Sports Concussion

Traumatic Brain Injury and Concussion

Facts and figures[1]bargraph
(source: http://www.cdc.gov/TraumaticBrainInjury/)

According to the Centers for Disease Control, the nation’s health protection agency:

Children and teens are more likely to get a TBI, including concussion, and take longer to recover than adults. TBI symptoms may appear mild, but the injury can lead to significant life-long impairment affecting an individual’s memory, behavior, learning, and/or emotions. Appropriate diagnosis, management, and education are critical for helping young athletes with a TBI recover quickly and fully.

It’s widespread

  • Each year, U.S. emergency departments treat an estimated 173,285 sports- and recreation-related TBIs (traumatic brain injuries), including concussions, among children and adolescents from birth to 19 years of age.
  • During the last decade, emergency room visits for sports and recreation-related TBIs, including concussions, among children and adolescents increased by 60%.

Who’s at risk?

  • Overall, the activities associated with the greatest number of TBI-related emergency room visits included bicycling, football, playground activities, basketball, and soccer.
  • Numbers and rates are highest in football and girl’s soccer Some 71 % of all sports and recreation-related TBI emergency room visits were among males and 70.5% were among persons aged 10-19 years. Children from birth to nine years commonly sustained injuries during playground activities or while bicycling. Females aged 10-19 years sustained sports and recreation-related TBIs most often while playing soccer or basketball or while bicycling.

[1] 2001-2009 is the latest period in which the CDC tracked and published data

How Parents Can Spot ConcussionGirls Soccer Play

  • If your child seems to be experiencing any of these symptoms after an injury, see a doctor right away. Remember that symptoms can worsen over hours or days.
  • Headache—a headache that occurs after a hit, or even ones that come and go, and especially those brought on by physical or mental exertion are signs that concussion has happened.
  • A dazed, stunned or confused look.
  • Inability to remember the hit or events just before or after hit.
  • Slow response to questions.
  • Inability to recall details of the game.
  • Insomnia or excessive sleeping.
  • Irritability, depression, and mood swings.
  • Sensitivity to light and/or noise.
  • Nausea.
  • Unsteadiness or dizziness.
  1. Get involved in your school’s athletic program. Coaches and athletic trainers are the first line of defense, and they need to understand the signs and symptoms of concussion. Make sure your school has and enforces a policy of removing injured students from play, and not returning them until they are cleared by a qualified health professional (qualified means the provider has expertise in the neurological examination, interpretation of concussion tests, and management of traumatic brain injuries).
  2. Make sure your child knows how serious concussion can be. A blow to the head may be followed by nausea, headache, vomiting and dizziness. If his or her vision is blurry or double, or if he or she feels “foggy” or sleepy, it’s important to get off the field and tell the coach, trainer, and you.
  3. Teach your child how to avoid injury. Make sure they know the importance of wearing the appropriate protective gear and joining teams where players are similar in height, weight, strength, and level of training.
  4. Make sure your child has had a baseline concussion test. These are done before a concussion and give a provider a good picture of your child’s usual brain function so it can be compared to one after a suspected concussion to see if there has been any change. The tests also allow a provider to tell when brain function has returned to baseline. These tests are mandated by professional and collegiate sports teams. Always stay vigilant. You are your child’s best protection against dangerous brain injuries.

Incidence of Headache in Retired NFL Players

Incidence of Headache in retired NFL Players. Correlation with Diffusion Tensor MRI Imaging and Neuropsychological Testing.

F. Conidi, Florida Center for Headache & Sports Neurology, Port Saint Lucie, Florida

Abstract

NFL alumni have a significantly higher incidence and frequency of headache, migraine and CM when compared to the general population. These individuals are not receiving standard headache treatment and lack access to both neurologists and headache specialists. TBI as measured on DTI-MRI appears to be related to an increased incidence of concussion and headache frequency.

Results

Mean age of the retired NFL players was 36.67 (+/- 4.5) (range 30-43 years). They played an average of 4.3 years (range 2-9 years), reported an average of 7.33 concussions (+/- 5.2) max 15. All had normal neuro exams. Mean CDR scale was 0.75, (max 1.0).

None reported headaches prior to college. Average years with headache 8.0(+/- 4.8), max 15 years. Mean headache days per month = 24 (+/- 9.3) up to 30 days (n=3), 14.6 days were considered as severe (+/- 11.84) (up to 30 days) and met the (IHS) Criteria for Migraine, 43% met the IHS criteria for CM. Mean years with CM 8.0 (+/-5.3) max=12 years. 50% were currently using narcotic pain medication.

Only one player was taking a migraine specific abortive medication. None were overusing medications. All players were rated with both depression/anxiety on the MINI. Neuropsych. testing demonstrated significant abnormalities in attention/concentration (66%), executive function (50%), learning/memory (50%) and spatial/perceptual function (33%).

All who met the criteria for CM had abnormalities on measures of attention/concentration, learning/memory. Players with daily headache had abnormalities on tests for attention/concentration and spatial/perceptual function. All who had positive spatial/perceptual function testing also had at least a 10-year history of headache. Two players had pos. DTI MRI’s (abnormalities in the left and right corona radiata. Both reported > 10 concussions and both players experienced > ten headaches days per month.

50% had a current or past history of substance abuse. 50% were using prescription narcotics (none for headache). There was a correlation (p-0.007) with # of headache days and years with CM and between age and CDR (p=0.04). No correlation was seen between years played and; number of concussions, severe headaches or CDR. Or headache days and; number of severe headaches, age or CDR.

Methods

A two day exam including comprehensive neurological/headache history, neuro examination, neuropsychological evaluation, Clinical Dementia Rating Scale (CDR), psychological and DTI MRI was performed in 10 retired NFL players.

The results were analyzed for headache and migraine frequency and phenotype (using the IHS Criteria (ICHD-II) including the revised criteria for chronic migraine). A second analysis looked for associations between headache frequency, duration and phenotype with markers for mTBI/TBI (DTI MRI), concussion incidence, neurocognitive impairment, behavioral abnormalities, migraine history, player position and years played in the NFL. Abortive/preventative medications for headache, medication overuse and a history of current/prior substance abuse were documented.

helmets infographic

Concussion Videos

https://youtu.be/4_CKo6l9Hss
https://youtu.be/N9S_Hdkqf08
https://youtu.be/GDzI5et7lmk

YouTube Links
*Videos courtesy of the Mayo Clinic

News, Links, and Additional Information

Study: 3,000 Minnesota teen athletes suffered concussions
Study: Teen Athletes Experience Concussion Differently
The King-Devick Test Can Help Recognize Concussions
Teen Concussions Are Not All The Same
FACT SHEET: President Obama Applauds Commitments to Address Sports-Related Concussions in Young People
Dangerous Concussions on the Rise in Youth Sports

Additional Information

Facts and Figures and General Information

http://www.mayoclinic.org/diseases-conditions/concussion/basics/definition/con-20019272
http://www.cdc.gov/concussion/sports/
http://www.cdc.gov/concussion/headsup/youth.html

Fact Sheets for Parents
A Better Test for Evaluating Sports Concussion on the Sideline?  (Bert Vargas, MD)
Sports Concussion and Associated Post-Traumatic Headache (Tad Seifert, MD)
Value of Helmets

The Role of the Headache Specialist in the Management of Sports Concussion