What are the six types of concussions?

The six types are cognitive fatigue, vestibular (central pathways), ocular (eye coordination), migraine, anxiety, and neck-related symptoms.

Do girls have more concussions than boys?

Yes, girls are more likely to have concussions. This is partly due to factors like higher rates of migraine and car sickness, which are risk factors for concussion, and potentially hormonal influences.

Is playing through concussion symptoms prolonging recovery?

Yes, research shows that playing even 15 minutes after experiencing concussion symptoms significantly increases recovery time, adding nearly a month to the average recovery period.

What is the most predictive symptom of a longer concussion recovery?

On-field dizziness is the most predictive symptom, being six times more likely to indicate a longer recovery (a month or more) than losing consciousness. Fogginess or feeling detached is the second most predictive.

Is concussion a treatable injury?

Yes, Dr. Collins firmly believes concussion is a treatable injury. Effective management and treatment can lead to full recovery without chronic cumulative problems, with early intervention yielding the best outcomes.

What is the recommended treatment for concussion: rest or activity?

Contrary to the traditional advice of rest, the recommended approach is retraining through activity. This includes targeted physical therapy for specific deficits, exercise to increase parasympathetic nervous system arousal, and exposure to busy environments.

Can hyperbaric oxygen therapy treat concussions?

Dr. Collins is not a believer in hyperbaric oxygen therapy for concussion treatment. He states there is no compelling data to support its efficacy, and it can lead to unnecessary anxiety and a focus on unproven solutions.

What is the risk of developing dementia or CTE after multiple concussions?

Current studies do not show a clear proclivity towards dementia or other neurodegenerative illnesses from repetitive head injuries, although research is ongoing. CTE is still being investigated, particularly the role of sub-concussive impacts.

How important is early specialized care for concussion?

Seeking specialty care within seven days of a concussion significantly improves the likelihood and speed of recovery, as treatments can be applied more quickly. However, recovery is still possible even years later.

What advice do you have for parents whose children may have a concussion?

If a child shows symptoms, remove them from play immediately and seek specialty care within a week, after ruling out serious issues like intracranial bleeds. Experienced concussion clinics offer more targeted treatment than general pediatricians.

Key Moments

263 ‒ Concussions and head trauma: symptoms, treatment, and recovery | Micky Collins, Ph.D.

Q: Are there any biomarkers or definitive tests for concussion?

Currently, there are no reliable biomarkers, blood tests, or imaging studies like MRI or PET scans that can definitively diagnose a concussion. Diagnosis relies on clinical evaluation of signs and symptoms.

Peter Attia MD

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Jul 24, 2023|76,689 views|1,585|294

Peter Attia MD Dr. Peter Attia Early Medical The Drive Podcast The Drive

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Key Moments

TL;DR

Concussions are treatable brain injuries impacting energy metabolism. Early, targeted treatment is key for recovery.

Key Insights

Concussions are cellular energy crises, not structural brain damage, affecting neuronal efficiency.

There are six types of concussions (cognitive fatigue, vestibular, ocular, migraine, anxiety, neck), each requiring specific treatment.

Dizziness and fogginess are stronger predictors of prolonged recovery than loss of consciousness.

Playing through concussion symptoms significantly prolongs recovery time (up to double).

Early intervention (within 7 days) is crucial for optimal concussion recovery.

Treatment focuses on retraining and active rehabilitation, not rest, addressing specific deficits.

THE EVOLUTION OF CONCUSSION SCIENCE

Dr. Micky Collins recounts the early days of concussion research, starting in the late 1990s when the field was virtually non-existent. Despite skepticism, his persistence, alongside mentors like Mark Lovell and Joe Maroon, led to the establishment of the first concussion clinic at UPMC in 2000. This pioneering work, including a groundbreaking JAMA paper in 1999 on college football concussions, laid the foundation for the current understanding and treatment of this complex injury. The progression from seeing few patients in a cubicle to managing thousands annually highlights the field's dramatic growth and the increasing recognition of concussion's significance.

THE PATHOPHYSIOLOGY OF CONCUSSION

A concussion is defined as a violent shaking of the brain, causing neurons to stretch and release potassium, creating an energy crisis. This metabolic mismatch leads to reduced cerebral blood flow and impaired neuronal function, though not cell death. This cellular struggle destabilizes various brain systems, leading to different types of concussions. Crucially, there is no current biomarker, blood test, or imaging technique (like MRI or PET scans) that can definitively diagnose a concussion, making clinical evaluation paramount.

RISK FACTORS AND VULNERABILITY

Interestingly, concussions are not solely determined by the impact, but are influenced by pre-existing vulnerabilities. Factors like a history of car sickness, migraines, strabismus (lazy eye), or anxiety can increase susceptibility and predict specific concussion types. Girls, for instance, are more prone to concussions and longer recovery times, partly due to hormonal influences and higher rates of car sickness and migraines compared to boys. This suggests a concept similar to 'cognitive reserve,' where underlying issues make individuals more vulnerable to the injury's effects.

DIAGNOSIS AND PREDICTORS OF RECOVERY

Diagnosing a concussion relies on identifying approximately 21 potential symptoms and observed signs. While loss of consciousness was once thought to be the primary indicator, research shows that on-field dizziness is six times more predictive of a longer recovery than losing consciousness. Symptoms like fogginess, fatigue, and sensory sensitivities (light, noise) are also significant predictors. Critically, playing through concussion symptoms, even for a short period, can double recovery time, highlighting the importance of immediate removal from play.

