A concussion is often treated as an injury that simply requires rest and time. However, newer approaches suggest that early, targeted care may help prevent symptoms from becoming persistent.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como continued her conversation with Dr. Robert Bashuk of the Concussion Center in Atlanta about central sensitization, exercise, headaches, sleep, inflammation, and the importance of beginning treatment early.
When Concussion Symptoms Become Persistent
Persistent post-concussion symptoms are generally symptoms that continue beyond the expected early recovery period.
These may include:
- Headaches
- Dizziness
- Light and sound sensitivity
- Brain fog
- Sleep problems
- Fatigue
- Anxiety
- Difficulty concentrating
- Neck pain
- Balance or vision problems
Dr. Bashuk explained that when symptoms continue, the nervous system may begin adapting in ways that make pain and sensory symptoms more difficult to resolve.
He described concussion as a possible nociplastic disorder involving central sensitization. In this model, the nervous system becomes increasingly sensitive, and symptoms may eventually continue even after the original injury has begun healing.
What Is Central Sensitization?
Central sensitization occurs when the brain and spinal cord become unusually responsive to pain or sensory signals.
At first, pain serves a useful purpose by warning the body about an injury. However, if the system remains activated for too long, it may begin amplifying signals.
A person may then experience stronger pain, greater sensitivity to light or sound, and symptoms that are triggered more easily.
Dr. Bashuk compared this to someone who continues having back pain after the original structural problem has already been treated. The nervous system may have learned and reinforced the pain response.
The goal of early concussion care is to interrupt that process before it becomes established.
Why Timing Matters
Dr. Bashuk emphasized that there may be a therapeutic window during the early stages of concussion recovery.
During this period, targeted treatment may help reduce inflammation, improve blood flow, support cellular energy, and prevent symptoms from becoming chronic.
He discussed beginning several forms of care early, when medically appropriate, including:
- Controlled aerobic exercise
- Vestibular therapy
- Eye-movement rehabilitation
- Cervical or neck therapy
- Headache management
- Sleep treatment
- Nutrition and hydration support
The correct treatment depends on the patient’s symptoms, medical history, and physical condition.
Complete Isolation Is No Longer the Standard
Older concussion advice often involved placing the patient in a dark room and avoiding nearly all activity.
This approach is sometimes called cocooning.
Dr. Bashuk recommended relative rest during the first one or two days, followed by a gradual return to controlled activity.
That does not mean returning immediately to sports, heavy exercise, or a full work schedule. It means introducing safe activity below the level that significantly worsens symptoms.
Remaining completely inactive for too long may contribute to physical deconditioning, emotional distress, sleep disruption, and delayed recovery.
Exercise Must Be Carefully Prescribed
Aerobic exercise was one of the most frequently discussed treatments during the episode.
Dr. Bashuk uses the Buffalo Concussion Treadmill Test and Buffalo Concussion Bike Test to determine a patient’s safe exercise threshold.
The patient exercises while the provider monitors symptoms and heart rate. The results help establish an appropriate level of activity for home exercise.
Patients may then complete supervised or prescribed exercise several times per week without exceeding the symptom threshold.
Dr. Bashuk warned that doing too much can make symptoms worse. Exercise after a concussion should therefore be based on the individual patient rather than a generic fitness plan.
Someone with a fracture, cardiovascular disease, serious balance problems, or another medical limitation may need an adjusted approach.
Supporting the Brain’s Energy System
A concussion can temporarily disrupt the brain’s ability to produce and use energy.
Dr. Bashuk discussed mitochondrial dysfunction and a temporary reduction in ATP, the energy used by cells.
This energy crisis may contribute to fatigue, brain fog, headaches, and difficulty tolerating mental or physical activity.
He discussed exercise, nutrition, and selected supplements as possible ways to support cellular recovery.
Supplements mentioned during the episode included creatine, CoQ10, vitamin D, omega-3 fatty acids, vitamin B12, melatonin, and curcumin.
Patients should not begin supplements or medications solely based on general recommendations. A qualified provider should consider existing medical conditions, laboratory results, dosages, and possible interactions.
