Although I don’t always agree with her, I admire Hillary Clinton greatly – and we have a few things in common. We both grew up in the Chicago suburbs, are Democrats, and have just one beloved daughter, but now we have one more thing in common. Ironic that when I wrote a press release for a journal article on concussion less than a month ago and mentioned Hillary, that I would be joining her as a concussed patient. I have been researching and writing about this topic since 2004, and I suddenly find myself experiencing this type of traumatic brain injury firsthand.
The most underreported, under diagnosed and underestimated head injury is concussion, accounting for 90 percent of traumatic brain injuries, with the number of cases ranging in the millions every year. The brain is a soft organ that is surrounded by spinal fluid and protected by the hard skull. Normally, this fluid acts like a cushion that keeps your brain from banging into your skull. But if you hit your head or body hard, the brain can crash into your skull and sustain an injury.
I wasn’t doing anything glamorous like water skiing or even riding my bike – but as I have written so many times, a moment of distraction can have unfortunate consequences. I was multitasking as I so often do – talking to my daughter on the phone and cleaning something under the counter. My daughter mentioned something off-color about a guy and wham; I stood up and banged my head on the underside of the kitchen counter! I immediately applied ice and hoped that it wasn’t anything serious. I have banged my head more than once around the house, as have most people.
At first I thought the symptoms were all in my head – well, they are, but they are not psychosomatic and indeed are physical. By the next day, the headache was actually worse and I felt a burning pain at the site of the bump and more diffuse burning around my scalp. Nearly a week later as I finish this article, I now know that I have a concussion. Diagnosis is based on the circumstances of the incident, a physical exam, and the presence of key symptoms. A concussion does not show up on imaging, but a CT scan may be ordered in some cases to rule out bleeding in the brain. The journal article mentioned previously showed that the following concussion symptoms occured with an absolute prevalence of 50 percent or higher:
- Headache: 75 percent
- Dizziness: 60 percent
- Blurred Vision: 75 percent
- Nausea: 54 percent
The authors stated that the most prevalent indicators of concussion, observed in alert individuals after a force to the head are:
- Observed and documented disorientation or confusion immediately after the event
- Impaired balance within 1 day after injury
- Slower reaction time within 2 days after injury
- Impaired verbal learning and memory within 2 days after injury
Although they didn’t use the symptoms in the final analysis due to bias in the studies, I can confirm that I am experiencing all but one of these – blurred vision. Despite reading hundreds of articles and writing several press releases on this topic, now I truly know that concussion is different for everyone. I thought I understood this head injury from a clinical standpoint until suffering one myself. It is true about everything in life – until you experience something firsthand, you really cannot comment about it with authority. This is a first – I am writing about concussion while in the throes of its physical effects – which is why I am doing this in fits and starts. I simply don’t have the energy or focus to complete this in one sitting.
- I have a headache that feels very different from other headaches. There is a burning sensation in my scalp and occasional pulsing. Compared to hormone-related migraines which I have experienced most of my life, this headache is more tolerable, but also more persistent. This one feels a bit like the headaches I was experiencing from artificial sweeteners – enveloping my head in an aura of light-headedness. It is reminiscent of an allergy-related and tension headache rolled into one, but not quite the same.
- It is like looking at life through a haze. I am not as alert as usual and it feels a bit like a hangover – which by the way, I have only experienced 2 or 3 times in my life. I would definitely not trust myself to operate heavy machinery, i.e.: in Jeff’s workshop.
- I am experiencing nausea, but it comes and goes and is mild. I have not vomited, but my stomach is more sensitive than usual. This has finally subsided after a full week.
- Light sensitivity is a symptom, albeit uncommon. I do feel like I am particularly sensitive to harsh light – my pupils feel delicate – as if the sun could burn a hole in them. I wear dark sunglasses when I go out, even when it is overcast. And when we were in Lowe’s, the fluorescent light exacerbated my nausea.
- I have a lack of energy and focus and feel more fatigued than usual. I can count on one hand the number of times I have slept during the day in my adulthood – the last time was when I had a horrible case of the flu in January of this year. Instead of writing this article, I really feel like going to bed and it is only 3 pm. The fatigue hits me like a ton of bricks – it is transient and comes out of the clear blue, then subsides, just as quickly.
- Despite being very tired, I am experiencing transient insomnia.
Although sports-related concussion garners a lot of media attention, many head injuries are sustained at home. Below are estimated head injury statistics (and concussions) for people treated at U.S. hospital emergency rooms in 2013, courtesy of the U.S. Consumer Product Safety Commission. Keep in mind that these numbers are low, since many people are treated at physician offices, immediate care centers, or are self-treated. The top 10 home categories with concussions in parentheses:
Floors or Flooring: 464,732 (36,755)
Stairs or Steps: 181,152 (19,198)
Beds or Bedframes (other or not specified): 172,418 (8,580)
Ceiling and Walls (interior completed): 97,605 (10,426)
Tables: 89,824 (6,433)
Chairs: 84,218 (6,968)
Cabinets, Racks, Room Dividers, and Shelves: 49,667 (4,040)
Doors: 41,554 (5,510)
Porches, Balconies: 21,546 (2,327)
Counters or Countertops: 17,531 (1,688)
My mom has fallen backwards twice and hit her head – once on concrete pavement in NYC and the second time last month inside her house. Both incidents required a trip to an emergency room and staples to close the gash on the back of her head. Remarkably, she did not incur a concussion or a more serious head injury either time. And that brings up the question of why some people bump their heads and incur head injuries that are superficial, while others, like the late actress Natasha Richardson, tragically die from an outwardly invisible head injury.
In lay terms, it seems to be almost random – or bad luck. It comes down to how hard you hit your head, the surface you hit it on, the angle, the area of the head you hit (front, back, side), and the blunt force. In clinical terms, brain rotations, velocity, and revolutions are analyzed by researchers, but too technical to explore in this blog.
In any case, anytime there is a traumatic brain injury, one has to worry about bleeding in the brain. There are two primary types of bleeding associated with brain injuries:
Epidural hematoma: can occur when blood accumulates between the skull and the dura mater, the thick membrane covering the brain. They are half as common as subdural hematomas and more often affect young adults. This is the head injury that led to Ms. Richardson’s death.
Subdural hematoma: in its acute form is a clot of blood that develops between the surface of the brain and the dura mater, the brain’s tough outer covering, usually due to stretching and tearing of veins on the brain’s surface. The veins rupture when a head injury suddenly jolts or shakes the brain.
In mild cases of concussion, symptoms tend to subside after 7-10 days. But some people experience headache and cognitive issues long after the original incident – I can only hope that I am in the former category. Either way, I learned the hard way that multitasking just isn’t worth it – a moment of distraction can indeed be a life changer.
And I have even more empathy for all those athletes who are now being compensated by the NFL in a landmark lawsuit for sustaining repeated concussions over the course of their careers. It is unacceptable to “get your bell rung” and go back on the playing field. You only have one brain, but there is always another game.