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Q: post concussion cure ( Answered 5 out of 5 stars,   2 Comments )
Subject: post concussion cure
Category: Health
Asked by: neznaika-ga
List Price: $75.00
Posted: 21 Jan 2003 09:08 PST
Expires: 20 Feb 2003 09:08 PST
Question ID: 146510
Hi, experts. Looking for information (websites, other forums, on-line
clinics) on post concussion sindrome cure.

Specific questions are
What medicine could I use (execpt for tylenol)?
Any diet recommendations? 
Tea, cofee, chocolate, drinking, smoking? 
Does it make a sence to take a vacation and sit at home a week, or may
be go to Cuba? Is travel or airtravel dangerous to me? Should I ask
company do not send me    into business trips for a while (for which
distance, which time period).
Should I do sport (jogging), could I watch TV/cinema, visit theaters,
night clubs etc?


I have a (mild) post concussion syndrome.
What I was already adwised by the doctor - tylenol and a week at home.
When had a concussion in childhood I have had a more diverse
and was restricted from TV, communications, reading etc for 2 weeks.

Now, After 3 weeks of tylenol therapy have some sindormes - fatigue,
coordination, memory problem, dizziness, fuzziness. I am computer
researcher and I like my profession, so I wish a complete recovery of
my cognitive abilities.
Sometimes have some fatugue/concentration/memory/insomnia problem
before, but not too serious.

How and why I felt I do not remember. After concussion spend a day in
emergency, next day I visited friend, and a really stressful day in
the reception of walk-in clinic (grr...thouse bitches from reception).
During the week at home played a little bit computer - was too anxious
and nervous to stay all the day in the beds, and sometimes talked with
friends (thouse phones).

Sorry for grammar.
Subject: Re: post concussion cure
Answered By: kevinmd-ga on 21 Jan 2003 17:08 PST
Rated:5 out of 5 stars
Thanks for asking your question.  Although I am an internal medicine
physician, please see your primary care physician for specific  
questions regarding any individual cases – please do not use Google  
Answers as a substitute for medical advice.  I will be happy to answer
factual medical questions. 
You asked the following: 
"1) Looking for information (websites, other forums, on-line
clinics) on post concussion sindrome cure.
2) What medicine could I use (execpt for tylenol)? 
3) Any diet recommendations?  
4) Tea, cofee, chocolate, drinking, smoking?  
5) Is travel or airtravel dangerous to me? Should I ask company do not
send me into business trips for a while (for which distance, which
time period).
6) Should I do sport (jogging), could I watch TV/cinema, visit
night clubs etc?"

1) Looking for information (websites, forums, on-line clinics) on
post-concussion syndrome.


Neurosurgery On-Call - Concussion

eMedicine - Post-Concussive Syndrome

Medline Plus - Brain Injuries

Support Groups:
Brain Injury Association 
1776 Massachusetts Ave. 
NW Suite 100 Washington, DC, 20036 
(202) 296-6443
(800) 444-6443

National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone: (301) 496-5751

American Academy of Neurology (AAN)
1080 Montreal Ave. 
St. Paul, MN 55116 
Phone: (651) 695-1940 
Fax: (651) 695-2791 

Brain Injury Association
105 N. Alfred St.
Alexandria, VA 22314
Toll-Free: (800) 444-6443
Phone: (703) 236-6000
Fax: (703) 236-6001

Brain Trauma Foundation
523 E. 72nd St. 
8th Floor
New York, NY 10021
Phone: (212) 772-0608
Fax: (212) 772-0357

On-Line Clinics:
A previous Google Answer detailed various on-line clinics that may
give you an answer:

There are a couple of Usenet forums that deal with post-concussive

2) What medicine could I use (execpt for tylenol)?

I realize that you stated medications other than tylenol, but tylenol
is the preferred medication for concussion:
"Headache and neck pains can be treated with over-the-counter
analgesics. Acetaminophen (Tylenol) usually is preferred over an
anti-inflammatory such as ibuprofen (Advil and others) or naproxen
(Aleve) because it is less likely to cause bleeding. If you have more
severe pain, your doctor may give you a prescription pain reliever."

Stronger pain medications are narcotic-based.  It is not recommended
because they may cloud real brain injury:
"Ellis says rest and take only Tylenol. Aspirin or ibuprofen are not
good because they could cause or increase bleeding. Narcotics should
not be taken because they can mask the symptoms of a brain injury,
Ellis says."

"Overall, no medical therapy treatment usually is prescribed for
patients after an acute injury. Pain control usually is achieved with
over-the-counter medications, such as acetaminophen. Avoid narcotics
so that clouding of the patient’s mental status or neurological
examination does not occur."

