Cobbers on the Brain

Concussions and migraines are both poorly understood conditions. In the past, both have been looked at as just bump to the head, or just a headache. However, we’re finding out that concussions are very serious and have way worse side-effects than a simple bump on the head if not handled correctly. A traumatic brain injury (TBI) can lead to damage in the brain that is deemed a concussion if the effects are large enough on the person. There are two connects between concussions and migraines that are interesting on their own and in light of my own experience with migraines.
First off, let’s clarify the different variations of migraines. There are two main categories, Migraines with Aura (MA) and Migraines without Aura (MO). MOs aren’t really important in this discussion because they haven’t been shown to be affected by concussions. However, MAs have been shown to interact with concussions through mechanisms of Aura.
Aura is a general category of symptoms in some MAs. The aura effect includes symptoms of vision like light sensitivity, blind spots, patterns, etc… as well as other symptoms beyond vision like general confusion, inability to comprehend language, extreme sensitivity to touch, dizziness and others. Aura is important in the connection between migraines and concussions because they are both in some portion attributed to spreading depression in neurons in the brain. Spreading depression is referring to the spread of an action potential down a neuron. In a concussion it occurs due to increased ionic flux (charged particles like sodium moving across membrane, depolarization) in neurons due to mechanoporation, which is essentially putting holes in the neuron. Sodium and calcium move in and cause the neuron to fire randomly. MAs have also been well associated with ionic flux, which is where the connection lies. Those who are susceptible to migraines already have been shown to be more responsive to TBIs (concuss easier) and certain mutations leading to migraines with numbness/paralysis on one side of the body (hemiplegic migraine) have also been associated with increased concussion risk. So essentially, MAs and concussions both involve ionic flux, which can serve as a way for concussions to increase migraine risk and vice versa.

I find myself to be an interesting case study in this association. I have a history of migraines in my family, both my mom and dad experience them and other family members. The migraines I experience are with the Aura as well as hemiplegic. Many people have a typical path to their migraine progression. Mine starts with hemiplagia. I will all of a sudden feel oddly light and then one extremity on one side of my body will go numb, my arm or leg partially or fully. This is when I medicate if I can. If it continues, often I will regain feeling in that side and lose it in the other. This is kinda scary because these feelings have been associated with multiple mini strokes in the past, which I don’t want. Regardless, after the numbness I get visuals, including extreme light sensitivity and tunnel visions. This is when I hide out in the basement and prepare for 2-3 days of an extreme headache. The pain follows right after visuals. My migraine then ends in nausea, throwing up releases the pain of the migraine almost completely.
My migraines didn’t start on their own though. In 6th grade, I received a headbutt from a friend right into my right temple extremely hard. We were playing football and we just collided going for a ball. At first my head only hurt a little, but in the next four hours it got so bad I had to go to the nurse, home, basement ASAP. It was the most painful thing, couldn’t do anything but feel the pain and ignore the light. This was the beginning of my migraines which happened a little more than once a month through highschool. But they all but stopped after highschool. I’ve considered that I manage my stress better, cince that caused them in the past, but I still seem to get just as stressed at times. However the mechanoporation offers an interesting explanation. The increased ionic flux from my head injury might have increased my risk for MAs. But over time, as my brain healed up slowly, less and less ionic flux was allowed and my migraines gradually went away. This is an interesting concept because the most important thing with concussions is allowing them time to heal, but it seems my healing process took over 6 years. How can we determine when it’s safe to play if my brain may have taken this long to fully heal one impact? More investigation is needed in the long term healing of concussions to determine how truly bad these are for our health.

The amount of misinformation about marijuana is astounding. Even though it is becoming legal in more and more states many people still don’t know much about this drug. Here are a few common questions and answers about marijuana:
Is it addictive?

• Yes, 10% of adults who smoke marijuana regularly become addicted. Seventeen percent of those who smoke marijuana as a teen become addicted.

Is it safe?

• No, especially for teenagers. Long term effects of marijuana include decreased IQ and memory loss. It can also cause respiratory infections, cancer, liver disease, and diabetes.    There are also adverse effects on mental health, especially for teenagers. Marijuana can cause depression, anxiety, and even increases the likelihood of schizophrenia.

Can you drive after smoking marijuana

• No, recreational marijuana impairs vision, judgement, and motor skills. It is not safe to drive after smoking marijuana.

How are recreational and medical marijuana different?

• Medical marijuana has low or no THC. THC is what causes people to get high. Medical marijuana is mostly a compound called cannabidiol. It has a lot of potential for long term pain relief (it is less addictive than opioids like OxyContin or Vicodin) and has also shown a lot of potential for treating seizures.

Is marijuana worse than tobacco or alcohol?

• Unknown. There is not enough research about recreational marijuana to tell. Currently in the United States marijuana is a schedule one drug. This makes it almost impossible to do research on it.

Marijuana is becoming more and more common. It is important for everyone to be educated about it so we can make responsible decisions.

