When a Headache Is Really a Concussion

When a Headache Is Really a Concussion

When a game goes south due to a head injury, the first question that pops up is, “Is it serious?” Blows to the head are a common risk out in the field, but not all of them result in a concussion or a serious injury. Athletes can also suffer from post traumatic migraines, menstrual migraines, tension headaches and even sinus headaches when allergies hit hard during the spring and summer. So when is a concussion evaluation warranted and what are some of the symptoms that make a serious injury more likely?

The science behind concussions
The brain normally floats around in a liquid suspension of cerebrospinal fluid inside the skull. With a blow to the head, the skull may accelerate faster than the brain resulting in a contusion from its collision with the bone of the skull. This may result in a brain bruise, or a concussion. In the process, delicate blood vessels may shear or rupture. The disturbance affects brain nerve cells or neurons.

The impact of a concussion
Players who suffer a blow to the head and experience loss of balance, confusion or have the sensation of being in a daze right after they are hit, are likely to have concussed. Although some believe that a loss of consciousness must occur in order for head trauma to qualify as serious, this is not always the case. Any disturbance of brain function that causes transient problems with thinking or speaking, confusion and memory loss may be the likely result of a concussion. The  key to identifying a concussion is identifying this brief disturbance of brain function on the sidelines.

A headache may follow a concussion immediately or a few hours (and sometimes even days) later. Post concussive headaches may be benign, but if these progressively worsen and result in memory problems, slurred speech, severe balance disturbance or vision changes the prescription is a trip to the doctor.

Traditional headaches are usually nothing more than annoying. They may be associated with nausea, sensitivity to light and even auras (like ringing in the ears or funny smells). Although thinking may be clouded due to pain, memory and balance are usually intact because groups of neurons (nerve cells) are not directly injured. Migraines are a result of a vascular disturbance and are often genetic, while tension headaches are due to muscle spasms and can radiate up from the back and neck, also causing excruciating pain. Sinus headaches are frontal and are a consequence of inflammation in the sinuses typically due to a cold or allergy. Although dizziness may be associated with a sinus headache, this dizziness is different from the type of disequilibrium and gait disturbance found in someone experiencing a concussion.

How to assess signs of a concussion:

Assess orientation

  • Ask the athlete: What stadium is this? What city? What month/day/year?

Assess for anterograde amnesia

  • Ask the athlete to repeat simple words, like dog, blue or girl.

Assess for retrograde amnesia

  • Ask the athlete the following questions: What happened in the first half of the game? What do you remember just prior to getting hit? Who was winning?

Assess concentration

  • Ask the athlete to tell you what day it is, then repeat the days of the week backward. Repeat a set of number of days backward.

Assess memory

  • Ask the athlete to repeat the three words from the earlier question, dog, blue, girl

References:
Orientation questionnaire: Lovell et al. Grade 1 or ''Ding'' Concussions in High School Athletes: The American Journal of Sports Medicine.

 

Photo by arloo Via Adobe Stock

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