If you are still interested in these narcotic medications, you must
work closely with your physician so you can be monitored closely.

Some examples of these prescription medications include:
- Oxycodone

- Tramadol

- Tylenol with Codeine

3) Any diet recommendations?

Here are some details for diet recommendations:
"If you bruise your brain, rest, water, higher protein diet can help.
Medication is used for specific symptoms."

"Over the past 10 years, I have found that certain foods and vitamins
can really make a significant difference in recovery. To obtain an
optimum result for you, it is important to know your specific needs,
such as do you have a cholesterol problem or are you diabetic, etc..
In general the following would be helpful. 

1) Eliminate all alcohol and wine. 
2) Eliminate all sugar and sugar substitutes, instead eat fruit with
low sugar content.
3) Eat lots and lots of protein 
4) Eat lots of vegetables 
5) Drink plenty of water"

4) Tea, cofee, chocolate, drinking, smoking?

I looked for connections between caffeine (i.e. tea, coffee and
chocolate), alcohol, smoking and concussion.

a) Alcohol

There is a definite connection between brain injury and alcohol. 
Keidel (1997) notes that alcohol is associated with a poor prognostic
"Head trauma (HT) and whiplash injury (WI) is followed by a
posttraumatic headache (PH) in approx. 90% of patients. The PH due to
common WI is located occipitally (67%), is of dull-pressing or
dragging character (77%) and lasts on average 3 weeks. Tension
headache is the most frequent type of PH (85%). Besides posttraumatic
cervicogenic headache or symptomatic, secondary headache due to SDH,
SAB, ICB or increased ICP, migraine- or cluster-like headache can be
observed in rare cases. Prolonged application of analgetics (> 4
weeks) can cause a drug induced headache. In 80% of patients PH
following HT shows remission within 6 months. Chronic PH lasting at
least 4 years occurs in 20%. Unfavorouble prognostic factors include
an age higher than 40 yrs, a low intellectual, educational and
socio-economic level, previous HT or a history of alcohol abuse. A
prolonged PH due to WI can be expected in patients with initially
severe headache, with an extensive decrease of mobility of the
cervical spine, with subjective impediment, with depressive mood, with
somatic-vegetative complaints, with a history of pretraumatic headache
and with increased age. Acute PH is treated with analgesics,
antiphlogistics and/or muscle relaxants; chronic PH with thymoleptics
(e.g. Amitryptiline or Amitryptiline oxide). Additional physical
therapy (e.g. wearing a cervical collar for a short time,
hydrocollator pack), physiotherapy incl. muscle relaxation techniques
(Jacobson) and psychotherapy can be performed. Medico-legal issues
should be solved as soon as possible." (1)

Evans (1992) also notes that alcohol is a risk factor for persistent
postconcussion syndrome symptoms:
"Manifestations of the postconcussion syndrome are common, with
resolution in most patients by 3 to 6 months after the injury.
Persistent symptoms and cognitive deficits are present in a distinct
minority of patients for additional months or years. Risk factors for
persisting sequelae include age over 40 years; lower educational,
intellectual, and socioeconomic level; female gender; alcohol abuse;
prior head injury; and multiple trauma." (2)

b) Caffeine
I could not pinpoint a connection between caffeine and post-concussive
syndrome.  Here are the results from my Medline search:

   3117 results
   16697 results

1 AND 2) 
   0 results

A search with Google, FAST, Inktomi, and Teoma did not yield any
definitive connection.

c) Smoking
I could not pinpoint a connection between smoking and post-concussive
syndrome.  Here are the results from my Medline search:

   3117 results
   62597 results

1 AND 2) 
   0 results

A search with Google, FAST, Inktomi, and Teoma did not yield any
definitive connection.

Carlsson (1987) suggests that smoking may cloud that post-concussive
syndrome picture, but could not pinpoint a definite lingering effect
from smoking:
"Data on defined head injuries, suffered during life, were related to
possible long-term sequelae among 1112 men aged 30, 50, or 60 years
who were sampled from the general population of Gothenburg, Sweden.
There was a significant relationship between closed-head injury
associated with reported impaired consciousness and occurrence of
symptoms of the postconcussional type, self-assessed health variables,
and the performance of finger-tapping and reaction-time tests. There
was a cumulative effect of repeated head injuries: the more head
injuries that were suffered, the more symptoms and more inferior
performance were noted. Age at the time of the accident did not
influence the occurrence of reported sequelae. Alcohol intake and
smoking were powerful factors confounding the postinjury picture, but
after taking these factors into account the results were generally the
same. The study indicates that head injuries with impaired
consciousness, no matter how short, are capable of causing permanent
sequelae." (3)

5) Is travel or airtravel dangerous to me? Should I ask company do not
send me into business trips for a while (for which distance, which
time period).

