Concussion is a common form of traumatic brain injury. Proper assessment and treatment in the acute phase is crucial for recovery. Integrative Neurology and functional medicine offers evidence-based complementary approaches.

Acute Concussion: Assessment and Management

A concussion, also known as a mild traumatic brain injury (mTBI), occurs when an external force impacts the head, causing the brain to move rapidly within the skull. This can lead to temporary impairment of brain function including alterations in consciousness, memory, cognition, balance, and vision. Concussions are common, with over 3 million diagnosed annually in the US. Proper assessment and management in the acute phase (within 2 weeks of injury) is crucial to maximize recovery and prevent long-term issues.

The first priority is to rule out more serious traumatic brain injuries like contusions, hemorrhages or skull fractures, which may require hospitalization and neurological surgery. Concussions themselves are generally managed conservatively. Assessment involves evaluating symptoms, cognitive function, balance and coordination. Common symptoms include headache, dizziness, fatigue, irritability, anxiety, problems concentrating, sleeping difficulties, blurred vision, light/noise sensitivity, and feeling in a fog.

First line treatment involves physical and cognitive rest until acute symptoms resolve, followed by a gradual return to activity. Precautions are taken to prevent reinjury during recovery. Patients are advised to avoid work, school, sports, exercise, video games, texting, TV, and reading as cognitive stimulation can exacerbate symptoms. Light activity like walking is appropriate once acute symptoms improve.

Pharmacological treatment may provide symptom relief. Acetaminophen is recommended for headaches and opiods can be considered for severe headaches not responsive to acetaminophen. Anti-emetics like metoclopramide help with dizziness and vertigo. Cognitive behavioral therapy and antidepressants may be beneficial in the subacute phase for mood and sleep issues.

Functional Medicine Approaches to Treatment

Functional medicine focuses on identifying root causes of health issues and uses evidence-based holistic modalities to restore optimal wellness. Several functional medicine approaches may help facilitate recovery in the acute to subacute phases after concussion:

Nutrition: avoiding fasting, eating regular nutritious meals, staying hydrated, supplementing with omega-3s, magnesium, antioxidants, and a multivitamin.
Botanicals: herbs like ginkgo, ginseng, rhodiola, bacosides, curcumin for cognitive function, and valerian, chamomile, lavender for sleep and mood.
Mind-body therapies: acupuncture, biofeedback, meditation, yoga, tai chi for pain, headaches, sleep, mood and coping.
Manual therapies: osteopathic manipulation, craniosacral therapy and massage for neck pain, headaches, dizziness.
Environmental: avoiding bright lights, loud noise, avoiding technology/stimulation as needed in acute phase.

The goal is to help the brain rest and recover from the metabolic, inflammatory and functional disruptions caused by the concussion. Functional medicine has an important complementary role in optimizing concussion recovery. However, more research is still needed on specific protocols. It’s best to work with a functional medicine practitioner to individualize treatment.

Integrative neurology acute concussion protocol

Some key supplements thought to help with concussion recovery include magnesium, curcumin, and omega-3 fatty acids.  

Magnesium plays important roles in neuronal signaling and can help reduce neuroinflammation after injury.
Curcumin, found in turmeric, has potent anti-inflammatory effects in the brain and may protect against neuronal damage and cognitive decline.
Omega-3 fatty acids like EPA and DHA in fish oil also have anti-inflammatory properties and support brain cell membrane integrity and signaling.

Other supplements that may aid in concussion recovery include dehydroepiandrosterone (DHEA) and pregnenolone. 

DHEA and pregnenolone are neurosteroids naturally produced in the body that play roles in neuronal growth, differentiation, neurotransmission, and neuroprotection. Levels of these neurosteroids often decline after traumatic brain injury. 

Some emerging research indicates supplementation with DHEA and/or pregnenolone after concussion may help restore depleted levels, reduce neuroinflammation, and improve outcomes related to mood, cognition, and post-concussion symptoms. 

Acute Protocol Supplements

References:

1. Harmon, K. G., Clugston, J. R., Dec, K., Hainline, B., Herring, S. A., Kane, S. F., ... & Putukian, M. (2019). American Medical Society for Sports Medicine position statement on concussion in sport. British journal of sports medicine, 53(4), 213-225.

2. Leddy, J. J., Baker, J. G., Kozlowski, K., Bisson, L., & Willer, B. (2011). Reliability of a graded exercise test for assessing recovery from concussion. Clinical Journal of Sport Medicine, 21(2), 89-94.

3. Elder, G. A., & Cristian, A. (2009). Blast-related mild traumatic brain injury: mechanisms of injury and impact on clinical care. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 76(2), 111–118.

4. Giza C. C., & Hovda D. A. (2001). The Neurometabolic Cascade of Concussion. Journal of athletic training, 36(3), 228–235.