Concussion and mTBI first aid

Helpful info for steering yourself through the post-acute phase

Brainwave is an informational resource for people whose concussion and mTBI symptoms don’t resolve after a couple of weeks. That said, some of you may be arriving here in the immediate aftermath of an injury, searching for answers.

Obviously, anyone who’s suffered a severe trauma should be seen in an emergency room. In such cases, there are very serious risks of secondary injury and death if a patient is not taken care of immediately. Changes in cerebrospinal fluid pressure and chemical cascades in the brain are very dangerous. If you even suspect that your injury was severe, seek out the appropriate level of care.

If You Suspect a Concussion

Information in this section is from the Centers for Disease Control. Quoting:

In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. Contact your healthcare professional or emergency department right away if you have any of the following danger signs after a bump, blow, or jolt to the head or body.

Symptoms that can be cause for concern and possibly a trip to the Emergency Room.

Danger signs in adults

• A constant severe headache that gets worse

• Sudden severe vomiting or nausea

• Fainting or blacking out or if people can’t wake you up

• Very drowsy

• Seizures or convulsions

• Cannot recognize people or places

• Increasing confusion, restlessness, or agitation

• Weakness, numbness or decreased coordination

• Slurred speech, trouble talking, or not making sense

• Fluid or bleeding from the ear or nose

• Unusual or strange behavior

• One pupil is larger than the other

Danger signs in children

Any of the adult danger signs above, and:

• Will not stop crying and cannot be consoled

• Will not nurse or eat

24 to 48 hours later: gentle physical activity and rest

Once you’re past the acute phase of the injury and in the post-acute phase, the information below may be helpful. Vet it with the medical professionals helping you.

Gentle physical activity helps a brain (and nervous system) recover from an injury. There’s some debate about exactly WHEN that activity should begin, but the latest thinking is that a gentle 30 minute walk or an easy 30 minutes on a stationary bike (perhaps ideal because the brain remains mostly stationary) can begin as soon as 24 to 48 hours after a concussion or mTBI (severe TBI may be another matter).

During this light exercise, keep your heart rate below around 140 beats per minute. If you experience symptoms, such as dizziness, lower your exertion level until you minimize those symptoms, but put in your daily 30 minutes. Go as slow as you have to.

Walking for 30 minutes provides your brain and body with a number of critically important benefits, including maintaining healthy oxygen levels in the brain and aiding lymphatic drainage from the brain. In other words, it keeps the good stuff coming in, and clears the bad stuff out.

Immediately after your gentle exercise, do a mildly challenging brain game. Boggle, for example, or solitaire, or light reading. This will further help bring blood and oxygen to the brain in concert with neurological activity.

The rest of the day, rest and eat healthy. If you can sit in the sun for awhile, do that. Maybe take an epsom salt bath.

Follow this daily light exercise and rest routine for a two weeks. Do no escalate the exercise yet. Do not increase the volume or intensity. In two weeks, follow the 5% rule to slowly and gradually increase your activity.

Going forward: obey the 5% rule

Many people who have lasting symptoms after a brain injury either do too much or too little. So don’t do too little—and don’t go from full stop to full speed ahead. Instead, use the 5% rule.

If you’ve ever returned to eating food after a fast, returning to activity using the 5% rule is a similar process. In fact, it’s even more gradual than that. It would be like fasting for a week, then eating 5% more food for two weeks, then 5% more food for another two weeks, and so on, until you eventually return to the original volume of food you were eating before the fast began.

Once you’ve established your baseline tolerable exercise level, which may be a simple 30 minute walk, you can increase elements of that exercise (time, hear rate, repetitions, etc) by 5% and see if you can tolerate that without triggering symptoms.

If any symptoms happen due to your activity, return to previous levels. Don’t push yourself. Eventually, try increasing by 5% again.

Breathing exercises

Breathing is part of what makes physical exercise helpful, but breathing alone (apart from exercise) can be a very effective tool for a wide variety of things, including mood regulation.

Two of the biggest challenges we face after a brain injury are: calming down when we want to calm down, and being alert when we want to be alert. Certain breathing techniques can help you do both.

One tool that I personally find indispensable is the Wim Hof breathing app, which houses a set of guided breathing exercises. I do the basic breathing every morning, and I occasionally use the mood regulation breathing to activate the parasympathetic nervous system.

Another tool I use daily is the Elite HRV app which contains a wide variety of breathing exercises. HRV training can help re-establish autonomic nervous system balance.

Here’s a general rule. If your inhale is longer than your exhale, you are elevating and activating your alertness or “up-regulating” your nervous system; If your exhale is longer than your inhale, you are calming or “down-regulating” the nervous system. Breathing gives you an “access panel” to your nervous system. Use it.

First-aid supplements

Here’s a list of supplements that are most likely to help you in the immediate aftermath (post-acute phase) and least likely to mess you up even further. 

