Headaches & Confusion in Concussion Management

Introduction

  • Speaker: Deepak Patel, physician in family medicine and sports medicine

    • Majority of practice is sports medicine, focusing on concussions.

  • Roles:

    • Assistant Professor at Rush Medical College

    • Medical Director for Rush Copley Sports Medicine

    • Chair of Sports Medicine Musculoskeletal CME Programming through the Academy

  • Overview of objectives for talk:

    • Discuss symptoms of concussions

    • Testing and monitoring protocols

    • Clinical exams specific to concussions

    • Guidelines on return-to-play recommendations

Engagement Instructions

  • Encourage attendees to interact through the conference app and audience response questions.

Introductory Anecdote

  • Shared a personal story about anticipating a high volume of concussion cases due to icy conditions leading to falls.

  • Discussed the importance of awareness regarding concussions among colleagues, patients, and parents.

Concussion Symptoms

Cognitive Symptoms

  • Types of cognitive symptoms include:

    • Amnesia (post-traumatic and retrograde)

    • Confusion and disorientation

    • Delayed verbal or motor responses, slurred speech

    • "Zoned out" or "foggy" responses

    • Impaired concentration (often recognized in academic or work environments)

    • Excessive drowsiness, inappropriate playing behavior (e.g., players hiding injuries)

Somatic Symptoms

  • Common somatic symptoms include:

    • Headache (most prevalent symptom)

    • Dizziness, gait problems

    • Visual disturbances (e.g., diplopia, photophobia, blurred vision)

    • Nausea, vomiting, noise sensitivity (phonophobia), tinnitus, fatigue

Affective Symptoms

  • Changes in mood may include:

    • Increased irritability, emotional dysregulation

    • Depression, anxiety, and sadness

    • Sleep disturbances (varying from insomnia to excessive sleep)

Assessment and Testing

Assessment Tools

  • Tools to be considered include:

    • SCAT 5 and SCAT 6

    • King Devic Testing

    • Neurocognitive testing (computerized vs. paper-based)

    • Balance Error Scoring System (BESS) and sensory organization testing

Recommended Tools

  • SCAT 6 for patients over 13; Child SCAT for ages 8-12

  • SCOAT for office assessment post 72 hours following injury to identify lingering symptoms

  • New tools for non-medical personnel to recognize concussions

Monitoring and Follow-Up

  • Key points on monitoring concussive symptoms:

    • Regular evaluations following injury in the first few days

    • Importance of assessing neck injuries alongside concussions

    • Neurocognitive assessments, Glasgow Coma Scale to measure consciousness levels

Red Flags for Serious Complications

  • Signs indicating need for emergency evaluation:

    • Neck pain, seizures, double vision, unconsciousness

    • Persistent headache, restlessness, agitation, or significant changes in Glasgow Coma Scale

Return-to-Play Guidelines

  • Individualized treatment plans required; no standard timeline for return

  • Pre-participation education regarding symptoms, stress on early recognition of injury

  • Follow graduated return to play protocols, with medical clearance documented

Management of Symptoms

Persistent Concussion Symptoms

  • Characterized if symptoms persist beyond four weeks

  • Referral to specialists (neuropsychologists, physical therapy, etc.) recommended

  • Use of biofeedback and cognitive behavioral therapy for emotional and cognitive support

Pharmacologic Management

  • Melatonin recommended for sleep issues post-concussion; avoid heavy sedatives

  • Consider neurocognitive therapy and vestibular rehabilitation in cases of persistent symptoms

Complications of Concussion

Second Impact Syndrome

  • Definition: Occurs when an individual suffers a second concussion before fully recovering from the first, potentially leading to severe brain damage or death.

  • Educating athletes about risk and recognizing early symptoms is critical.

Mental Health Implications

  • Higher incidence of depression, anxiety, and cognitive decline in those with persistent symptoms

Preventative Measures

  • Education on safe playing techniques and rules

  • Equipment advancements (helmets, padding)

  • Training programs emphasizing neck strength and proper falling techniques

  • Data indicate reductions in incidence when preventative measures enforced

Conclusion

Key Recommendations

  • Educate patients and families on concussion management and prevention

  • Use evidence-based guidelines for imaging and treatment

  • Implement individualized rehabilitation and monitoring plans

  • Be aware of the current understanding of concussion risks and complications

Questions and Discussion

  • Open invitation for further discussion, patient cases, and email inquiries for continued support.