Concussions – not just for kids
It happened in an instant: One minute I was vertical, walking the dog down my driveway, and the next moment my forehead was slamming into the pavement – the result of tripping over the leash.
My head felt like a bell smacked by a giant clapper, although I did not lose consciousness and was able to ask a neighbor to drive me to the emergency room. There, the doctor did a cognitive screen and, because I’m “older,” ordered a CT scan to check for an intracranial bleed. She said it was likely I had a concussion, or “mild traumatic brain injury” (TBI), and said to take it easy and avoid alcohol and screens such as TV and my computer.
I also was told to return immediately to the ER if any danger signs of brain trauma appeared:
- Persistent drowsiness or inability to wake up
- One pupil looked larger than the other
- Worsening headache
- Slurred speech
Otherwise, I was to touch base with my primary care physician if the headache, tiredness, facial pressure, sound and light sensitivity, and cloudy feeling didn’t clear in a few days.
I was lucky. My symptoms did clear up, although it took several weeks, not several days. It was a wake-up call, however, that head injuries are a danger not only to young athletes but to adults, particularly those of us of a certain age.
In fact, TBI is a “significant” health issue for people over 65, according to a 2012 article in the journal Current Geriatrics Reports. It’s responsible for 80,000 ER visits each year for that age group, and 80 percent of those visits are caused by falls, according to the Centers for Disease Control and Prevention. Adults 75 and older had the highest rates of TBI-related hospitalization and death of any age group, according to the CDC.
“A lot of people, they associate concussions with sport-related injuries, but the truth of the matter is that anybody at any age can suffer head trauma,” said Cape Cod Healthcare neurologist Dr. Sean Horrigan, DO.
“Mild Traumatic Brain Injury” is the New Term
Many medical professionals now avoid the term “concussion” in favor of mild TBI, Dr. Horrigan said. “Mild” signifies that while there’s no structural damage to the brain, there are transient symptoms such as headache, dizziness, disturbed sleep, cognitive impairment, fatigue, irritability and changes in mood.
“I think the reason why there's that push is that for a lot of people, when they hear the term ‘concussion’ used, there's maybe a little too much reassurance that everything's going to be fine, that these symptoms are transient, and you should be OK in a few days,” he said.
Those “transient” symptoms of a mild TBI can last a few days, a few weeks, a few months, or as long as a year, Dr. Horrigan said. He and other neurologists usually get involved only when symptoms are stubborn. Most people take up to three months to recover well and about a third of patients take more than six months, he said.
Women are more likely to have persistent TBI symptoms. Researchers aren’t sure why, although they suspect it may have to do with the structure of women’s necks, the effects of hormones, or inconsistencies in diagnosis between men and women, according to a 2016 article in Scientific American.
Of course, the older you are, the more complicated a head injury can be, depending on the state of your health. And repeated head injuries can put someone at higher risk for dementia, Parkinson’s disease and chronic traumatic encephalopathy, or CTE, the degenerative disease of the brain that’s a big issue in sports right now.
What Can Doctors Do?
If transient symptoms continue, doctors base some TBI treatment around self-care, such as scaling back on work, continuing regular light exercise, and making sure to get enough sleep, Dr. Horrigan said.
Most people need at least seven to eight hours of sleep, he said, but people who have suffered head injury may need nine to 10 hours.
“The longer you can sleep to get into that more restful, restorative sleep state, the better you're going to feel over the long run,” he said.
If necessary, he also can try medications to help with headache or suggest physical therapy for vertigo and dizziness. He also has tools to address mood swings.
“Sometimes there is benefit to being on antidepressant therapy, and also working with a therapist for cognitive behavioral treatment,” he said. “So sometimes it can take a team of several different providers to help someone on their journey to make a faster recovery.’”
He’s optimistic, however, that new developments in imaging and the current attention to TBI bode well for patients of all ages.
“In the years ahead, we are going to have improved technology to better evaluate brain injury,” Dr. Horrigan said. “As technology continues to advance, we will be able to more accurately diagnose the location and severity of head trauma to best help our patients.”