CONCUSSION INFORMATION
Listed below are informative blog posts with practical discussions of common sport-related concussion symptoms and concerns with helpful treatment recommendations. Please click on each bullet point below to access the particular article
Concussions do not necessarily require being hit in the head or getting knocked out. The full definition of a concussion is any fall, blow, or trauma that causes physical, emotion, or mental changes with or without loss of consciousness.
With formal names like Convergence Insufficiency and Saccadic Dysfunction you might indeed think that this stuff is far too technical to grasp, but in reality, these issues strike at the very heart of some basic life functions.
Experts Debate: How Many Concussion are Too Many for an Athlete?
In the midst of the usual complexities of recovering from a sports-related concussion, I have found that one simple mantra of "re-start activity in 15-20 minutes blocks" can be an anxiety reducing guideline.
Given that headaches are the most common symptom after concussion and often the last to fully resolve, I spend a good amount of time with my patients discussing headache triggers, anticipated healing course, and how to reduce intensity and duration
To convince you of the importance of healthy visual function after a concussion (and to get you to read this entire blog), let me ask those who have had a concussion to answer a few simple questions.
- Does even reading a few pages lead to heavy feeling of the eyes or headaches?
- Do you cringe at the prospect of hours of note-taking due to blurry vision, losing track of words, and again, onset of headaches?
- Does trying to follow ball movement when you watch practice or a game lead to dizziness, double vision, and a strong sense of futile frustration and a desire to vomit?
Now, while there are other potential causes for all the above issues, one very common post-concussion denominator is indeed visual dysfunction, also known as oculomotor dysfunction.
With formal names like Convergence Insufficiency and Saccadic Dysfunction you might indeed think that this stuff is far too technical to grasp, but in reality, these issues strike at the very heart of some basic life functions.
Now, without further delay, I will describe the two most common types of oculomotor dysfunction and how they can affect school and sports.
1) CONVERGENCE INSUFFICIENCY
Convergence insufficiency occurs when your eyes don't work together while you're trying to focus on a nearby object. When you read or look at a close object, your eyes need to turn inward together (converge) to focus. This gives you binocular vision, enabling you to see a single image. (courtesy of Mayo Clinic)
Real world consequences
- Blurry vision, headaches, and dizziness when trying to change focus from more distant objects (screen, smart board, white board) to closer objects (note pad, lap top, worksheet)
- Similar symptoms while trying to track and object coming closer to the face, such as catching a ball
2) SACCADIC DYSFUNCTION
Saccades – the ability to jump your eyes from one target to another accurately.Saccades are necessary for tracking skills while reading or copying information. In order to process visual information properly, the eyes must move smoothly and quickly from one object to another. Saccades are crucial to the ability of the visual system to perceive and interpret images. When smoothly tracking with the eyes, the eyes must also be able to cross the midline of the body without hesitation; (courtesy of NorthShore Pediatric Therapy)
There are 2 flavors of Saccadic Dysfunction- horizontal (side to side) and vertical (up and down)
Real World Consequences
HORIZONTAL
- Fatigue, blurry vision and headaches with reading (both screen and book/paper) as eyes loose track of words and lines due to inability to smoothly move from side to side
- Double vision, headaches and even nausea when trying to follow back and forth ball movement, such as at a tennis match
VERTICAL
- Similar symptoms of distress when repeatedly looking up at a board or speaker, then looking down at a piece of paper or a computer screen
- Worsening symptoms if trying to look up at a target (basketball hoop) or tracking a ball coming down from the sky
How can I get help with these problems?
Practical in-office testing strategies have been developed to better identify these issues, so do not hesitate to contact a sports medicine or concussion specialist for evaluation.
Depending on symptoms and evaluation findings, potential treatment strategies could include:
- Classroom modifications
- Assistance with note-taking
- Listening to lectures or reading assignments rather in place of actual reading
- Reduction in reading assignments
- Oral testing
- Oculomotor exercises
- Options include home-based versus formal office-based programs
- On-going research efforts are attempting to study ideal time frame after concussion to start visual exercises, and how to determine length of programs
Given that headaches are the most common symptom after concussion and often the last to fully resolve, I spend a good amount of time with my patients discussing headache triggers, anticipated healing course, and how to reduce intensity and duration. While this post is not intended to make a formal diagnosis or suggest specific treatments, I do hope to share some insights on post-concussion headaches that will help patients, families, and fellow medical providers.
