Concussion is defined as a temporary cessation of normal brain function as a direct result of a traumatic impact to the skull and thus to the brain itself. Generally it arises from a "blunt" impact, as distinct from a penetrating wound, such as a missile. Blunt trauma can actually cause major damage to the brain, including bleeding, alteration of brain cell function, and progressive changes in its chemicals and its connections. Although at one time it was believed that a concussion should be defined by the presence of a true period of loss of consciousness, it is now believed that even a momentary period of confusion or a moment of feeling "dazed" qualifies the injury to be a concussion. The more severe concussions are associated with loss of consciousness and coma.

Trauma to the head often injures both the head and the neck. It is of some interest that although the head may take the blow, the neck is often injured along with the head, and sometimes it is more injured than the head.

The symptoms of concussion vary widely, including head and/or neck pain, sleep disturbance, mental dullness, dizziness, ringing in the ears, personality change, irritability and orneriness, loss of humor, and other subtle or at times more obvious neurological and psychological deficits.

When mild to moderate concussions occur for the first time, the symptoms generally improve quickly, with resolution of most symptoms within days to several weeks. Nonetheless, even mild first concussions may have long-lasting and severe effects. The more severe concussions or subsequent concussions are more likely to have long-lasting if not permanent consequences.

Currently research demonstrates that when an individual experiences more than one concussion, the effects are additive, meaning each subsequent concussion adds to the damage from the previous concussion. Moreover, having had a previous concussion renders an individual more likely to experience the next one, even with mild trauma.

These issues have come to have importance in considering athletic injuries. Professional athletes are known to experience multiple concussions during the course of their professional careers, particularly those in the most fierce contact sports, such as boxing and football. Many suffer life-long problems that prompt some to retire early. Early dementia is an increasingly recognized problem in some of these athletes, as well as life-long headaches and neck problems.

Recently we have seen a number of young headache patients who appear to have developed headaches as a result of repeated "headers" during soccer. While professional athletes often minimize their injuries or hide them altogether, the symptoms eventually catch up to the athlete.

This issue should be of particular concern to the parents of young athletes. Parents must decide whether after a first concussion or neck injury it is wise for their son or daughter to continue pursuing contact sports, which would make them more vulnerable to subsequent injuries. It is currently the prevailing attitude of neurologists who specialize in head injuries that a moderate concussion should serve to limit future contact sports, though not all neurologists would agree. The first mild head injury probably should not prevent further participation.

There are many treatments available for concussion and the neck that is often injured along with the head. Individuals who suffer from concussion, whether it be mild or more severe, require a full neurological assessment and specialized testing for brain injury as well as for thinking and memory functions. Identifying a baseline level of performance is very important, particularly if continued athletic activity is anticipated. Various medicines may be helpful, as well as numerous non-medicinal interventions, nerve blocks, and other therapies. Strategies and exercises for thinking and memory disturbances may also prove very helpful as well as a variety of rehabilitative efforts in those severely damaged.

Joel R. Saper, M.D., F.A.A.N., Founder and Director