THE SIX TYPES OF CONCUSSIONS AND TREATMENT APPROACHES

Dr. Collins outlines six distinct concussion phenotypes: cognitive fatigue, vestibular dysfunction (central pathways), ocular motor issues (eye teaming), migraine, anxiety, and neck-related symptoms. These are not mutually exclusive and can coexist. The core treatment philosophy is not rest, but active rehabilitation and retraining of affected systems. For example, vestibular problems are treated with targeted physical therapy and exercise, while anxiety is managed by increasing parasympathetic nervous system activity through exercise and regulated sleep. Identifying the specific aberrant signal is key to applying the correct, individualized treatment.

TREATMENT STRATEGIES AND PROGNOSIS

Effective concussion management involves a multi-faceted approach tailored to the individual's specific deficits. This includes vestibular and ocular motor therapy, cognitive exercises, and addressing anxiety and sleep disturbances. 'Exertion therapy,' a targeted, aggressive workout regimen, is employed to retrain affected systems and increase the parasympathetic nervous system response. Early intervention, ideally within the first week of injury, significantly improves outcomes. While prolonged recovery is challenging, Dr. Collins maintains that even chronic concussions, years after the initial injury, are treatable with specialized care, emphasizing hope and effective management.

ADVOCACY FOR SPECIALIZED CARE AND FUTURE RESEARCH

The increasing awareness of concussions, partly due to high-profile cases in professional sports, has led to more research and specialized clinics. However, Dr. Collins stresses that concussion management requires expertise beyond general medicine, urging patients to seek out concussion specialists. He highlights the need for well-controlled research to definitively understand long-term effects like CTE and the relationship between repetitive head injuries and neurodegenerative diseases. Current research, including large-scale, controlled studies at UPMC, aims to provide clarity on these complex issues.

SPECIAL CONSIDERATIONS AND EMERGING AREAS

The impact of concussion on specific populations, such as adolescents and the elderly, requires tailored approaches. Adolescent brains are more vulnerable, leading to longer recovery times. In older adults, falls are a significant concern, and concussions can exacerbate existing issues, leading to fear, isolation, and further deconditioning. Dr. Collins expresses passion for treating this demographic, noting that even at 90 years old, individuals can significantly improve with targeted therapy. Research is also exploring hormonal influences, particularly in women, and the role of genetics like APOE4, though definitive conclusions are still pending.

Mentioned in This Episode

●Supplements

●Software & Apps

●Tools

●Organizations

●Books

●Concepts

●People Referenced

Common Questions

A concussion is defined as a disruption of brain function caused by a violent shake, where the brain shifts inside the skull, stretching neuronal membranes. This leads to an energy crisis at the cellular level due to a mismatch between energy demand and supply, without causing cell death.

Topics

Brain-Health Health & Longevity Neuroscience & the Brain Human Performance Sports Medicine Traumatic Brain Injury Concussion Management Vestibular Therapy Neurological Recovery Symptom Assessment

Mentioned in this video

personNick Saban

Head football coach at Michigan State University who approved Micky Collins' research involving the football team.

toolMEG

Magnetoencephalography, a neuroimaging technique that does not show structural changes associated with concussion.

supplementcalcium

A chemical that influxes into neurons when their membranes stretch, causing vasoconstriction and decreased cerebral blood flow during a concussion.

toolJama

Journal of the American Medical Association, where a groundbreaking study on concussion in college football co-authored by Micky Collins was published in 1999.

toolfMRI

Functional Magnetic Resonance Imaging, an imaging technique that does not show structural changes associated with concussion.

personPeter Attia

Host of The Drive podcast, expert in longevity and performance, and interviewer in this discussion.

personTroy Aikman

Former NFL quarterback who publicly discussed his concussions, contributing to the growing awareness of the issue.

personSteve Young

Former NFL quarterback whose widely reported concussion in 1997 highlighted the lack of understanding surrounding the injury.

organizationUniversity of Florida

Institution where Micky Collins and his team worked and collected data for concussion research.

supplementPotassium

A chemical that leaks out of neurons when their membranes stretch due to the brain shifting inside the skull during a concussion, increasing cellular energy demand.

studyMRI

Magnetic Resonance Imaging, an imaging technique that does not show structural changes associated with concussion.

toolPET Scan

Positron Emission Tomography scan, an imaging technique that does not show structural changes associated with concussion.

toolEEG

Electroencephalography, a neurophysiological monitoring method that does not show structural changes associated with concussion.

toolUCLA

University of California, Los Angeles, where a researcher coined the phrase 'cognitive reserve'.

organizationNFL

National Football League, whose high-profile concussion issues have brought significant attention to brain injuries in sports.

organizationMassachusetts General Hospital

Hospital in Boston where significant research on the long-term effects of concussion has been conducted.

drugSertraline

An SSRI medication that can affect both the vestibular and nervous systems, sometimes used in concussion treatment.

drugWellbutrin

An antidepressant that may be used in conjunction with other treatments for concussion-related issues.

supplementLexapro

An SSRI antidepressant that may be used for concussion-related symptoms.

studyAPOE4

Apolipoprotein E4 genotype, which has been studied in relation to concussion susceptibility, but currently lacks definitive supporting data for increased risk or specific outcomes.

organizationNIH

National Institutes of Health, a source of funding for Micky Collins' research on head injuries.

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