According to the Center for Disease Control, Americans sustain approximately 3.8 million concussions annually from sports and other recreational activities. The risk is particularly high for high school and college athletes who not only have increased exposure for opportunities to sustain a traumatic brain injury (TBI), but their brains are increasingly vulnerable as they are still undergoing development.
The true seriousness of concussions if often either disregarded or goes unnoticed due to the fact the damage is typically on a microscopic rather than macroscopic level. In fact, many individuals that have been concussed show little to no observable or physical changes, unless exposed to specific conditions which result in an overuse or overstimulation of the injured area of the brain.
It is for this reason that concussions are often seen as in invisible disease. They are often disregarded, or warily acknowledged at best, both of which can be detrimental for the recovery of the concussed individual.
Recovery from a concussion should be regarded with utmost importance and is not something to be ignored. Unlike a sprained ankle or broken arm, it is difficult to isolate and prevent use of the brain. To stop thinking is to stop functioning – to stop being a human, to stop living. It simply is not possible. As such, the brain takes longer to heal as it must continue to function all the while. That is not to say it should continue to function at normal (prior concussion) levels. In order for proper and expedited recovery, use of the brain should be limited when possible.
Athletes are often at the highest risk for concussions (particularly college or professional) and stand to experience the most harmful effects (on a yet developing brain) if their injuries are not treated properly. Sadly, they are also met with the most difficult situations when facing a proper and hasty recover.
All too often, a concussed athlete is met with skepticism and doubt, as well as resistance. Sadly, this is often received from their educators.  Concussions are an immediate injury and often difficult to comprehend. One day the student is fine, working on homework or taking a test, the next, they may have difficulty coherently reading a paragraph. This drastic change in ability can, understandably, be difficult to accept. However, it is imperative that we do. For the best possible recovery, most physicians suggest that student athletes take a complete break from school, following the injury. This period of time or “break” can vary in duration depending on the individual and the severity of the concussion. Following this “break” the individual typically follows a return to learning protocol, which gradually eases them back into the academic rigor they previously experienced. If the concussed individual is not supported and encouraged to follow these important recovery processes, it may prevent them from healing properly and take them far longer than it should.

Even with support, playing “catch up” after such an academic break can be daunting and perhaps impossible. Understanding that teachers/professors must be fair to all of their students, I think it is a worthy goal to search for methods (either as a professor or as a college) that can allow students who sustain a TBI to remain on track academically without having to drop a class, or be overloaded with material to catch up.
Even more important than academic support, in my opinion, is the support and understanding these concussed athletes receive from their coaches. In many cases, especially because concussions can be undetectable without significant testing, a coach may witness a potential cause for concussion and let it go unreported or unnoticed. They are not alone as many athletes may well choose to disregard the possibility of concussion, whether purposefully or unknowingly. However, in the case of concussions, all precautions should be taken. Second impact syndrome is a very real disease which occurs when a “second impact” or TBI is sustained before the healing process of the first has been completed. This can result in diffuse cerebral swelling, brain herniation, and death.

It is for this reason that a high expectation of responsibility and observation must be placed on coaches. It is difficult to bench the star player in the final minutes of a tie game, even more so if the player doesn’t feel as though they need to sit out. However, it is a coach’s duty to objectively view the situation and do what is in the best interests for the health of their athlete, whether the athlete protests or whether it costs the team the game.
It is important that we rid the stigma that can often come with concussions. Just because it may seem “invisible”, does not mean it should be treated as such, and devastating effects can occur if it is. It is imperative that we determine a method as coaches, teachers, individuals etc. to look objectively at situations involving concussions and work to provide the best care and best environment for an individual to recover and prevent further damage.

Today, we see entertainment, money, and/or temporary happiness as potential higher priorities compared to our brains. TBI’s (traumatic brain injury) like a concussion can cause detrimental molecular issues which can have short and long lasting effects on your brain and the rest of your body. I am going to write about how people are ignoring the facts of a concussion just so they can do what they want and be “successful” in their realm of work. I will first talk about how concussions can vary and you can manipulate your concussion, and secondly, I will talk about the second impact syndromes well as the effects of a concussion short and long term and how TBIs can lead to higher probably chances of issues like suicide.
As a professional athlete like Tom Brady or Canelo Alvarez, the last thing they want to do is sit out because of a concussion. For Brady, his team relies on him, he is their QB, and for Alvarez, he is practically fighting for himself but he knows if he fights he gets paid regardless and even more if he wins. These men will sometimes do whatever they need to do to make sure their involved in their sport and that may lead to providing false information on any concussion or TBI they have had. I encourage you to read up on one football players perspective on concussions found here. People today impact themselves in so many ways and the way these two men do it is through physical contact to their bodies and most importantly their brain. These men may make a lot more than the average guy, but they simple are doing their job. Their career, and unfortunately their physical degradation gives us entertainment all throughout the week on television. These men most likely also get joy and happiness through their sports, but they are missing huge key facts that concussions can cause short and long term issues as well as what happens when you don’t properly heal from a previous concussion.
Concussions commonly lead to rapid onset of short-lived impairment of neurological function that resolves spontaneously. At the molecular level hours after the concussion/TBI, hypometabolism occurs via decreased amounts of ATP, NADH/NAD, and N-acetylaspartate and this can occur up to months after a moderate or severe TBI. This gives evidence along with a high calcium influx that sets the stage for another severe brain injury after a repeated concussion—described clinically as second impact syndrome. In a general sense, symptoms and signs may evolve over several minutes to hours. Some short-term issues involved include: headache, foggy feeling, behavioral and emotional symptoms, slowed reaction times and insomnia.
According to Concussion Foundation, 87 of the 91 former NFL brains that were in a study had a progressive neurodegenerative disease called Chronic Traumatic Encephalopathy. This disease has symptoms of memory loss, confusion, impaired judgment, paranoia, and much more. The tau protein in the brain gets misfolded and causes build ups throughout the brain which cause neurons to die slowly. Another major issue found from concussions is their link to suicide. According to Canadian Medical Association Journal, someone who encounters just a mild concussion is three times more likely to commit suicide than someone who hasn’t had a concussion. Regardless of short or long term issues, concussions aren’t going anywhere soon and we as society need to be more informed on what they can do to your health over a lifetime.