Postconcussion Syndrome - A Naturopathic Approach

Part I: Definition & Discussion of Postconcussion Syndrome

Concussions are extremely common in our society — an estimated 75% of all people will experience one in their lifetime!^[1] The majority of people recover completely from concussions within a week or two; yet, for a considerable number of people, the negative effects can last for months and even years.^{[2, 3]} Mood symptoms like anxiety, irritability, and depression coincide with physical symptoms like headaches, fatigue, nausea, and dizziness; added to that are cognitive symptoms like problems with memory, decision making, and concentration difficulties. This constellation of symptoms is known as postconcussion syndrome (PCS).^[2] Observational studies have shown that these symptoms can last for 10 years or longer.^[3] The good news is that effective natural treatments are emerging, and people can access additional strategies to help reduce this burden.

The first step in recovering from a concussion is getting an accurate diagnosis. It is important to have a thorough examination and interview from a trained health-care professional who understands PCS, as this syndrome is easily mistaken for other diseases like depression and fibromyalgia. The requirements for a PCS diagnosis are a history of traumatic brain injury and the presence of three or more of the following eight symptoms: headache, dizziness, fatigue, irritability, insomnia, concentration/memory difficulty, and intolerance to stress/emotion/alcohol.^[4] Standard medical treatment for a concussion consists of rest and education. Using this approach, it appears that the symptoms present 3 weeks after injury are indicative of the symptoms that you will see at 10 years.^[5] Fortunately, new treatments in the fields of exercise therapy, nutrient supplementation, and homeopathy show promise both in clinical trials as well as in naturopathic practice. Also, emerging knowledge about the physical processes underlying the development of PCS suggests new treatments that may prove useful in the years to come. Naturopathic treatment of PCS focuses on correcting the biological changes induced by concussion, and healing the injured brain tissue.^[6] The following articles will discuss treatments in the context of the physical processes that they address, and will offer tips for prevention that will be especially helpful for people at high risk for head injury.

Correcting Postconcussion Imbalances: Cerebral Blood Flow and Inflammation

After a concussion, the brain and body become severely imbalanced, but due to the wonder of the human body and its instinct to heal, homeostasis is usually regained. When the normal systems for regaining balance fail, naturopathic treatments can help.

The brain requires a steady source of nutrients and oxygen from blood. During a concussion, the body has a paradoxical response — just when your brain needs even more oxygen and nutrients, the body decreases the blood flow to the brain.^[7] In PCS patients, adequate blood flow may not be returned to the brain.^[8] Natural therapies that improve blood flow to the brain include aerobic exercise, acupuncture, and herbal medicine. Of these, aerobic exercise has been best studied for its ability to improve symptoms of PCS, with promising results.^{[9, 10]} Because many people with PCS report intolerance to exercise, alternatives for increasing cerebral blood flow are needed. Acupuncture may be the answer for some; studies have shown that specific acupuncture points increase blood flow in the brain significantly.^[11–13] Though there have been no clinical trials evaluating the efficacy of acupuncture for PCS as of yet, the US military has been using acupuncture to treat brain injuries in Afghanistan with good results.^[14]

Herbal treatments that have been shown to improve blood flow in the brain are Bacopa monieri ^[15] and Ginkgo biloba,^{[16, 17]} but these have yet to be evaluated as potential treatments for PCS. Though Bacopa and Ginkgo have yet to be studied for PCS, other herbal compounds — curcumin, green tea extract, and resveratrol — have shown promising results in animal trials.^[18] Based on clinical experience, curcumin has been especially helpful. These compounds are not known for their ability to enhance circulation in the brain, indicating that another process is at play. A clue comes from a study showing that high levels of CRP (an indicator of the body’s level of inflammation) are correlated with increased rates of PCS.^[19] Decreasing inflammation may be the route through which these potent anti-inflammatory compounds affect positive changes in animal models of PCS. These herbs also have antioxidant activity, which could help repair the injured brain tissue directly. Anti-inflammatory treatments are most effective when paired with an anti-inflammatory diet, high in fresh whole foods, and low in processed foods and potential food allergens. Homeopathy, the application of minute substances that stimulate the body’s ability to heal, has also been evaluated in the treatment of PCS. In a randomized, double-blind, controlled trial, application of individualized homeopathic remedies resulted in clinically significant improvements in PCS symptoms.^[20] Naturopathic care is all about rebalancing, and balance is exactly what is needed after brain injury. Exercise therapy, acupuncture, herbal treatments, homeopathy, and dietary changes all have the potential to help.

