brain injury

28 September 2020

Aimovig after Concussion?

James Discoveries & Stats, Medications 0

Now that several CGRP related medications are on the market for migraine, researchers are interested in finding other uses for the same drugs (even to fight COVID-19). One case in point is the use of Aimovig (erenumab) for headache from a hit in the head.

There are a series of different types of headache that are due to head or neck trauma. Under the heading of “Acute headache attributed to traumatic injury to the head“, the International Classification of Headache Disorders 3 points out that the common definition is a headache that starts within 7 days of the injury, although this is “somewhat arbitrary”, because there is some evidence that the headache could start up to three months later. The problem is that, the longer the interval, the harder it is to connect the headache with the injury.

Millions and millions of head injuries happen every year, so this is a very common issue. A concussion is really a type of brain injury, and there is still a lot that we don’t know about how concussions affect the body (although we’ve learned a lot in the past 20 years).

So from this small initial study, how did Aimovig measure up when it comes to post-traumatic headache (due to mild traumatic brain injury, or concussion)?

It should be noted that these patients were all women, and had suffered from their headaches for over a year (to several years). They had also already tried at least one other daily preventative for headache. So this is not a case of someone with a bit of a headache a couple of weeks after a fall – these are ongoing, difficult cases. And the headaches were moderate to severe.

Taking erenumab, the patients found that, on average, the pain decreased by about half. All five patients were able to stop taking at least one other medication. Four out of five patients continued taking erenumab after the study was completed. But even better, patient #5 stopped taking it because their headaches disappeared completely.

There were no serious side effects, though three patients did have some constipation.

It’s a small study, but for challenging headaches like these the results look good. It may be that other CGRP receptor blockers will also have a wider application for headache treatment.

For more, read the study abstract here: Use of CGRP receptor blocker erenumab in the management of post-traumatic headache: a case series of 5 women

16 February 2017

Concussion: What Kind of Rest is Needed?

James Uncategorized 0

A large study is questioning some of the common wisdom regarding treatment of concussion in children.

We’ve talked a lot in the past about concussion (which is a brain injury), especially related to sports injuries. Concussion needs to be taken seriously – it could result in ongoing symptoms. Recent recommendations include being very cautious of activities that could result in another concussion, and getting sufficient rest after the injury.

In particular, cognitive rest. That is, avoiding (for example) reading, homework, and video games. (For more, see the 2014 study Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms)

But while getting rest and avoiding activity with a risk of concussion seems to be the best, does that mean that the child or teen should lie in bed all day? Apparently not.

A study involving 3063 children and teens (up to the age of 18) compared patients who returned to physical activity (within 7 days) with those who were restricted to more “conservative” rest. The question – which group was experiencing more postconcussive symptoms at 28 days?

Postconcussive Symptoms in Children and Youth As you can see from the chart, those who went back to physical activity within 7 days were significantly less likely to have the unwanted symptoms.

Depending on who you talk to, there seem to be two dangers. First, keeping your child away from any physical activity seems to be a danger. Activity is all the more critical to growing children and teens – it can play an important part in their recovery. But the other danger remains – not taking the concussion seriously, and putting the child right back into the sport that caused the injury in the first place.

A slow and cautious return to low-risk physical activity, with limited brain-work for a while, seems to be the best advice.

For more on the study, see the abstract: Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. Also see Early return to physical activity after concussion may reduce post-concussive symptoms at the New York Headache Clinic.

11 July 2016

What causes the symptoms of a concussion?

James Discoveries & Stats, Information 2

Confusion, sensitivity to noise, drowsiness, headache – these are some of the symptoms that may occur minutes, or even days, after a concussion. But exactly what causes concussion symptoms?

Concussion is a type of brain injury usually caused by a blow to the head, although it can be caused by any whiplash-type motion, even if the head is never touched. This is another way to see that helmets protect the skull, but can never give 100% protection against concussion.

A concussion is not structural damage that can be seen in a typical CT or MRI scan. The damage actually goes down to the cellular level.

Brain tissue is very soft – think soft butter. When the brain tissue is pushed against the skull, or suddenly twisted, the brain cells themselves can twist and tear.

Cells are like little factories, with highly developed communication systems tying them together. When the little factory is damaged, a number of things can happen.

For example, important materials may “leak” out of the cell, no longer properly contained. Communication between cells may break down. Normal balance is lost. And those little factories go into high gear to try to get everything working again. They may start to produce more of certain things that your brain may have trouble dealing with, such as free radicals or inflammation.

Clean up Think of a city after a war, or riot. Bricks are lying everywhere. Normal communication is broken down. There may be looting. But hopefully most citizens are trying to get things back to normal. Meanwhile, nothing is normal. Buildings may not be recognized. Family members may not know where other family members are. There are gas leaks, fires, and broken pipes.