- The location of the headache may be exactly at the point of impact, or perhaps on the different side of head, or even involve the entire head.
- Not uncommon to have all-day headaches right after a concussion. Waking up without a headache should be considered the first sign of improvement. Once that occurs, often headaches will still be daily, but will tend to occur later and later in the day. In the final stages of recovery, the headaches might not be daily, but rather may occur every few days.
- Look at a throbbing headache as a "pop-off valve" warning sign indicating overload of the healing brain.. While this type of headache might be frequently seen immediately after an injury, the evolution of a throbbing headache later in the recovery can indicate excessive activity, such as too much reading/schoolwork, noise exposure, or screen/media time or even a combination of all those factors at one time. Reviewing and making adjustments in schedules and environments can turn down the cumulative overload and hopefully the throbbing headaches.
- Have found that using the 15-20 minute rule can be quite helpful for patients and families in determining if someone can read/text/play video games/watch TV after a concussion? The goal of course is to not trigger a headache or other symptoms.
- Pick one activity (let's say reading to start) and try to do it in a relatively quiet environment for 15-20 minutes. If that time limit is reached without a headache, cool- stop, take a break and maybe come back 30-60 minutes later for another 15-20 minute period of reading. If that second attempt also goes well, then can increase the activity period to 20-30 minutes 2-3 times a day.
- If headaches come about before the 15 minutes are up, then stop activity, note the time that passed before the headache began, and after the headache has resolved, try the activity again but stop 1-2 minutes before that past headache onset time.
If a headache quickly worsens, such as the throbbing headache noted above, an immediate reduction in activity should cause some reduction in intensity. However, in any worsening headache or especially in the case of a "worst headache of my life", one should not hesitate to seek immediate emergency medical evaluation.
While the initial trauma to the head can be a primary cause of post-concussion headache, there can be several other contributors leading to more prolonged and intense symptoms:
- Commonly see a relative muscle imbalance in the suboccipital region where the skull connects to the cervical spine that can be the basis for one-sided or both sided headaches starting "in the back of the head" or with "neck pain". These types of headaches may be more noticed as the patient starts returning to reading, taking notes, and doing other activities that require holding or turning the head for longer periods of time.
- Headaches often associated with dizziness, blurring of words, or double vision that all may increase with reading, screen work, or note-taking could be a result of disordered vestibular-ocular function affecting the visual and balance centers of the brain.
- Altered sleep patterns, commonly with difficulties either initiating or maintaining sleep, can lead to insufficient rest and an increased in headache duration and intensity. One particular trigger in the post-concussion patient is heightened sensitivity to light emitted from screen devices. Good general rules for all of us (not just post-concussion patients) include no screen devices at least one hour before bedtime and not having screen devices in the bedroom.
- Inadequate food and fluid intake can be a headache trigger for almost anyone, so just imagine how these issues can be amplified after a concussion. Multiple small meals can be helpful as nausea or diminished appetites are common right after a head injury. Post-concussion dizziness may also be improved with adequate fluid intake, but please do check with your medical provider before increasing or adjusting any type of fluid intake after a concussion.
- Too much noise or too much light, often in combination with each other or with attempts to concentrate. May need to turn off or reduce background sounds, work individually in a quiet room, or use noise-cancelling devices. Reducing ambient lighting, turning down screen intensity, not sitting near windows with bright exterior light, or using regular or blue-light reducing sunglasses can also be helpful.
There are also over-the-counter and prescription medication, vitamin, and herbal supplements that can assist with headaches after a concussion, and I feel that a discussion of these options is best done in direct consultation with a medical provider who has examined the patient and reviewed all aspects of the medical history.
Please let me know of any other tips for dealing with post-concussion headaches.
