Post-concussion Syndrome TreatmentsApril 27, 2018
Post-concussion syndrome (PCS), aka postconcussive syndrome, is a complex disorder in which various symptoms- such as brain fog, headaches, and dizziness- continue for weeks, months, or even years after a concussion. This article will update new research on treatments.
Among sports-related injuries, post-concussion syndrome is one of the most elusive and challenging problems to treat.
While many patients will recover from their concussion, just as many will not. To make matters worse, as an athlete sustains repeat concussions, the chance of recovery becomes less likely. Symptoms of post-concussion syndrome vary from patient to patient but can include a headache, difficulty in tracking objects, slower reaction times, anger, lightheadedness, anxiety, depression, blurred vision, difficulty in concentration, photophobia (intolerance to bright light), and phonophobia (intolerance to loud sounds). These symptoms can range in severity from being slightly annoying to becoming an overwhelming disability.
Doctors in Israel write: “Persistent post-concussion syndrome caused by mild traumatic brain injury has become a major cause of morbidity and poor quality of life.” Unlike the acute care of concussion, there is no consensus for treatment of chronic symptoms.
Moreover, most of the pharmacologic and non-pharmacologic treatments have failed to demonstrate significant efficacy on both the clinical symptoms as well as the pathophysiologic cascade responsible for the permanent brain injury.
A most promising new direction is the use of hyperbaric oxygen therapy, which targets the basic pathological processes responsible for post-concussion symptoms.”1
Hyperbaric oxygen therapy can improve post-concussion syndrome years after mild traumatic brain injury.
Another research team from Israel provided convincing evidence that hyperbaric oxygen therapy may be the coveted neurotherapeutic method for brain repair.2
This is in agreement with earlier research that said hyperbaric oxygen therapy can repair chronically impaired brain functions and improved quality of life in traumatic brain injury patients with prolonged post-concussion syndrome at late chronic stage.3
Researchers in China take this one step farther and suggest traumatic brain injury and post-concussion syndrome patients undergoing hyperbaric therapy achieved significant improvement suggesting its utility as a standard intensive care regimen in traumatic brain injury.4
A later study from Louisiana State University School of Medicine and the University of North Dakota School of Medicine confirmed these findings in the United States, Iraq ,and Afghanistan War veterans. The aim of this study was to assess safety, feasibility, and effectiveness of hyperbaric oxygen treatments for mild post-concussion syndrome disorders and post-traumatic stress disorder in the veterans. Significant improvement was seen in 29 of 29 patients in regard to neurological exam, symptoms, intelligence quotient, memory, measures of attention, dominant hand motor speed and dexterity, quality of life, general anxiety, PTSD, depression (including a reduction in suicidal ideation), and reduced psychoactive medication usage. At 6-month follow-up subjects reported further symptomatic improvement.
Hyperbaric oxygen treatments were found to be safe and significantly effective in all four outcome domains: clinical medicine, neuropsychology, psychology, and SPECT imaging. Veterans also experienced a significant reduction in suicidal ideation and reduction in psychoactive medication use.5
Is it really a concussion?
Athletes and others reporting cognitive difficulties after a head injury are usually diagnosed as having had a concussion. But is it really a concussion? A recent study published by University at Buffalo medical faculty finds that many of the same symptoms are common to concussions and to injuries to the neck and/or balance system, known collectively as cervical/vestibular injuries.
The research was based on responses about symptoms from 128 patients – some of whom were professional athletes – who were being treated at University at Buffalo’s Concussion Management Clinic in the School of Medicine and Biomedical Sciences.6
A study in The Journal of orthopaedic and sports physical therapy also called into question whiplash and concussion similarities.
“The clinical presentations of whiplash injury and concussion have considerable overlap. Both diagnoses are generally based on presenting signs and symptoms, and a history of neck or head trauma. With incomplete knowledge of the trauma, differentiating between whiplash injury and concussion can be clinically challenging.”7
Prolotherapy Post-Concussion Syndrome Treatment
Dr. Greenberg’s story: At the age of 18, Dr. Greenberg was involved in an accident involving a drunk driver. He suffered from post-concussion syndrome related symptoms, including debilitating headaches for 10 years. Prolotherapy treatment into the cervical spine and occiput cured these decade long issues. This launched Dr. Greenberg’s career in regenerative medicine 18 years ago.
