How do you treat a concussion at home?Jun 27, 2021
Typically when you are dealing with the immediate effects of a mild traumatic head injury (concussion), you will be told that symptoms will subside within a matter of days or weeks. Although this is true for example for the majority of sports related concussions, we also know from the latest statistics that up to 30 percent or more of those dealing with a head injury, do not completely recover after the initial three weeks post injury. Some research papers even show that up to 50% still suffer from cognitive problems after three months and that of those that seem to have recovered clinical investigation reveals that they are still in the repair phase after their head injury.
After the initial visit to your doctor or other health care provider you will most likely have been advised to take rest or lay down in a dark room until symptoms subside. This as you will see is common sense and probably the best thing during the first two days. However, according to those researchers and clinicians that really know, prolonged complete rest after the first acute phase is in most cases not the best idea or way to recover.
In this article I will lay out how you can best deal with your concussion in the home situation. Note that when symptoms exacerbate or do not subside after three weeks you will have to revisit your physician to get examined and referred to a specialist to find out what causes the delay in your recovery
First, do I have a concussion?
Many of the clients that we have been dealing with in our clinic did not have a hit on the head from an object, neither did they slam their head into a wall or onto the pavement while biking. Mind you in contrast to what many even experienced health care providers say, concussions (also called mild traumatic head injury) can come about due to severe jarring, shaking or jolting from the head of the head. As a result the brain is thrown back and forward within the skull. As you may remember from school your brain is a firm jelly like structure and the inside of the skull full with bumps and ridges. In other words a car accident , violent movement of the head because of a fall can cause it too.
NOTE: Although it goes beyond the scope of this post, it is important to know that there is often something going on in the brain that cannot be seen on regular MRI or standard CT. Many scientific papers state for example that next to a process called brain inflammation, neuro-vascular uncoupling and an metabolic (energy) crisis, micro damage does occur, we just do not often have the imaging available to accurately pinpoint the source of damage: for example in the transition zone between the outside cell layers of neurons in the neocortex and their projections (also called axons, which are grouped together into so called white matter tracts) to the rest of the brain and other parts, also in the white matter, long tracts, any compression, traction and especially torsion (for example in a whiplash like accident where the body and head are orientated into different directions)another source of injury can be the fatty sheet (also called myelin sheet) around the nerve tracts.
So what signs and symptoms point to that you are dealing with a concussion? Although the list below is certainly not conclusive it is accurate and depicts what most dealing with a traumatic injury experience to some extent. In fact, any of the items in the below list that are unusual and came about after the head injury points to the presence of a concussion.
- Heart beat irregularities (some of the time)
- Light and/or sound sensitivity
- Sleep disturbances
- Pressure in and/or around the head
- Persistent neck pain
- Slurred speech
- Changed eating habits
- Unusual tiredness
- Blurred vision
- Car sickness or nausea
- Change in taste or smell (or loss)
- Tinnitus (ringing or buzzing in the ear
- Losing balance more easily or unsteadiness
- Dazed appearance
- Delayed response to questions
- Difficulty concentrating
- Difficulty reading
- Difficulty finding things
- Difficulty reading
- Easily distracted
- Brain fog, inability to think
- Getting lost
- Short term memory poses problems
- Slowness to decide, think or act
- Feeling overwhelmed
- Low energy and/or motivation
- Variety of mood or personality changes
- Easily angered
- More emotional than usual
- Uninterested in favorite or usual activities
(Please note that when you have the feeling that there is an emergency going on with the loss of or deteriorating level of consciousness, awareness, response, confusion, memory, slurring of speech or any other thing that may alert to that a situation is getting worse, you consult, I repeat consult, immediately with your doctor or go to the emergency room to get things checked (again).)
Fortunately, most concussions will resolve within the first two weeks or at least three months, depending on the severity of your concussion and whether you have had repeated head trauma and/or previous neck injuries like a whiplash-associated disorder.
So what can and should you do at home to facilitate recovery?
Especially during the first days it is of utmost importance to keep all activities at bay, sleep as much as you can and avoid as much sound, visual stimulation, stress as you can. This is not just common sense it is backed up by the current literature on concussion. However, in contrast to what is often advised, beyond the first two, three days it is important to not avoid all stimulation.