Neuroinflammation and Headaches
Headaches are among the most common concussion symptoms.
Dr. Bashuk estimated that they occur in a large majority of acute concussion patients and may begin immediately, several hours later, or the following day.
A severe headache can also create a cycle of worsening symptoms.
Pain interferes with sleep. Poor sleep may contribute to inflammation and reduced glymphatic clearance. That may then worsen headaches, fatigue, and cognitive symptoms.
Breaking that cycle early may improve the overall recovery process.
Medications Used for Post-Traumatic Headaches
Dr. Bashuk discussed medications that target calcitonin gene-related peptide, commonly called CGRP.
CGRP plays an important role in migraine and may also increase following concussion. Anti-CGRP medications are commonly used to prevent or treat migraine headaches.
Dr. Bashuk said he sometimes uses these medications off-label for post-traumatic headaches.
Off-label use means the medication is prescribed for a condition that is not specifically included in its regulatory approval. This is a decision that must be made by a qualified medical provider based on the patient’s symptoms, risks, and medical history.
Other headache treatments may include anti-inflammatory medication, acetaminophen, or triptans, depending on the patient.
No medication is appropriate for every concussion patient.
Why Sleep Is Part of Brain Recovery
The brain’s glymphatic system helps remove waste products, with much of that activity occurring during deep sleep.
Concussions frequently disrupt normal sleep patterns.
A patient may have difficulty falling asleep, wake repeatedly, sleep during the day, or develop an altered sleep schedule.
Dr. Bashuk discussed several approaches that may support sleep and circadian rhythm, including regular exercise, daytime light exposure, consistent sleep schedules, and carefully selected supplements.
Persistent sleep problems should be discussed with a medical provider rather than treated indefinitely with over-the-counter products.
The Role of Attitude and Education
Dr. Bashuk also discussed pain catastrophizing, which occurs when someone develops an overwhelmingly negative view of their pain or injury.
This does not mean that the symptoms are imagined.
Fear, helplessness, and uncertainty may increase distress and make symptoms harder to manage. A newly injured person who sees frightening stories about permanent brain damage may assume that recovery is impossible.
Early education can help reduce that fear.
Patients should understand that a concussion involves real physical and metabolic changes, but many people do improve with appropriate treatment and time.
Providers should offer realistic encouragement without making promises about a specific recovery date.
Look Beyond the Headache
Concussion treatment should address more than pain.
Dr. Bashuk emphasized evaluating several areas that may contribute to persistent symptoms:
- Neck injuries
- Eye-movement problems
- Vestibular dysfunction
- Sleep disruption
- Anxiety and depression
- Nutrition
- Hormonal concerns
- Cognitive changes
- Hearing or auditory processing
- Driving ability
A patient may need help from several providers rather than one professional treating every symptom.
Pre-Existing Health Can Affect Recovery
A patient’s health before the concussion may influence how quickly they recover.
Dr. Bashuk discussed several factors that may complicate recovery, including:
- Anxiety or depression
- Chronic pain
- Previous central sensitization
- Long-term opioid use
- Poor physical conditioning
- Nutritional deficiencies
- A highly inflammatory diet
- Negative expectations about recovery
Someone who is physically active and metabolically healthy may have a stronger foundation for recovery than someone already dealing with several chronic conditions.
That does not mean a patient in poor health cannot improve. It may simply mean the recovery process requires more time and support.
Early Care Should Be Coordinated
Emergency departments must first rule out life-threatening problems such as bleeding, airway concerns, or serious neurological decline.
Once the patient is stable, Dr. Bashuk believes early education can help prepare them for the next stages of recovery.
The patient should understand what symptoms to monitor, when to seek emergency help, how to follow up with a knowledgeable provider, and why a gradual return to activity may be recommended.
Concussion treatment is rarely one single intervention.
It is a coordinated process involving exercise, symptom management, sleep, rehabilitation, education, and close monitoring.
The earlier those needs are identified, the better the opportunity may be to prevent short-term symptoms from becoming a long-term problem.
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