Not Every Headache is a Concussion

This is going to be a frank discussion today.  About a difficult topic.   I'm going to talk about concussions today. 

I've definitely talked a lot about concussions.  So has everyone else.  Concussions are all over the media.  Almost too much.  Almost.  Every time somebody gets hit in the head, the concussion question comes up. 

There was a recent report about a study of the brains of former NFL players.  110 out of 111 brains examined (they were dead, of course), showed significant evidence of Chronic Traumatic Encephalopathy (CTE), presumed to be the result of concussions.  Maybe one...maybe many. 

We know that repeated concussive events can lead to CTE.  It is beyond discussion. 

The symptoms for CTE resemble progressive dementia.  In the early stages, it manifests itself as memory loss, headaches, visual disturbances, and dizziness.  Next comes erratic behavior, personality changes, and social instability.  Late stages find the victim unable to perform many daily tasks.  Hygiene suffers.  Headaches might be intolerable.

The rate of suicide among those with CTE is alarmingly high.  The 2012 suicide of Junior Seau of the San Diego  Chargers was attributed to CTE.  There have been others.  Too many, really.

And here's the problem.  WE are to blame.  Health care professionals.  Athletic Trainers.  Physical Therapists.  Doctors.  Coaches.

In my career, which is admittedly long, if you "got your bell rung" but recovered to where you could answer a few simple questions, you could go back in the game.  In long ago days, even if you lost consciousness briefly, you might be allowed to play. 

Multiply that out from high school to college to the pro's and it adds up.  Then throw in the mentality that we should "get tough" and play through our injuries that was so prevalent when I was growing up and you can see how we have gotten to where we are now.

My how things have changed.  They've changed because we know oh so much more. Today, if you get a blow to the head, regardless of the circumstances, regardless of the activity, and have any symptoms, we treat it like it is a concussion.   Period.

Those symptoms might include headache, dizziness, blurred vision, difficulty concentrating, or sensitivity to light.  We treat it like it is a concussion until proven differently.

We have standardized cognitive tests that we administer to determine how well the brain is working.  We work diligently to do those studies on every high school athlete in our service area so that we have a baseline to compare to.  We test balance and coordination and a bunch of other things.  Just to be sure. 

But here's the dilemma:  Not every blow to the head that results in a headache is a concussion.  Yet hardly a day goes by that I'm not asked to examine an athlete that has been hit in the head and might have a headache.  Or might have had a headache for a few minutes but they're fine now.

How do we make that distinction then?  How do we know that it isn't a concussion?  We don't.  We treat them all like a concussion. 

Does it take expensive testing like CT Scans and multiple medical examinations to prove that it isn't a concussion?  Not always.  Sometimes it is a matter of professional judgment.  Judgment that comes from education,  experience, study, and knowing our players.

But when we're in doubt, that player is out.