Sleep is your biggest friend and actually the best medicine for your brain to recover. It is the only time when the debris is really cleared from your brain (through the glymphatic system among others, this is the brain's lymphatic system that was only recently discovered), and where repair takes place. Another benefit of sleep is that it quietens so called neuro inflammation. The process where the immune system gets activated after an impact to protect and clear any damage.
Try to take short naps or even one longer one if you manage to sleep of one and a half hour (this is the average sleep cycle) Naps should range from 10-30 minutes not longer.
If sleep poses a problem for you, you can try to take l-theanine, ashwagandha, and magnesium (preferably magnesium threonate and taurate, these have the most benefit for your brain) These supplements support more restful and relaxed sleep without having side effects. In this light, I also want to mention that although melatonin has formidable qualities, it it is never a good idea to take it for long periods. It is a hormone and especially in children may have an effect on maturation. For this reason I do not recommend melatonin, other then for very short periods of time.
Next on the list of absolute do’s while recovering, is to engage in low-grade exercise. After an injury, the brain has to deal with an energy crisis (the energy factories at a cellular level shut down and go in survival mode), neuroinflammation (as mentioned in the rest section), and decreased vascular supply (also called neurovascular uncoupling) to the areas that have been affected by the impact or other forces placed on the brain. For this reason it is vital that you provide your brain with proper fuel (more on nutrition later) and oxygenation. The easiest way to do this is to engage in low-level graduated exercises. What do I mean by this? As you most likely will not feel like exercising right from the start (neuroinflammation has this effect on the drive to activate motoric activity to prevent you from moving too much) or notice that exercise has an adverse effect, you will have to build this up very gradually. There are some good guidelines that you can use for this (more on that a little later). In any case you should try to have at least 30 minutes of movement on a day or when you can handle it twice a day. Exercise should consist of low-level cardio activities, that get your heart rate up (but not to much) and your circulation going. The best types of exercise are easy walking, stationary bike, and or elliptical trainer (x-trainer). Especially during the first weeks any more intense exercise, even if this does have a beneficial effect in later stages of recovery, is not a good idea. In fact your exercise routine should under no circumstance cause a big flare up of symptoms. A little is alright but should never hold on for more than 30 minutes after the exercise stops. The best way to do this is to gradually build your 30 or two times 30-minute exercise up. Start for example with 10 minutes and over the period of a week or two weeks, depending on the severity of your symptoms, build this out.
So how do you know if what you are doing is alright? Monitor the symptoms before you engage in an activity like walking grade yourself for with the concussion symptom checklist and if during the exercise symptoms increase take notice when this happens and either reduce the time of the exercise so you ease off before there is a flare-up the next time or you maintain the same duration but exercise at an even easier pace (you can also use a heart rate monitor and exercise at 80% of the heart rate that you had when you experienced your flare-up). Another easy way to get to at least 30 minutes of low-grade exercise during the day is to break it up into three 10 minute exercise routines.
Do not avoid all mental activity
Although you most likely feel like not engaging in any heavy thinking, reading, or activities with other people, you should be aware that after the initial two days it is wise to not entirely walk away from this. Why? It is very easy to decondition yourself where avoidance leads to the point that activities like reading or listening to the radio become so difficult that you will avoid them altogether. Research shows that gradually increasing mental activities after a concussion will help you recover quicker and more complete even if at the time this may feel uncomfortable. This is not to say that you should engage in mental activities regardless of what happens after. A very gradual build-up is in most cases the best way, where you monitor very closely how you react to any mental activity you engage in to see how much is possible the next time.
The timing of any mentally demanding activity is however vital. Do so after you had your exercise routine. The brain is more engaged and ready after exercise, more blood flow, oxygen and activation make the brain more accessible for stimulation. You will notice that this makes a lot of sense and works!
Examples of mental exercise, include reading, puzzles, crosswords, sudoku, engaging in a conversation, listening to music, or a podcast, doing daily routines in the house like preparing for a meal. No matter what your activity is, make sure that it is something not to heavy and that for you it would normally be a fun activity. This will make the transition to your normal routines a lot easier.
