Both as a neurologist and the father of football-playing sons I’ve heard a lot about traumatic brain injury (TBI) generally and concussion in particular. “Concussion” is a commonly used but poorly understood term that deserves some attempt at clarification, and if only due to its high prevalence the persistent post-traumatic headache (PPTH) that may result from concussion also calls for some attention.
Making sense of any medical disorder first requires a specific definition with a uniform set of diagnostic criteria that are widely accepted. Once these are in place – and not before – clinical trials can be initiated. If all goes well, those trials will yield ever-improving evidence-based management.
In many ways, the present confusion and lack of evidence-based management for concussion and PPTH are analogous to what existed in the past for chronic daily headache. Even though over 4% (>6 million) of the general population has daily or near-daily headache, only within the last 15 years has chronic migraine received formal designation as a primary headache disorder. Consequent to this designation we have managed to develop no less than 6 safe, well-tolerated, and effective evidence-based therapies for suppression of chronic migraine. Concussion and PPTH are no less prevalent than chronic migraine…and no less deserving of effective diagnosis and management.
Concussion is the clinically mildest of the traumatic brain injuries, but not all of what people refer to as “concussions” meet the currently accepted diagnostic criteria for concussion. By definition, “concussion” implies the following:
· a traumatically-induced disruption of brain function
· any period of loss of consciousness and/or loss of memory for events immediately before or after the injury
· the absence of significant alteration of mental status at the time of injury
· if performed acutely following the head trauma, normal brain imaging (CT or MRI)
The constellation of symptoms we refer to as post-concussive syndrome involves some combination of vestibulopathy (dysequlibrium/imbalance/”dizziness”), sensitivity to sound or motion, sleep disturbance, impaired cognition (issues with memory/”forgetfulness” and concentration), emotional disturbance (irritability, anxiety, depression) and – most common of this symptom group – headache.