Sometimes things that should be helping can cause other problems – a fire hose causing flooding in a nearby room, police cars blocking roads.

Remember that this is all happening on a cellular level. It’s incredibly complex, and it’s not easy to see what’s going on from the outside, which is why it’s taking researchers so long to understand the details.

Usually, the brain regains its normal function within a couple of weeks. However, there may be parts of the injury that do not resolve. This can lead to long term problems, such as post concussion syndrome, or chronic traumatic encephalopathy (CTE), a condition occurring late in life in people who have had repeated brain trauma (such as people who played contact sports).

Though we still have a lot to learn about concussion, we’ve come a long way in the past few years. Understanding what is going on in the brain after a concussion is helping with the development of new treatments.

For example, if there are too many free radicals in the brain, could we use antioxidants (as a patch or oral supplement) to clean things up faster, and maybe avoid long term issues?

Meanwhile, if you get a concussion, see a doctor. Be sure to rest and stay away from computer screens and heavy mental activity for three days. Let your doctor know if new symptoms appear, or if some don’t go away.

More tips here: What Should You Do If You Think You Have Had a Concussion?

12 September 2014

Football Helmets and Sports Concussion

James Information, News, Resources, Tips 0

The debate about concussion in sports continues to heat up. Recently FIFA’s medical committee chairman, Michel Dâ€™Hooghe, recommended that games be stopped for three minutes so that players could be properly assessed for brain injury (that is, concussion). Meanwhile, Will Smith and Gugu Mbatha-Raw are set to star in a new movie about concussion in the NFL.

The controversy about football helmets isn’t over either. On the one hand, some studies seem to show that helmets can protect players from concussion to some extent, while some experts claim that the protection is minimal to none.

Virginia Tech has come up with a five star rating system for helmets, based on testing both on the field and in the lab. Certain helmets, such as the Schutt AiR XP Pro VTD and Riddell 360, for example, far out-performed the Schutt Air XP Ultralite and Riddell Revolution IQ.

To see the ratings, visit Adult Football Helmet Ratings – May 2014.

Although ratings are helpful, players need to know one thing above all the controversy and hype. If you’re playing a contact sport, especially sports like American football, hockey or rugby but including sports like football/soccer and basketball, you’re in danger of brain injury. Even if you buy the best protection, it won’t protect you anywhere close to 100% from concussion.

Does that mean don’t play the sport? Not necessarily, but it does mean that you can’t keep your brain from banging against the side of your skull using a helmet. That’s why there is a call for proper assessment of injuries, the need to visit a doctor or specialist, the need to get out of the game when there is an injury, and to think carefully before you put yourself in danger again.

There are also movements for better training on how to tackle, and better rules to protect players. (See the ideas from one specialist here)

The bottom line? Get the best helmet you can, but don’t trust it to protect you from concussion, a brain injury which can have consequences for years ahead.

For more thoughts, see this recent news report (video and article): High school football helmets tested for concussion risk See also this article on Head sports trauma

10 September 2014

Is it Concussion or Migraine?

James Information 0

If you’re dealing with headache symptoms, and you suspect you may have had a concussion, it’s natural to ask – is it concussion or migraine?

First, some important background. Many people don’t realize that concussion is a brain injury. It’s important to start here, because there are still those who think that concussion is a minor, temporary injury.

Although some injuries are certainly worse than others, a single concussion can lead to long term problems. For more see Is it a Concussion or a Brain Injury?

So back to our question. Concussion can lead to something known as post-concussion syndrome (PCS). In PCS, although the concussion (read: mild brain injury) may have happened several days or even weeks ago, you start developing symptoms such as dizziness, fatigue, headache, anxiety, and insomnia. (More about post concussion syndrome symptoms here)

Now PCS can indeed look a lot like migraine, and sometimes it is difficult to know the difference. In fact, some might say that PCS is triggering actual migraine attacks.

But more likely when you ask if it is concussion or migraine, you’re asking if the concussion is at the root of the problem, and if you should be looking for treatment that is different from typical migraine treatment.

How to tell if you have PCS: Here are some important clues. First, in order to be diagnosed with PCS, your symptoms must be new. These symptoms usually appear between a few days and four weeks of the concussion. So if you’re having the same symptoms as before, you probably won’t be blaming them on the concussion.

If, however, you had struggled with headaches before the concussion, but your symptoms have changed, you may have PCS. You should see a doctor without delay.

After you have confirmed that your symptoms are new, or that they have changed, your doctor will want to know more about they symptoms you’re experiencing, when they started, how severe they are, and so on.

If you decide after speaking with your doctor that you don’t have PCS, you still need a proper diagnosis for your symptoms. There are various types of headache, and even various kinds of migraine. Getting a specific diagnosis will help you find treatment that will be effective.

For more information, see Post Concussion Syndrome – causes and treatment