How long should you engage in these activities? Exercising your brain is like exercising your body. A gradual build-up is better, a couple of minutes to start with, monitor afterward how you are doing, and build out gradually. If this poses too big an obstacle only do the activities briefly and repeat them throughout the day for brief periods. You get the point. Remember though that mental activity for a brain that is struggling to recover is a task that may cause you to feel not so good. That is not necessarily a bad thing though and unless it really continuous for a long time, is a sign that you are bound to experience before further recovery.
Basically, your brain goes into survival mode after an accident. Ideally, this is a short-lived thing that passes after a couple of days, but for many something that continuous way beyond the initial stages after a head trauma. Stress under normal conditions is not a bad thing, it actually can enhance learning, the immune response of your body, and improve physical functioning, however, when it continues to be chronic it hinders the repair and healing of your body.
For this reason, it is almost mandatory to partake in some form of mindfulness and/or meditation, or see someone to learn how to deal with the after effect of an accident (like a psychologist that does EMDR when you relive what happened during an accident for example). Stress reduction can also be reached by engaging in yoga, Tai Chi as long as you physically can handle this. Other activities that reduce stress are singing, stroking a pet, massage, talking with a good friend or spouse, writing down what you experience as unpleasant, journaling etcetera.
If nothing works then there are certain botanicals that can lower your experienced stress without having serious side effects. Here are a few that you may try. Of course always consult your pharmacist or doctor to learn whether you can use these in conjunction with your regular medication. You can also go to examine.com which provides very good insights into the validity and effectiveness of taking botanicals/ supplements:
The last thing that I want to mention is breathing. Breathing is probably the easiest way to change your state and levels of brain oxygen next to exercise. I do realize that it sounds easier than it actually is. Most if not all of us find it challenging when really focusing on breathing to do this properly and with ease. Paying attention to breathing is, even when you do not do anything with the previous advice, really worthwhile. There is for example one particular technique called the physiological sigh that can within a very short time change your physiology when under stress. Please watch Andrew Huberman's short presentation on the topic, you will be amazed with how easy it is (insert link). For in-depth background on breathing and oxygenation of your brain I refer to the following masterclass that I made on the topic: (insert link to breathing/oxygenation masterclass)
The way you eat also has a big impact
A low inflammatory diet is key in further recovery. As you are probably aware of (or not) this is a real problem in our society. The diet of the average person is usually proinflammatory and is seen by many experts to be the leading cause, next to pollution and stress, for most chronic diseases, including, diabetes, cancer, heart and vascular disease and autoimmune problems.
Because It goes beyond this article, I will keep to the most important things that you should watch. Minding the following will greatly enhance your recovery and is probably one of the easiest ways to make yourself feel better and greatly support the recovery process:
- Avoid carbs, yes you heard me right, carbs in the form of pasta, bread, refined flour products, products with sugar in them (especially avoid diet products since they contain ingredients that can really disrupt your brains function like aspartame etcetera).
- Take gluten an dairy out of your diet since these products contain many counterproductive ingredients for brain recovery and gut brain health (see also masterclass on gut brain health)
- A plant based diet with a high content of good fats, for example out of nuts (not peanuts!!) avocado, omega 3 rich wild fish, game and grass fed cow meats is an absolute must for recovery
- Avoid any form of alcohol, soda’s etc. during the initial months of recovery because they can really disrupt the recovery process and flare up low-grade neuroinflammation.
An excellent text on the matter is for example Stephen Gundry’s plant paradox and any of David Perlmutter’s books. In these books, you get all the information on the topic of which foods are good for you and which foods will prolong or even make your symptoms worse and why.
