We have all had the unfortunate experience of bumping our heads and seeing stars at least once in our lives. Head trauma, even from minor incidents, can cause a wide range of mental, emotional and physical ailments that may seem unrelated but can, if you look carefully, be traced to specific events. Traumatic brain injuries (TBI) can have profound negative consequences in many areas of a person’s life, and the impact is not limited to the person suffering the initial injury. Since many sequelae are behavioral, TBI can cause significant suffering for family members, colleagues, and others in a patient’s social circle.
There are a number of rapidly evolving and highly effective therapies for TBI. In my practice, I use hands on Cranial Osteopathic manipulation, nutritional supplementation, and referral for Neurofeedback, depending on each patient’s specific needs. Good therapeutic decision-making depends on accurate assessment.
Every 23 Seconds
The Centers for Disease Control estimate that a head injury occurs at least once every 23 seconds, translating into approximately 1.5 million incidents yearly. Most researchers believe that number is low; the actual figure may be closer to 3 million each year. The most common causes of TBI are falls, followed by motor vehicle accidents, physical contact from sports injuries, and assaults.
A concussion is the most common type of traumatic brain injury (TBI) and usually involves a temporary loss of brain function that heals itself with time. Most cases of TBI are mild concussions occurring most frequently in young children. Up to five percent of sports injuries are concussions. For unknown reasons, having had one concussion, increases a person’s risk of having another by 50%. Neuroimaging studies like MRI and CT scan normally show no gross or structural changes to the brain, but abnormalities may be seen on SPECT and PET scans, and EEG. Loss of consciousness (usually less than 30 minutes), or amnesia (usually less than 24 hours) may occur with more severe head injuries.
Generally, if you ask patients, “Have you ever had a brain injury?” they will answer, “No.” People tend to forget or minimize the significance of “minor” incidents that did not cause physical damage, loss of consciousness, or hospitalization. If you ask specific and detailed questions, you’ll get a much more accurate picture. I’ve found the following questions very helpful in eliciting good information:
• Have you ever been in a car accident?
• Do you ride horses, motorcycles or bicycles?
• Do you play sports?
• Do you ski?
• Is your work dangerous?
• Have you ever slipped backwards on the ice or in the bathtub?
• Have you ever felt dizzy after falling?
• Were you in the military? If so what was your job?
While headache is the most common physical symptom, others include dizziness, fatigue, pituitary dysfunction, sensory loss or exaggeration, loss of motor control or coordination, bladder and bowel changes, vomiting, nausea, ringing in the ears, blurry vision. Cognitive and emotional symptoms include confusion, disorientation, difficulty focusing attention, insomnia, unexplained anxiety or panic. Common symptoms in children include restlessness, lethargy and irritability.
More severe head injuries may involve emergencies such as hemorrhage. Indications of this may include worsening symptoms such as headache, persistent vomiting, a deteriorating level of consciousness, seizures and unequal pupil size. This is why more severe cases are observed for 24 to 48 hours.
The mechanism of injury usually involves a rapid acceleration and rotational force (getting punched in boxing), that is not absorbed by the cushion of cerebrospinal fluid. The parts of the brain most affected are the midbrain and diencephalon, however other areas include the upper brainstem, the fornix, the corpus callosum, temporal and frontal lobes. There can be damage to the brain cells and neurons due to altered blood flow and metabolism.
Prevention
Prevention of brain injuries involves general measures like airbags in cars and wearing seatbelts, headgear in athletes, and helmets for children on bicycles. Older people are encouraged to try to prevent falls by keeping floors free of clutter and wearing thin, flat shoes with hard soles that do not interfere with balance. Avoiding activities on rainy or snowy days can prevent slips and falls. Maintaining good balance with core stabilization exercises is also effective.
Treatment
Usually concussion symptoms go away without treatment after a few weeks to a few months. Rest is the most important treatment including plenty of sleep. Oftentimes activities that worsen the symptoms must be limited and stopped altogether: reading, television, computers, video games, physical exertion, exercise, and stress. Children and adults often have to take time off from school and work for recovery.
Medical treatment is often focused on symptom relief and may include analgesics and anti-inflammatory medications. When the psychologic symptoms are prominent supportive psychotherapy and the use of antidepressant and antianxiety medications may be helpful.
