the Carolina Headache Institute.
“ Repeat concussions appear to make it more likely that these headaches will become intractable,” Dr. Finkel says.
THE RISK FOR PERMANENT DAMAGE
In addition to extending a headache condition, repeat concussion can also turn other concussion side effects( e. g., memory and concentration deficits, sleep disorders and balance difficulties) into more serious and longer-lasting concerns.
Perhaps even more alarming, repeat concussion can lead to permanent brain damage, including the potential for a progressive degenerative disease called chronic traumatic encephalopathy( CTE). Although CTE was once known as a boxer’ s condition and is receiving media attention for its effects on football players, it can affect anyone with multiple head traumas. The condition, which leads to brain atrophy and nerve cell damage, can cause progressive memory and cognition deficits, long-term personality changes, suicidal behavior and dementia. 4( Turn to page 24 to learn more about CTE.)
Repeat concussion can also trigger second-impact syndrome( SIS), a rare complication in which the brain swells rapidly, leading to death or severe disability. SIS can develop if a second concussion occurs before symptoms of an earlier one have subsided.
Unfortunately, researchers don’ t yet know how many concussions are too many and which concussion might lead to permanent damage. The threshold may vary from person to person, depending on differences in genetics, the environment and the dynamics of the injury, according to Dr. Cady. Uncertainty aside, physicians do agree that prevention and early treatment can help reduce concussion risks.
THE IMPORTANCE OF DOWNTIME
Helmets and protective gear can help reduce the risk of head trauma to an extent. Dr. Finkel suggests it would also be helpful for the military to train soldiers“ to avoid situations where head injuries are more prevalent.” But ultimately, Dr. Finkel and Dr. Cady agree that, given the way wars are fought today, there is really no effective way to prevent a concussion.
“ The military provides sophisticated protective gear and training to help soldiers in combat prevent injury,” Dr. Cady says.“ However, the magnitude of an assault like that of an improvised explosive device is beyond the limits of this protection.”
To optimize recovery following a head injury, early diagnosis and treatment of post-traumatic headache is essential. Further, military servicemen and women must be offered an environment in which the brain has time to recover from the assault, Dr. Cady says.
“ When adequate time and proper environment for recovery are not provided, this can lead to more disabling headaches and other symptoms associated with concussion,” Dr. Cady says.“ Also, when the brain is concussed, reaction time and cognition may be affected, which increases the risk of re-injury.”
To fully recuperate, military personnel may need to take time off from active duty. While this may seem initially disruptive, it can lead to a healthier life in the long-term and the maintenance of a functional deployed status. With proper conservative care and a gradual return to regular activities, most brains recover from injury, even after repeat concussion, Dr. Cady says.
Unfortunately, with the risk of a disrupted tour of duty, soldiers may be reluctant to seek treatment. But military leaders are increasingly urging servicemen and women to seek treatment instead of downplaying their symptoms. In an effort to reduce the side effects of traumatic brain injury, the U. S. Army developed new guidelines that require troops caught within 165 feet of a blast to be removed from the battlefield for at least 24 hours and examined for evidence of a concussion. 5 Soldiers sustaining three concussions in one deployment are required to undergo a more detailed evaluation before being cleared to return to combat.
If implemented successfully, the latter effort combined with adequate downtime could save many soldiers from carrying home the insidious effects of concussion. HW www
Learn more about concussions at www. besmartbewell. com / tbi.
4. Stern et al.“ Long-term Consequences of Repetitive Brain Trauma: Chronic Traumatic Encephalopathy.” PM & R. 2011; 3: S460-S467.
5. Zoroya.“ More Troops’ Concussions Diagnosed Under New Rules.” USA Today. October 28, 2010.
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