain a concussion recover within days or weeks and do not develop dementia when they get older.
10. MYTH: There are blood tests and brain imaging tools that can diagnose a concussion.
REALITY: At this point, there are no blood tests or brain imaging that can diagnose a concussion.
Many researchers are working to identify markers that might someday help identify concussions, but as of now a concussion is a clinical diagnosis based on a health care professional’s evaluation of symptoms.
11. MYTH: Concussions sustained early in life will cause memory problems or dementia later.
REALITY: Other factors are more likely causes of dementia.
Most people who sustain a concussion do not develop dementia and linking the onset of dementia later in life with a brain injury that occurred decades ago is not possible with any certainty in an individual case.
12. MYTH: There are no treatments for a concussion.
REALITY: There are a variety of treatments for symptoms of a concussion.
Initial light rest for a day or two is generally recommended, but a return to normal activities as soon as possible has been found to be helpful. Too much rest or “total rest” without any physical or mental activities may perpetuate or bring on symptoms. Treatment should be targeted to the symptoms the patient is displaying (for example, headaches, nausea, etc.), and gradual return to normal activities is encouraged. Light exercise has been shown to be associated with more rapid recovery after a concussion.
Most concussions resolve without any long-term problems. However, if you or your loved one has concussion symptoms that don’t seem to go away, or if you’re concerned, please reach out to us and request an appointment with one of our specialists.
