Concussion care has improved greatly in the last decade. Public awareness and quality interventions have advanced far beyond the “sleep it off and pay it away” approach. That said, the complexities of concussions still pose challenges for some individuals in achieving full recovery. This article highlights some hidden difficulties of concussion recovery and provides helpful pointers to accelerate recovery.
1. Vestibular Issues
Vestibular issues, encompassing symptoms like vertigo, dizziness, and imbalance, often go untreated post-concussion, leading to persistent challenges in spatial orientation and balance. People can wake up dizzy or have a seemingly unrelated issue like a sinus infection re-trigger old issues. The challenge comes with differentiating between central and peripheral issues. Peripheral issues are problems with the vestibular organ itself. Central issues involve miscommunication between the vestibular signals and those from the eyes and neck.
The current landscape of post-concussion dizziness is often handled by physical therapists, who are frequently more suited to treat peripheral issues. While this works for many symptoms, chronic vestibular symptoms are usually a result of treating central issues in a peripheral model. If you have ongoing dizziness issues, consider functional neurology as an alternative treatment. Their paradigm is more central and tends to aid in resolving stubborn dizziness issues.
2: Digestive Issues
After a concussion, some people may experience digestive issues as a lesser-known but significant aspect of post-injury symptoms. The intricate connection between brain health and gut function, known as the gut-brain axis, can be disrupted by the neurological effects of a concussion. Symptoms such as nausea, vomiting, indigestion, abdominal pain, and changes in appetite or bowel habits may arise due to altered signaling between the brain and the digestive system.
Moreover, stress, inflammation, medication side effects, and dietary changes post-concussion can further worsen digestive disruptions. If you’re struggling with digestive issues after a concussion, vagal nerve stimulation can be helpful. It acts as a way to jumpstart the parasympathetic system and restore proper signaling to the gut. Stool testing can also help to identify any specific digestive issues and develop a more targeted strategy.
3. Emotional Dysregulation
People who have experienced a concussion often struggle with emotional dysregulation, causing mood swings, irritability, and heightened emotional sensitivity. These issues can be challenging to treat, leading to emotional distress and difficulties in relationships. Prolonged recovery is often associated with depression and anxiety. It’s easy to lose hope when several doctors tell you nothing is wrong.
It’s also easy to spiral into anxiety when you can’t figure out what’s wrong. Support groups and mental health coaching can help alleviate some of these emotional problems. Finding people going through similar things can help the whole thing not seem so isolating. Coping skills and other ways to manage emotional swings are also a vital part of the long-term recovery from concussions.
4. Sleep Disturbances
Sleep disturbances such as insomnia, disrupted sleep patterns, and excessive daytime drowsiness are often overlooked and not adequately addressed in the context of concussions. This may seem paradoxical, as most people experiencing concussion symptoms will report excessive fatigue yet poor sleep. Addressing autonomic issues, adopting good sleep hygiene, and supporting the vagal system are all excellent strategies to improve sleep after a concussion.
The 3-2-1 rule is a good place to start if you’re new to sleep hygiene. No food 3 hours before sleep, no work 2 hours before sleep, and no screen time 1 hour before sleep. Turn the lights down a few hours before sleep, and try to get maximum natural sunlight first thing in the morning.
5. Sensory Sensitivities
Sensory sensitivities such as light sensitivity, sound sensitivity, and heightened sensitivity to stimuli often go unnoticed and unaddressed after a concussion. This can make discomfort worse and lead to sensory overload. Environmental management and getting assessed to identify any concussive damage to these sensory areas are vital to long-term recovery. Understanding what situations are overstimulating and adopting techniques to mitigate symptoms is an excellent first step in the early stages.
However, you don’t want to avoid these over time. Consult a functional neurology practitioner to identify an injury to the midbrain and parietal lobes. These are often the source of overstimulation, incredibly light, and sound sensitivity. Progressive rehab exercises can strengthen these areas. This ensures you can tolerate noise and light without deliberately planning for symptom management.
6: Immune function
The immune function is essential for protecting our body from harmful pathogens, infections, and foreign invaders. It consists of a sophisticated network of cells, tissues, and organs that collaborate to detect and neutralize threats, while carefully balancing recognition and tolerance. In the first weeks of recovery, the body prioritizes rest and repair. In this period, other systems that govern immune function can often become compromised, leading to complications. Old infections that were effectively walled off can re-emerge and manifest symptoms associated with the original virus.
Keep an eye on mold exposure, small intestinal bacterial overgrowth (SIBO), Lyme disease, and the Epstein-Barr virus. Functional medicine testing to identify sub-clinical markers of infection is an excellent place to start. Traditional medical testing will often only check for signs of an active infection. Latent post-concussion infection will usually fly under the radar, making its detection difficult in traditional Western testing.
7: Dysautonomia
Dysautonomia is a multifaceted disorder that impacts the autonomic nervous system, responsible for regulating involuntary bodily functions. This condition can occur after a concussion due to the impact on brain function. Post-concussion dysautonomia can cause a wide range of symptoms, including changes in heart rate, blood pressure, temperature regulation, gastrointestinal motility, and sweating patterns. These autonomic function disruptions can lead to dizziness, fatigue, cognitive impairment, exercise intolerance, and orthostatic intolerance.
Tilt table tests are effective in diagnosing POTS (postural orthostatic tachycardia syndrome), a common symptom in concussion recovery. Identifying the underlying source of autonomic dysfunction should also be a priority. In my experience, unresolved issues with the vestibular, ocular, and cervical systems are commonly overlooked sources of autonomic function. Digestive problems can also play a role here and should be prioritized early.
Conclusion
By bringing attention to the often overlooked symptoms of concussion, we can help identify and address these subtle yet impactful manifestations, leading to a more thorough approach to concussion recovery. If you or a loved one is struggling with post-concussion recovery roadblocks, feel free to reach out and request a consultation with one of our doctors. We see a variety of concussion complications and would be happy to direct you in the most appropriate direction.
About the Author
Dr. Thompson Maesaka is a co-owner and clinician of The Neural Connection, a functional neurology clinic in Edina, Minnesota. The Neural Connection specializes in treating concussion, dizziness, and migraine holistically. He is a Minnesota native and is passionate about empowering people with the education they need to take a more active role in their recovery. You can reach him at drmaesaka@theneuralconnection.com
*Note: The content presented in this article is intended solely for educational purposes and does not establish a doctor-patient relationship. It is advisable for patients to seek guidance from their healthcare provider or primary care physician before attempting any treatments or therapies on their own.