Natural remedies would include arnica montana, a homeopathic remedy for trauma and pain. Herbal support would include bromelain, curcumin, quercitin and ginger; feverfew if migraine symptoms. Nutrition support with omega 3 fatty acids (three grams daily for 90 days) to reduce inflammation and protect the nervous system; vitamin D (3000-5000 IU per day for 3 months); magnesium (200-400 mg daily, deficiency can lead to hyperexcitability of the nervous system). Also helpful are vitamin B12 injections, folic acid, coenzyme Q10, alpha lipoic acid, phosphatidylserine, NAC, and broccoli seed extract. Gluten elimination can be very helpful in any brain injury patient with digestive difficulties. Calorie restriction and ketogenic diets are highly beneficial and may improve mitochondrial function while reducing inflammation throughout the body.
Education is the most important role of the physician to assure the patient and family members that their symptoms are not unique or crazy but part of a well described syndrome. Also educating employers, attorneys, insurance companies and other physicians is essential as it takes time for the brain to recover.
Osteopathic Medicine
Also known as Osteopathy, its philosophy considers and treats the whole rather than narrowly focusing on a specific ailment. Discovered in 1874 by Andrew Taylor Still M.D., it is based on the belief that the structure of the body is intimately related to its function. In treating patients, osteopaths utilize various forms of physical manipulation, which allow the body’s innate self healing mechanism to operate more efficiently.
A gentle hands-on technique called cranial osteopathy (craniosacral therapy) can be applied to the head and can be quite beneficial in the healing process and the management of symptoms related to brain injuries. It is performed by osteopaths (D.O.s or Doctors of Osteopathic Medicine) who are medical doctors licensed to practice all aspects of medicine and surgery. Osteopaths gently and precisely determine the rhythmic flow of the cerebrospinal fluid after a brain injury. They can detect any abnormal patterns of movement in the cranial bones and sutures, and discern the original forces of movement that caused the head injury. Often this approach can also directly address the area of the brain involved from the trauma, and help to restore motion, circulation and overall brain function. The gentle techniques can also remove deep-seated compressions in the skull where the pituitary and hypothalamus glands reside and help to restore the flow of hormones and the endocrine system. The dural membranes within the skull are also addressed with cranial osteopathy and restrictions here are very important to free-up. Cranial treatments are usually done one to two times a week until symptoms resolve.
Case Study: M.J. was a female client who was referred by a local neuro-feedback practitioner for persistent headaches, fatigue and dizziness after a concussion that resulted from a cheerleading injury about a year ago. Osteopathic structural evaluation revealed severe compression at both major sutures between the occiput bone and the temporal bone (behind the ear). This is a major site for drainage of the venus blood out of the head. Congestion was causing increased inflammation within the base of the skull. A simple, precise technique called venus sinus drainage was applied to specific locations to relieve the congestion and then cranial techniques were applied to free up the sutures and restore overall motion to the head. After the initial visit the patient had major improvement in her symptoms, and was able to go back to cheerleading practice.
Even a mild brain injury – the forgotten bump on the head, or a fall from a horse – can cause changes in memory and should be treated as soon after the injury as possible.
Neurofeedback: Non-invasive, Highly Effective at Healing Head Injuries
Recent studies indicate that neurofeedback has an 80% efficacy in traumatic brain injury. Essentially, it is a form of biofeedback guided by electro encephalography (EEG). It involves connecting the patient to a computer based system via electrodes with at least three different points of contact to the scalp and ears. The process begins by using EEG to create a map of the patient’s brain, and to identify the particular point or points in the brain that may not be functioning optimally. Depending upon the type of neurofeedback, the patient may sit in the chair for seconds or up to an hour. The system monitors brain waves, and may also send impulses back to the brain – though they are at such a low level that the patient generally does not feel it. Reported improvements include: reduced anxiety, improved memory, attention of cognitive disturbances, elimination of behavior problems, improved organizational and executive function, better attention, reduced pain, and resolution of mood disturbances.
Dr. David Johnston is an Osteopathic physician and the founder of the Osteopathic Wellness Center, LLC in Ridgefield, Connecticut. His practice focuses on a holistic approach to assisting clients back toward health with gentle hands-on Cranial Osteopathy and nutrition. For any questions, comments or further tips about Natural Approaches for Managing Head Injuries, please call us at 203-438-9915 or check out our website www.OsteopathicWellness.net.