Healing the Injured Brain

So far, we discussed returning the body to balance after a concussion. In order for optimal healing to occur, we also have to address the injured tissue: the brain itself. When we think about healing the brain, we cannot forget to consider the compounds important to brain cell signalling: neurotransmitters and hormones.^{[6, 21]}

Nerves are stretched, sheered, and sometimes broken after brain injury. Supplementing with targeted nutrients can help restore brain health more rapidly.^[22] Omega-3 fatty acids from fish oil are important factors for nerve health,^[23] and have been used to treat a variety of mood and nervous system disorders.^[24] It is no surprise that they would also be effective in treating the symptoms of PCS.^{[25, 26]} There are two important types of omega-3 fatty acids found in fish: eicosapentaenoic acid (EPA) and docasahexaenoic acid (DHA); though both types are helpful, DHA seems to be the more beneficial of the two.^{[27, 28]} In response to the physical impact of the initial injury, the brain dumps out so many excitatory neurotransmitters that it becomes toxic to the surrounding tissue and causes even more damage!^[1] The antioxidant compounds discussed in the last section (curcumin, resveratrol, and green tea extract) may have a role to play in limiting and even repairing this. Neurotransmitter and hormone levels are often disordered long after a head injury. It appears that up to 30% of those with a history of head trauma may have a variety of minor hormonal deficiencies; 20% have significant growth hormone deficiency, which is correlated with a poorer quality of life, greater disability, and more depression.^{[29, 30]} Melatonin (a sleep-signalling hormone) is also often reduced in people with PCS — replacement may improve symptoms of disordered sleep.^{[31, 32]} Naturopathic doctors can evaluate neurotransmitter and hormone levels, and prescribe natural treatments to help enhance your body’s production of these compounds. Though there are promising natural treatments for PCS, developing resilience to head injury and preventing PCS are preferable to treating it. The final part of this article will cover the prevention of postconcussion syndrome — a must-read for anyone at increased risk for head injuries, including athletes, military personnel, and parents of children and adolescents.

Preventing Postconcussion Syndrome

There are three main avenues for preventing the development of postconcussion syndrome:

1. Ensure optimal nutrition.
2. Reduce inflammation.
3. Timely treatment of acute concussions.

Of course, safety guidelines at work and play should always be followed, because never getting a head injury is truly the best prevention! Ensuring optimal nutrition to prevent brain damage is simple if you know what to target. The most important nutrients are DHA and EPA (two omega-3 fatty acids from fish oil).^[33] However, other nutrients are also important, namely magnesium, folate, vitamin C, and vitamin K.^[34] If you suspect that you aren’t getting enough of these key nutrients in your diet, supplementation may be required. Because inflammation is associated with poorer outcomes after head injury, it makes sense to take steps to reduce it beforehand. A plan to reduce inflammation would involve treating any underlying chronic diseases such as autoimmune disease or diabetes, optimizing digestion, following an anti-inflammatory diet, and targeted supplementation. In addition to being key nutrients for brain health, omega-3 fatty acids are strongly anti-inflammatory.^[35]

If you get a head injury, the emergency room should be your first stop. After life-threatening complications have been ruled out, naturopathic treatment can be started right away. Immediate treatment after a concussion may save nerves from being destroyed. One tactic that we can use is to make sure that the cells aren’t exhausted. When the mitochondria (cellular energy generators) can’t keep up with their cell’s energy needs, they signal their cell to commit suicide (also known as apoptosis). This is why rest is so important after a head injury: to prevent your brain cells from literally dying of exhaustion! Creatine,^[36] omega-3 fatty acids,^[37] and curcumin ^[38] supplementation immediately after head injury have all been shown to help improve the energy stores of nerve cells — thereby preventing cell death and the development of PCS. These supplements also offer protective benefits if taken before the injury. Other acute treatments for head injury that show promise for preventing long-term effects are the antioxidants melatonin ^[39] and glutathione.^[40] These antioxidants are circulated to the brain and help to prevent the damage caused by the toxic amounts of neurotransmitters that we discussed in the previous section.^[6]

Conclusion

A smart plan for preventing postconcussion syndrome should include maintaining optimal nutritional status through diet and/or supplementation, and managing the body’s overall level of inflammation. For people at high risk for head injury, it would be wise to keep some remedies on hand for immediate treatment, should an accident happen. These articles have outlined some of the safe, effective, evidence-based, natural therapies available for treating and preventing postconcussion syndrome. You can take control of your brain health and safety more than ever before. Consult a naturopathic doctor for further guidance in this area.