Concussion and mTBI first aid
Helpful info for steering 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—including my future self—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 one suspects that an injury was severe, seek out the appropriate level of care.
If One Suspects 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 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. I am not a medical professional.
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, it’s advised to keep a heart rate below around 140 beats per minute. If one experiences symptoms, such as dizziness, the exertion level can be reduced until one minimizes symptoms, but it’s generally considered helpful to do at least 30 minutes of walking a day. Again, vet this plan with your doctor.
Walking for 30 minutes can provide the 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 gentle exercise, a mildly challenging brain game might be a good idea. Boggle, for example, or solitaire, or light reading. This can further help bring blood and oxygen to the brain in concert with neurological activity.
If one can sit in the sun for awhile, that could be helpful. An epsom salt bath might also be helpful.
If the fight or flight impulse won’t recede, some have found comfort from doing Vagus nerve resets (there are many videos on YouTube, including one where ice packs are placed on opposite sides of the neck for 15 seconds at a time).
Going forward: obeying the 5% rule
Many people who have lasting symptoms after a brain injury either do too much or too little. To avoid that, one can 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 the baseline of tolerable exercise levels is established, which may be a simple 30 minute walk, physios often increase elements of that exercise (time, hear rate, repetitions, etc) by 5% and see if their patients can tolerate that without triggering symptoms. If any symptoms arise or are worsened by activities, a PT will often advise returning to previous levels before eventually 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 one faces after a brain injury are: calming down when one wants to calm down, and being alert when one wants to be alert. Certain breathing techniques can help with both states.
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 the inhale is longer than the exhale, one is elevating and activating alertness or “up-regulating” one’s nervous system; If one’s exhale is longer than the inhale, one is are calming or “down-regulating” the nervous system. Breathing creates an “access panel” to one’s nervous system.
First-aid supplements
Here’s a list of supplements that are most likely to help in the immediate aftermath (post-acute phase).
In general, I personally avoid any “brain boosting” nootropics or cognitive boosters. I know it’s tempting to think these will lift the brain fog, but that’s like thinking one 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, I also avoid increasing my caffeine consumption to mask my brain fog.
The main aim at this point is to create a safety net for the brain.
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 can be helpful, 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. However, if one gets migraines, L-theanine might be a migraine trigger. As with anything else here, your mileage may very, proceed with caution, and ask your doctor.
One reason I’m emphasizing morning vs. night here is to underscore the importance of re-establishing (or teaming up with) one’s circadian rhythm. Over time, this will allow one to relax more deeply at night and be more alert during the day.
For more about supplements, see:
Don’t forget about the neck
It typically takes a far lower g-force to injure a neck than it does to injure a brain. If one takes a blow to the head, and one’s neck is involved, there may be soft tissue damage.
The symptoms of mTBI and whiplash have great overlap, and one might be surprised to discover just how many symptoms may 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 one’s recovery team.
The neck isn’t merely a mechanical structure. It plays an essential role in one’s 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.
There are several options for neck treatments and self-care, including: epsom salt baths, massage, acupuncture, 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 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 someone with an array of treatment options outside the realm of what one 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:
Wrapping up
If a concussion is suspected, 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, it is now recommended to begin gentle activity which has zero risk of further head injury, such a light walk, which one can follow with a gentle cognitive exercise like a game. Ideally, one can steadily increase physical activity and higher level cognitive challenges, using the 5% rule.
A doctor of physical therapy (DPT) with concussion recovery experience can be super helpful. Among other things, they can address whiplash and other neck issues, balance issues, oculomotor issues, and more.
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.