In general, I would avoid any “brain boosting” nootropics or cognitive boosters at this point. I know it’s tempting to think these will lift the brain fog, but that’s like thinking you can take a car with misfiring spark plugs (the brain is an electrical organ after all) and make it run better by adding a battery. On a related note, avoid increasing your caffeine consumption to mask your brain fog.

The main aim at this point is to create a safety net for your brain. Look at taking: 

Morning

Creatine: Many studies have shown a wide range of benefits and, if you wish, you can read about them at Examine.com. Here are some brief quotes and extracts from that site.

• A reduction in mental fatigue has been observed in various scenarios such as demanding mental activity, sleep deprivation, and traumatic brain injury. 

• Dizziness as a side-effect of traumatic brain injury is reduced with 400 mg/kg/day. 

• 400 mg/kg/day in children and adolescents subject to traumatic brain injury reduces headache frequency from around 90% down to near 10%.

• 400 mg/kg/day in children and adolescents subject to traumatic brain injury reduces fatigue frequency from around 90% down to near 10%. 

• Depression symptoms seem to improve noticeably. This improvement is probably related to serotonin (creatine supplementation appears to enhance SSRI therapy).

Night

Magnesium: There are many kinds of magnesium, each performing a different function. Taking magnesium bisglycinate (Thorne makes a good version) about an hour before bed is solid choice, both for sleep support and nervous system support.

L-theanine: See Examine.com for more info. About 200mg taken with magnesium an hour before bed is the sleep cocktail I use. I was able to stop using melatonin (after more than a decade of feeling totally dependent on it for sleep) by replacing it with L-theanine in combination with magnesium bisglycinate. However, if you get migraines, L-theanine might be a migraine trigger. As with anything else here, your mileage may very, proceed with caution.

One reason I’m emphasizing morning vs. night here is to underscore the importance of re-establishing (or teaming up with) your circadian rhythm. Over time, this will allow you to relax more deeply at night and be more alert during the day.  

Down the road, you can look at adding more supplements as you climb up from the depths.

For more about supplements, see:

Supplements for brain injury recovery

Don’t forget about your neck

It typically takes a far lower g-force to injure a neck than it does to injure a brain. If you took a blow to the head, your neck was involved, and you likely have soft tissue damage, or worse.

The symptoms of mTBI and whiplash have great overlap, and you might be surprised to discover just how many of your symptoms originate from cervical damage and dysfunction. A whiplash diagnosis will likely lead to treatments from a vestibular therapist or musculoskeletal physiotherapist, and this could prove to be an essential member of your recovery team.

The neck isn’t merely a mechanical structure. It plays an essential role in your balance system and is tightly integrated with vision as well. In many ways, the neck serves as a kind of brain-body interface, and it’s a surprisingly intricate structure for something that looks so simple and elegant from the outside.

You’ll have several other options for neck treatments and self-care, including: epsom salt baths, massage, acupuncture, CBD creams, red light therapy, a pillow upgrade, and, of course, chiropractic.

A brief word about chiropractors

Anyone who’s ever tried different car mechanics soon realizes how much of a qualitative difference there is between one individual and the next, even when those individuals have the same training. Chiropractors are no different.

There are three categories of chiropractor I would consider seeing: atlas orthogonal (preferred), NUCCA (someone who does both NUCCA and atlas orthogonal might be ideal), or a chiropractic neurologist (they’ve had a few years of training in functional neurological rehab).

Of those three, chiropractic neurologists are the ones most likely to present you with an array of treatment options outside the realm of what you might expect from a chiropractor (for example, cognitive rehab exercises). Here again, caveat emptor (buyer beware).

The last time I had a head bonk, one of the first things I did was schedule a much-needed appointment with my atlas orthogonal chiropractor. For me, having an aligned atlas (the first vertebra, right below one’s skull) is one of the indispensable foundations of general wellbeing. When I don’t need an adjustment, my chiropractor sends me on my way without one. To me, this is the hallmark of a trustworthy and competent provider.

Beware lingering brain inflammation

In a recent study, researchers discovered that inflammation around injury sites in one’s cerebral cortex can cause additional secondary neuronal loss in the thalamus if the inflammation in the cortex continues unchecked. For more about the study and its implications, see the following post:

New pathway emerges for post-concussion treatment option

Wrapping up

If you suspect a concussion, seek out medical treatment based on CDC guidelines.

The old post-concussion protocol was to do nothing for a week or two, but the latest thinking is that doing nothing can make matters worse. After 24 to 28 hours, resume gentle activity with zero risk of further head injury, such a light walk, which you can follow with a gentle cognitive exercise like a game. Ideally, you’ll be able to slowly take on more physical activity and higher level cognitive challenges as you go, using the 5% rule.

You’ll likely want to get a doctor of physical therapy (DPT) with concussion recovery experience on your team sooner rather than later. Among other things, they can address whiplash and other neck issues, balance issues, oculomotor issues, and more.

If your symptoms persist for weeks, that’s when the information at Brainwave might help you survey the various treatment options available. Here’s what we’ve covered so far, more is on the way.

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Brainwave is an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I endeavor to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve simply had a lot of sports-related concussions and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.