Trent Anderson, PhD, expands on what treatment options are currently available, and innovative research that may lead to new therapies

Every year, at least 1.7 million people in the U.S. experience a traumatic brain injury. The majority of these traumatic brain injuries are concussions, which can present as a headache and symptoms from confusion and blurry vision to difficulty sleeping and agitation. However, if the headache and symptoms that last days after the traumatic injury, the patient should seek treatment for post-traumatic headache from their health care provider.

Dr. Trent Anderson, a neuroscientist and associate professor at the University of Arizona’s College of Medicine in Phoenix and a member of the International Concussion Society’s Scientific Advisory, has spent years studying post-traumatic headache to better understand the underlying mechanisms behind it. “Research into concussion from my own laboratory focuses on understanding and examining new therapies for treating the headaches that often develop and persist following concussion,” he says.

Dr. Anderson spoke with us about what post-traumatic headache is, what treatments are currently available for it, and what research is being done on the condition.

What is post-traumatic headache?

Post-traumatic headache is a headache that starts within seven days of a traumatic brain injury. “Post-traumatic headache may occur after any traumatic brain injury, but is most common after a mild post-traumatic brain injury, which includes concussion,” Dr. Anderson says, adding that the prevalence of post-traumatic headache following a concussion is between 47 and 95 percent.

The symptoms of post-traumatic headache most closely resemble a migraine or tension headache. If the headache persists for more than three months after the initial concussion, Dr. Anderson says it becomes a condition referred to as persistent post-traumatic headache, or chronic post-traumatic headache.

How to treat post-traumatic headache

Post-traumatic headache can be difficult to treat, especially once it has transitioned into a persistent stage. No medications exist specifically for treating post-traumatic headache, at this time.

“As post-traumatic headache most often resembles migraine and tension headaches, the best current treatment strategies often use medications approved for these other types of headaches,” Dr. Anderson says.

However, these treatments aren’t necessarily effective in post-traumatic headache patients, he says. “And how these medications alter the brain’s recovery process from a traumatic brain injury remains unknown.”

Promising research on the horizon

Although post-traumatic headache resembles migraine, Dr. Anderson says it may develop in the brain differently and respond to treatment differently. “We believe this may be due to the complexity of having multiple ongoing injury and repair processes from the mild post-traumatic brain injury that may act to promote, resist or work alongside the development of headache,” he says.

Dr. Anderson and his research team at the University of Arizona have been conducting research in order to properly understand the mechanisms behind post-traumatic headache. They began their research by studying the physiological differences between migraine and post-traumatic headache.

Then, the team created animal models of post-traumatic headache to research how traumatic brain injury sensitizes the brain to headache. They are also studying biomarkers that might be able to predict who is more likely to develop post-traumatic headache following concussion.

“As basic scientists and clinicians, we have a lot of work to do to improve our understanding [of post-traumatic headache] and identifying who is at risk for developing it,” Dr. Anderson says. He hopes his lab’s research on post-traumatic headache using animal models will help lead to the development of therapies that could help treat the condition.

“The development of post-traumatic headache in patients can be devastating, but it provides a unique opportunity to understand how a traumatic brain injury, like concussion, can induce headaches in an otherwise healthy person and brain,” Dr. Anderson says.

Raising awareness for post-traumatic headache

There has been significant increased awareness about the potential complications and risks related to concussion in the last few years. But Dr. Anderson still sees room for growth when it comes to educating people on post-traumatic headache.

“We need to continue on this avenue to ensure patients, parents, physicians, coaches and the general public have the best available information to make informed decisions and help recognize the signs and symptoms of a concussion,” he says. “As part of this effort, I believe we still have significant work to do to raise awareness, particularly of post-traumatic headache.”

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Trent Anderson, PhD, is a Scientific Advisory Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org  is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

Five common misconceptions of concussion

Popular culture has perpetuated several myths about concussions. This misinformation can be dangerous, as it can lead to improper protocol and treatment of concussions.

We’ve debunked five of the most common concussion myths so you can keep yourself, your family and your friends safe the next time someone experiences a head injury.

Myth 1: You Need to Lose Consciousness to Have a Concussion

This is one of the most pervasive myths about concussions, and it’s propagated by TV and films. This myth is particularly dangerous, as it can lead people to think they haven’t suffered a concussion because they never lost consciousness.

In reality, only around 10% of concussions include loss of consciousness, according to the University of Pittsburgh Medical Center (UPMC).

In addition, loss of consciousness doesn’t necessarily mean the concussion was more severe. A research study conducted by UPMC followed those who suffered from a concussion, including people who did and didn’t lose consciousness. Their research found that loss of consciousness did not mean the injury was more severe or that the person would have a longer recovery time.