In this article, "Medical Advice for Commercial Air Travellers", the
authors do not cite post-concussive syndrome and concussion to be
conditions to be wary of during flying.

In the Merck Manual, there is a chapter entited "Air Travel".  It
makes no specific points prohibiting those with post-concussive
syndrome from flying:
"Traveling by air can cause or worsen certain medical problems. Very
few medical conditions absolutely prohibit air travel; however, some
patients must plan and take precautions. During a flight, physicians
may be asked to help in cases of illness; all U.S. domestic commercial
aircraft have first aid and limited medical supplies . . . Turbulence
may cause air sickness or injury."

In summary, there is no absolute contraindication for people with
post-concussive syndrome to fly.  However, common-sense says that if
the flight is very turbulent, it may not be the best situation for
post-concussive syndrome - however that is just speculation on my

6) Should I do sport (jogging), could I watch TV/cinema, visit
night clubs etc?

There is no consensus for this.  Most say that the main criteria to
return is complete clearning of all symptoms.  This is addressed in
several responses below.

"Return to Play: 
Return-to-play criteria are controversial. Similar to classification
guidelines, several different guidelines regarding return to play have
been established. No scientific evidence exists to justify one
criterion versus another criterion. The main criteria include complete
clearing of all symptoms, complete return of all memory and
concentration, and no symptoms after provocative testing. Provocative
testing includes jogging, sprinting, sit-ups, or push-ups, in other
words, some type of exercise that raises the athlete's blood pressure
and heart rate. The rules are the same for athletes who have a
concussion that prohibits return to play during competition. Only
after all symptoms have cleared both at rest and with exertion should
an athlete even consider returning to practice or competition. In
addition, the athlete has to show complete resolution of any emotional
lability, mood disturbance, attention, or concentration difficulty.
Relatively minor concussions may have more prolonged neurological
deficits. Therefore, the most important aspect of all published
guidelines is the concept of an athlete not being allowed to return to
play until completely asymptomatic."

Here are some words about the prognosis of post-concussive syndrome:
"Postconcussion syndrome consists of prolonged symptoms related to the
initial head injury. Unfortunately, severity of the concussion does
not necessarily predict who will experience prolonged symptoms.
Similarly, the number of concussions is not necessarily predictive of
future problems. Symptoms usually consist of persistent recurrent
headaches, dizziness, memory impairment, loss of libido, ataxia,
sensitivity to light and noise, concentration and attention problems,
depression, and anxiety. Most patients with traumatic brain injury
(TBI) recover in 48-72 hours, even with detailed neuropsychological
testing, and are headache free within 2-4 weeks of the injury. Obtain
a more detailed history of emotional, concentration, and associated
symptoms for patients with persistent symptoms lasting more than 1

Consultations: Consultation with a neurologist or primary care sports
medicine physician is indicated for patients with prolonged symptoms.

Neuropsychological consultation also may be considered to document any
deficits that may interfere with return to sport, school, or work."

eMedicine also states that:
"Patients who are not better within 1 year will probably not get

This infers that it may take up to 1 year until one regains full
cognitive ability.

I stress that this answer is not intended as and does not substitute
for medical advice - please see your primary care physician for  
further evaluation of your individual case.  
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.  
Kevin, M.D.

FAST, Teoma, Google and Inktomi search:
post-concussive syndrome
caffeine concussion
smoking concussion
alcohol concussion
travel concussion
air travel medical conditions
air travel concussion
concussion patient information
concussion support group

Medline Search:
concussion, post-concussive syndrome and smoking/caffeine/alcohol

1) Keidel M. Diener HC. [Post-traumatic headache]. [Review] [56 refs]
[German] Nervenarzt. 68(10):769-77, 1997 Oct.
2) Evans RW. The postconcussion syndrome and the sequelae of mild head
injury. [Review] [179 refs] Neurologic Clinics. 10(4):815-47, 1992
3) Carlsson GS, Svardsudd K, Welin L. Long-term effects of head
injuries sustained during life in three male populations.  J Neurosurg
1987 Aug;67(2):197-205.

(see question 1 above)

Request for Answer Clarification by neznaika-ga on 22 Jan 2003 08:26 PST
Hello Kevin, 

thank you very much for your work. 

I would like to clarify:

Yes, I understand, it is probably the best to see
a phisisian, however Canada has a lack of family doctors,
and walk-in clinics does not always suggest the best
I do not question benefits of tylenol. But when I got a 
concussion many year before (former Soviet Union) 
I have a more diverse therapy:
which included cerebrolysin, vitamins and something more. 
Are these unknown or unrecognized in Canada/US?