Through research into how the body naturally fights pain, I discovered prolotherapy, a holistic procedure that involves a series of injections into damaged ligaments, tendons, and joints that produces repair.
Agents used for prolotherapy restoration include lidocaine, dextrose, phenol, glycerin, and more recently growth factors derived from the patient’s own body known as platelet rich plasma (PRP). The exact mixture or substance used in prolotherapy is not nearly as important as the precise diagnosis and treatment into the area of damage that is causing the symptoms of post-concussion syndrome.
One may ask, how could injections into the neck and head possibly cure the problems of concussion and head injury?
The answer has to do with a complete understanding of what happens during a head injury.
I have studied films of the hits that have caused devastating concussions and observed that trauma to the skull does not just damage the brain, it also creates a significant whiplash injury to the neck and the base of the skull. Within these areas lies the brainstem, an area of the brain that controls our balance and coordination, and supplies nerves to the muscles that control the eyes, ears, face, and portions of our autonomic nervous system (ANS).
Injury to the cervical and skull base changes the relationship between the brainstem, base of the skull, and cervical canal, causing increased pressure on the nerve control that I have described above. This leads to many of the symptoms of post-concussion syndrome. Fortunately, prolotherapy and PRP injections (injections of a patient’s own platelet rich plasma) into these damaged areas can normalize the relationship between the skull base and cervical canal, and relieve excessive pressure on the nerve. Once this happens, symptoms of post-concussion syndrome resolve!
Prolotherapy and PRP injections are certainly the silver lining around a dark cloud, but must be used with caution. Having performed tens of thousands of procedures in my career, I know it takes an extreme amount of skill and dexterity to treat damage from concussion. However, successful treatment leads to regaining the patient’s life, allowing them to function again without pain, headache, blurred vision, and all of the other lingering symptoms of concussion. While there has never been a controlled clinical trial on Prolotherapy for treatment of post-concussion syndrome, the results speak for themselves.
-Scott Greenberg, M.D.
For more information on post-concussion syndrome, traumatic head injuries or symptoms of these conditions, please visit us at The Magaziner Center For Wellness.
1. Hadanny A, Efrati S. Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions. Expert Rev Neurother. 2016 Aug;16(8):875-87.
2. Boussi-Gross R, Golan H, Fishlev G, Bechor Y, Volkov O, Bergan J, Friedman M, Hoofien D, Shlamkovitch N, Ben-Jacob E, Efrati S. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury – randomized prospective trial. PLoS One. 2013 Nov 15;8(11):e79995. doi: 10.1371/journal.pone.0079995.
3. Sigal T et al. Hyperbaric oxygen may induce angiogenesis in patients suffering from prolonged post-concussion syndrome due to traumatic brain injury. Restor Neurol Neurosci. 2015 Oct 7.
4. Wang F, Wang Y, Sun T, Yu HL. Hyperbaric oxygen therapy for the treatment of traumatic brain injury: a meta-analysis.Neurol Sci. 2016 May;37(5):693-701. doi: 10.1007/s10072-015-2460-2. Epub 2016 Jan 8.
5 Harch PG, Andrews SR, Fogarty EF, Lucarini J, Van Meter KW. Case control study: hyperbaric oxygen treatment of mild traumatic brain injury persistent post-concussion syndrome and post-traumatic stress disorder. Medical Gas Research. 2017;7(3):156-174. doi:10.4103/2045-9912.215745.
6. Is it really a concussion? Symptoms overlap with neck injuries, making diagnosis a tough call – See more at: http://www.buffalo.edu/news/releases/2014/07/040.html
7 Elkin BS, Elliott JM, Siegmund GP. Whiplash injury or concussion? A possible biomechanical explanation for concussion symptoms in some individuals following a rear-end collision. journal of orthopaedic & sports physical therapy. 2016 Oct;46(10):874-85.