Myth 2: You Have to Hit Your Head to Get a Concussion

Because football-related concussions are covered so frequently by the media, people might believe that concussions only occur from intense blows to the head during athletic activities.

Although concussions can be the result of a direct blow to the head in contact sports, they can also occur in non-contact sports and everyday activities. For example, concussions can be caused by an abrupt bump or jolt to the body that shakes the head, like whiplash in a car crash or a fall down the stairs.

Myth 3: You Have to Keep Someone with a Concussion Awake

People have long believed that it’s dangerous to let people with concussions sleep, for fear they’ll fall into a coma or lose consciousness without anyone knowing. Many believe that it’s important to monitor people with concussions and wake them up often to prevent this from happening. This misinformation, the BBC notes, comes from the thought that if a person is suffering from a brain bleed, or a hematoma, sleeping could lead to a rare, potentially fatal complication called a lucid interval.

However, internal bleeding in the brain is rarely associated with concussions, and if a person with a concussion has been cleared by a medical professional, it is safe for him or her to sleep.

In reality, sleep is beneficial for those who have suffered concussions. One of the best ways to treat concussion is through mental rest, and sleep is the perfect way to give the brain the cognitive rest it needs, according to the Cleveland Clinic. Everyday activities can be more tiring when recovering from a concussion, which is why sleep is so important.

Myth 4: If You Don’t Have Symptoms Immediately, You Don’t Have a Concussion

In some cases, concussion symptoms won’t show up for hours, days or even a week after an injury. In addition to early symptoms such as confusion, headache, dizziness and memory loss, more delayed signs and symptoms might include sensitivity to light and noise, irritability, difficulty sleeping, fatigue and depression, according to the Washington Post.

Myth 5: You Can Return to Play as Soon as You Feel OK

Because it can take up to a week for the symptoms of a concussion to appear, it’s wise for someone to wait to return to play until he or she has been cleared by a medical professional. Even though someone might feel physically ready to play, he or she needs to make sure they have had enough mental rest, too.

Entering play too soon can lead to dangerous and potentially fatal complications, such as post-traumatic headache—a headache that can persist for months—or second-impact syndrome, in which someone suffers a second concussion before he or she has healed from the first one.

Robert Scales, PhD, explains how concussion victims can exercise their way to better brain health

Cardiovascular health is directly related to brain health. “There’s a lot of people out there suffering from medical conditions where cardiology-based exercise physiology can help—and post-concussion syndrome happens to be one of them,” says Dr. Robert Scales, Director of Cardiac Rehabilitation and Wellness at the Mayo Clinic in Scottsdale, Arizona.

The phrase “Use it or lose it” applies both to cardiac and brain health, but, Dr. Scales says, with the right frequency, intensity, time and type (FITT) of exercise, “You can get it back quickly.”

This perspective dates back to a 1968 landmark bed rest study, where researcher Dr. Bengt Saltin recruited young men from the University of Texas Southwestern Medical Center to rest in bed for three weeks, measuring their heart function and fitness performance. This coincided with a dramatic decline in fitness, heart function and other metrics, including blood volume, says Dr. Scales. “Within 10 days of resuming exercise, blood volume returned to normal along with cardiovascular fitness and heart function. All of these measures continued to improve with consistent exercise training over a two-month period.”

The benefits of becoming active

The symptoms of a head injury include headache, dizziness, fatigue, insomnia, difficulty concentrating, memory lapses and a disturbed autonomic nervous system, which can throw off heart rate and blood pressure. Appropriately monitored cardiovascular exercise, however, can help improve the way the heart and blood vessels respond, which results in a slower stronger heartbeat. “Control of the blood flow to the brain normalizes and therefore, the symptoms can improve,” Dr. Scales says. “So, aerobic continuous exercise can work on some of the disturbances that happen when you get hit on the head, and start to help bring it back to what it should be.”

At the Mayo Clinic’s Heart Health and Performance Program, Dr. Scales manages a gym within a cardiology clinic and often works with patients with post-concussion syndrome—persistent symptoms beyond three months post injury. “My role is to help people become more active again from a cardiovascular standpoint, which prevents deconditioning and helps normalize some of the symptoms that these people may be having,” says Dr. Scales.

Based on research from John Leddy, MD, FACSM, FACP, Dr. Scales uses a scaling system for patients to identify their symptoms while they exercise so that they can exercise below the exertion threshold that exacerbates concussion symptoms like headache or dizziness. “A conservative but progressive plan improves exercise tolerance,” Dr. Scales says, eventually normalizing post-concussion symptoms.

There are strategic forms of activity for concussion recovery: recumbent stationary biking puts less gravitational pull on the bloodstream pumping to the heart; in aqua aerobics or deep water running with a flotation belt, the hydrostatic pressure of the water facilitates blood flow and improves cardiovascular efficiency in the body. With improved symptom management, athletes can then gradually return to more strenuous upright land-based exercise like jogging.