A short word on a very simple way to speed up recovery after brain trauma. One of the ways to really speed up the recovery of your brain and lower any inflammatory responses is intermittent fasting. Basically what this means is that you prolong the period that you do not eat for example from 19.00 in the evening to the next day 10 to start of with and later ideally a couple of days a week even until 12.00-13.00. What this does is to prolong the recovery and rebuilding time at a cellular level. It has a huge effect on mitochondrial energy production, it lowers inflammatory responses, and is very beneficial for blood sugar levels. One of the other beneficial side effects of intermittent fasting is that you start to produce so-called ketones because there is are no simple carbohydrates to turn into energy. Ketones are a much more efficient source of fuel than either fat or sugars. If intermittent fasting sounds like a bridge to far you may also try out exogenic ketones that any health store stocks nowadays. Also, see dr Gundry’s website or books on this topic.
Gradual return to activities
Ideally, you start feeling gradually better after two weeks or at least in the next three months after the incident that caused your concussion. If this is the case you gradually and naturally will increase the activities that were mentioned before. You can increase your mental activities as you notice a gradual improvement, engage for example in easy social activities, like a talk with a good friend or having someone over for dinner. In addition you can start planning a gradual return to school or work activities for some hours at the time. Ideally, you start at home doing these activities before you really go to school or your work. Make sure that you do not go from one moment to the other to full return. Make a plan with the school and work for a gradual return over the period of some weeks and make them aware of what happened and that to quick return may easily cause a major setback. If all goes well the return goes as planned and may actually be easier than anticipated. Do make sure though at this time you really get your rest and sleep and continue to practice the advice given in the article so far. When you notice that things do work out and that everyday live challenges do not seem to have a major impact on how you feel, then you know you are well on the way to recovery
What should you not do?
Just a word of warning, there are during your period of recovery also a couple of no-no’s that you really should take to heart. Do not at any time engage in activities that may cause another head trauma, no contact sports whatsoever. Remember with this that because of your injury your balance, perception of risks, physical awareness, visuospatial and movement perception are often to some extend already disturbed, which makes it even more likely to suffer another incident!
Also do not engage in any vigorous exercise like running. This will compromise and challenge the already disturbed inter[play between, neck, balance systems, eye functionality and brain even further. When symptoms subside and return to normal activities is a fact you can pick this up in a graded way again.
If there is one single thing that you should avoid during the initial stages of recovery the it is spending to much time behind a screen! You heard me right screen time equals more symptoms and a delay in recovery. Why? Artificial screens are just to demanding for the visual system (which is often disturbed by and very vulnerable to head injury), the brain can simply not deal with the tremendous amount of information because it is occupied by the circulatory, inflammatory problems and energy crisis and is thus not waiting for something to overburden its processes (most of us use visual information as our prime source of input). In addition, the blue light emitted by screens is too much input for the already challenged visual system. In addition, the use of the eyes darting over a screen is often way to much for a compromised interplay between the central vestibular system, the eyes and deep spinal muscles from the cervical spine. All of which are united into a system that has constant interaction with, feedback and commands from the brain.
So be aware that spending too much time behind any screen may hinder and delay your recovery. You probably may not like this but other than that you will experience what it does if you decide to have more screen time then is good, it is probably one of the best advice I can give you. Like with any mental activity, screen time should be gradually increased over time. Just be aware that it is one of the things that will have the most impact on how you feel so please hold back on how quickly you increase your time with your smartphone, Ipad, gaming console, computer, and/or TV.
So what do you do if you do not recover?
Unfortunately, some do not recover that well or quick after a concussion, this can be for a lot of reasons, the severity of the impact, genetic makeup ( a small percentage of us have genes that dictated slower recovery after a head injury), the presence of previous head injuries, pre-existing disease, such as diabetes, autoimmunity a Lyme infection, Eppstein Barr will, for example, make rapid and complete recovery more complicated (In future articles we will go into depth into these factors). If symptoms persist after the three-month mark, then next to consulting your regular physician it may pay of to go to a functional neurologist or schedule a free consultation with us and find out what is holding your recovery back. In most cases, this will be a continuing of the energy crisis, neuroinflammation, uncoupling of the neurovascular interplay (all of which can cause continuing cognitive problems), central vestibular integration issues or a disturbance in the interplay between the balance system, eyes, neck information, and the brain. A thorough check-up and investigation can highlight what underlying factors there are which not only gives you an explanation for the continuing problems you are experiencing but also makes it easier to devise a plan for your further recovery.
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