What concerns tea it seems that I have browsed a site
where cofein was actually recomended for
post-concussion cure.

Nicotin was prohibited by doctor

Someone with medical education (but not practicing)
have recomended me to drink less water,
but I do not trust him too much.

I think after the previous concussion I was adviced
to not travel beyand 200 km for 5 or 10 years.

Clarification of Answer by kevinmd-ga on 22 Jan 2003 09:18 PST
Thanks for your clarification request.

1) Cerebrolysin
Cerebrolysin is currently not availabe in the United States or Canada.
 It is an investigational medication used in the treatment of
Alzheimer's disease and possibly stroke.  There are no clinical trials
suggesting that they are effective in post-concussive syndrome.

2) Vitamins
A Medline search did not come up with studies mentioning a connection
between vitamins and concussion:

 3117 results  
 9121 results

1 and 2)
 zero results

More diverse treatments are not necessarily unknown, but it has not
been conclusively studied.  You may have been prescribed vitamins or
cerebrolysin in the past - the chance of harm in taking vitamins is
low.  However, in North America, this are no consensus guidelines and
no appropriate studies to recommend more diverse treatment:
"Outpatient care is the cornerstone of treatment and involves
multidisciplinary teams that provide testing and treatment, including
cognitive rehabilitation, psychotherapy, stress management, vocational
counseling, and pain management.
No treatments have been proven effective; however, the
multidisciplinary approach is believed to be worthwhile."

3) Tea and herbs
Regarding tea, there are several websites that claim that tea and
herbs improves concussion.
"Acantha is one of several herbs in a group which will heal mild
concussion damage when eaten (the leaves are the most beneficial). It
can be found in a wide range of climates -- from near desert
conditions to moist ocean beaches."

Again, herbal remedies make a lot of claims - there are no clinical
studies that confirm this fact and thus, cannot be recommended.

4) Water
It is true that drinking excessive amounts of water can cause brain
swelling.  This sometimes occur in marathon runners:
"In the study, Arieff suggests the following mechanism. The body, in
an attempt to keep a balance of salt and water levels between the
blood and tissues, begins to draw water out of the blood, leading to
puffiness in the skin and swelling in the brain. The brain responds to
the pressure by sending an emergency distress call to release water
into the lungs. The lung fluid, or the brain pressure, eventually
kills most patients with hyponatremia, Arieff said."

However, I cannot make any recommendations for you since I have not
met you, examined you nor reviewed your films.  I can say that there
are no clinical studies linking water drinking and post-concussive
syndrome specifically.

5) Travel
As I have previously mentioned in my answer, there is no absolute
contraindication between air travel and post-concussive syndrome. 
Note that there have been cases where people have sustained a
concussion because of turbulence:
"Seven people were injured during the incident, including a flight
attendant who suffered a concussion and multiple leg fractures."

Again, without knowing your personal history, I am not going to make
any recommendations as to whether you can fly or not.

I strongly suggest you consult a neurologist or your primary care
physician for questions regarding your individual case.  I can only
refer you to what has and has not been studied, and what is accepted
by the general medical community.  You can take the information in
this answer and better inform yourself as a patient when you see your

Kevin, M.D.
neznaika-ga rated this answer:5 out of 5 stars
Thanks, good job. More specific question I should ask to physician as patiant

Subject: Re: post concussion cure
From: vrdr-ga on 16 Feb 2003 20:34 PST
As an emergency physician, the only comment I would add to Kevin's
excellent and detailed answer relates to travel.

If the concussion is recent, there is a real, but very slight, risk of
worsening symptoms or complications. Travel poses risk in addition to
problems from travel itself.  During the time of travel, and at the
destination, one may be less able to access emergency medical care if
needed.  Going from Canada to Cuba, for example, one may have a change
in access to doctors, hospital facilities, etc.  The same would be
true with a wilderness camping trip, for example.  Access to care
should always be considered when recovering from an illness or injury.

Best wishes.
Subject: Re: post concussion cure
From: ngadai-ga on 18 Feb 2003 03:15 PST
Dear Neznaika,

European and Asian physicians routinely prescribe hydergine and /or
piracetam/oxiracetam after head injury. I believe neither medicine is
routinely available in the US for the usual reason that because both
are out of patent it is impossible for US drug manufacturers to earn
megabucks by selling them. As a non-physician I cannot comment on
their mode of action and efficacy but both seem relatively harmless
and free of side effects. However people who are sensitive to ergot
derivatives should avoid hydergine. Hope this helps.

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