Exercise can normalize symptoms

Dr. Scales has helped train former NFL players who have endured numerous concussions over the years. “They’ve also experienced orthopedic injuries and metabolic changes that have adversely impacted their blood pressure, cholesterol, blood glucose and body weight. We find that they have aged prematurely, partly because of their sport,” Dr. Scales says. However, “Even with those individuals, we can help them normalize the symptoms and live a healthy life.”

The collaboration between neurology and cardiology, Dr. Scales believes, is an untapped potential therapy. “It can help people,” he says. “And I think as evidence-based research continues to grow, we will be able to write clinical practice guidelines that are more defined.”

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Robert Scales, PhD, is a Scientific Advisory Board Member of the International Concussion Society. The International Concussion Society sponsored website Concussion.Org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.

If you experience a head injury, follow these five steps

Concussions are a form of traumatic head injury caused by a bump or blow to the head, or even a subtle, sharp jolt. While their symptoms can seem minor or take some time to appear, concussions carry serious risks and can have long-lasting side effects. If you feel “off” after a head injury and think you might have a concussion, follow these five steps to evaluate your symptoms and figure out what to do next.

1. Immediately Respond

Don’t be dismissive about any form of head trauma: Concussions can occur from even a minor bump, and you don’t need to be knocked out to experience a concussion. If you’ve sustained a head injury during an activity, like playing sports, immediately remove yourself from play and take inventory of how you’re feeling. Symptoms of concussion might not develop until hours—or even days—after a blow to the head, according to the CDC. It’s best to take it easy and err on the side of caution. Ignoring the signs of a concussion—especially by resuming physical activity too soon after a head injury—can make those symptoms worse, make recovery take longer, according to the Centers for Disease Control, or even cause lasting side effects like post-traumatic headache.

2. Sit Out

Whether you’ve just pulled over after a fender-bender or removed yourself from play during a game, consult a medical professional if one is available, or call your a primary care doctor to discuss your injury. Recovery from a concussion takes up to two weeks for many people, or even longer for about 20 percent of the population, according to the Mayo Clinic. Don’t try to rush back into action until you’ve been cleared by a doctor.

3. See a Doctor

It’s best to seek medical attention as soon as you recognize concussion symptoms for an exam and diagnosis. Even if you felt well initially after your head injury, visit your doctor if you start to feel any concussion symptoms later. It’s not unusual for the effects of a concussion to be delayed by days or weeks. Post-concussive syndrome can appear even months after your initial injury. Untreated concussions can have serious, long-term effects, including post-traumatic headache and neurodegenerative issues, according to the Mayo Clinic.

4. Watch for Additional Symptoms

Concussion symptoms aren’t limited to head pain. Sluggishness, clumsiness and just feeling “off” are key indicators that your head injury could be more serious. Even if you don’t feel different immediately after bumping your head, you might still have a concussion and should watch out for the typical warning signs. Nausea, loss of consciousness and head pain are more noticeable symptoms of concussion, while others—like changes in your behavior or personality, or mood swings—can be harder for you to recognize. Concussion symptoms can vary from person to person, and they can emerge or worsen when you engage in physical activities or activities that require concentration. Be as detailed as possible in describing when your symptoms appeared and how severe they were; this can help a doctor determine the severity of your injury.

5. Recovery

Once you’ve been diagnosed with a concussion, follow your doctor’s prescribed treatment plan. There’s no one “cure” for a concussion, but following your treatment plan will give your brain the time and care it needs. It can take several weeks to recover from a concussion, and during this time you’re especially vulnerable to brain injuries like second impact syndrome—a second concussion before the first one had time to heal. So take it nice and slow. The CDC recommends asking your doctor for guidelines on when you’ll be well enough to drive or ride a bike and return to work. Get plenty of rest and avoid alcohol, drugs and physically demanding activities, and reintroduce things into your routine gradually.

People with concussion can return to playing sports and being active once their concussion has healed and they’ve been cleared by a medical professional. Returning to play should be done with the utmost care. Follow the CDC’s five-step approach to returning to physical activities safely. Ease in with light aerobic activities, gradually working your way back, and monitor your concussion symptoms closely during this time.

Very few medical institutions have specialized concussion teams in place. Lawrence C. Newman, MD, FAHS, wants to change that.

Unfortunately, many patients that enter an emergency department or urgent care with a suspected concussion leave with little instruction for outpatient care. In fact, the trouble starts even before the patient walks through the door. “There’s no universally adopted protocol for concussion management in the emergency department,” says Dr. Lawrence C. Newman, Director of the Headache Division at NYU Langone Health in New York City. In a 2017 study published in the Journal of Neurotrauma, researchers investigated concussion protocols across emergency departments in New England and found that one-third of all departments did not have a critical practice guideline in place. A little more than half reported having a protocol, but there were inconsistencies in how each was carried out.

“The good news is that almost everybody who left the emergency department got some sort of written discharge instruction,” Dr. Newman says. “However, instructions were not consistent. Some patients were told they needed to follow up with their doctor, but it wasn’t stated when they should follow up. Other people were told they needed to follow up with a specialist, but no recommendations were given for who or what type of specialist they should see.” A recent study conducted in a large New York City emergency department reported similar outcomes.

The lack of a specialized concussion team and detailed practice guidelines has serious consequences for a patient’s condition. Patients are left to their own devices to determine when it is safe to resume physical activity. Dr. Newman wants to put an end to that, and proposes that hospitals establish a dedicated concussion care team with standardized guidelines for in- and outpatient care.

An outdated practice

Several years ago, the Acute Concussion Evaluation was published for use in emergency departments. However, “most people don’t look at it; most people don’t do it,” Dr. Newman says.

It’s not for lack of educational activities that ACE is not more widely used, he adds. Rather, it’s a lack of concussion awareness.

Dr. Newman explains that this is a pervasive problem not limited to emergency departments. “Even if people go to their primary care doctor or an urgent care center,” he says, “the information they’re getting is all over the place. It’s not based on guidelines, and a lot of times it’s based on old data. I’m still seeing patients who were told they needed to cocoon themselves for two weeks despite the fact that recent data shows that’s outdated.”

A new approach to concussion treatment

Under Dr. Newman’s proposed plan for standardized concussion care, a patient who arrives at the hospital with a suspected concussion would be seen by a neurologist who would then perform a complete neurologic exam.

If a patient is suspected of a stroke or heart attack, a specialized team is called in to fully assess the patient with sole regard for the specific condition. “That’s where my idea came from,” Dr. Newman says. “We have stroke teams, MI teams and rapid response teams in the hospital. If someone has a critical illness while they’re in the emergency department or admitted to the hospital, and they experience life-threatening complications, a rapid response team rushes to the bedside and tries to figure out what’s going on and gets the appropriate testing done rapidly.”

Rather than require additional resources, Dr. Newman’s concussion team calls for a redistribution of responsibility. “The team can be the neurology resident on-call and the attending neurologist on-call,” he explains. “If a patient has a headache, it makes sense for a neurologist, who knows how to treat headache and the different types associated with concussion, to treat the headache. Most times, however, neurologists aren’t even called to evaluate the patient.”

With a dedicated concussion team in place, physicians can ensure that a patient’s exam and diagnosis is correct and that an effective treatment plan is in place. “If the patient is ready to be discharged from the emergency department, we can make sure that they are given clear timelines and guidelines for how long they need to rest and when they can go back to school and resume physical activity,” Dr. Newman says. Additionally, they can be referred to an appropriate neurologist for outpatient follow-up.

Concussion awareness is key to patient care

Dr. Newman calls for an increase in concussion awareness, starting at the academic level. “Not every hospital, not even every academic center has a concussion program, but they all have neurology programs,” he says. “It’s just a matter of training the neurology residents on how to evaluate and treat concussion. If you have somebody who you’re considering has a concussion, you call the neurology resident trained in concussion management,” he explains.

By standardizing a hospital’s response to concussion, physicians are better suited to care for patients and prevent long-lasting effects from their injuries. “It’s a call to action that we can change,” Dr. Newman says. “Perhaps we can change the way concussion is addressed in the emergency room and if we do that, early intervention strategies can be employed similarly to what we have seen happen with heart attack and stroke. We can change the course of many people’s concussion scenarios by interacting early, and interacting correctly.”

Next steps

In response to the lack of a standardized concussion protocol, Dr. Newman is currently drafting and strategizing his own plan for a specialized concussion team and protocol with the help of his colleagues at NYU Langone Health. His hope is that both the team model and protocol can be implemented in emergency departments, urgent cares and the like immediately. “The simplest step is to have a lecture series on the acute evaluation of concussions, including how to evaluate concussions for the neurology resident, and what steps to take in the emergency room,” he says. It may also include drafting a guide that outlines the warning signs of a concussion, current treatment options and available resources once the patient leaves the hospital. This guide would be available in the emergency room and distributed to patients by the residents on call.

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The International Concussion Society sponsored website Concussion.Org is the number one destination for information related to concussion prevention, diagnosis and treatment. Our mission is to serve medical professionals, athletes, administrators, coaches, patients and the public by providing a central repository of accurate and scientifically vetted concussion research. Working alongside our world-class scientific advisory board, Concussion.org aims to be the most trusted global index on one of the most common, yet least understood, forms of traumatic brain injury. If you would like to be interviewed for an influencer profile, please fill out this form.