Schweitzer 1

Maddie Schweitzer

Dunham

ENG 1201

2 May 2021

What are the Long Term Effects of Multiple Concussions?

Majority of people around the world have been diagnosed with at least one concussion in

their lifetime. Most concussions are caused by various sports injuries or simply just by accident.

Some high performing athletes have been forced to end their careers because of having too many

concussions but, how many is too many? At what point do concussions begin to have detrimental

impacts on the brain? I personally know the pain and agony of multiple concussions. My first

concussion was diagnosed when I was only in the 6th grade. I’ve played soccer, which can be an

intense contact sport, for 14 years. Since my first diagnosis in the 6th grade, I’ve had three more

medically diagnosed concussions. Surprisingly, none of these concussions have been my fault.

Whether it was an elbow or cleat to the head or possibly too many headballs, I will suffer from

Post-Traumatic Concussion Syndrome for the rest of my life. After I was diagnosed with my 4th

concussion, I had to have a very difficult conversation with my doctor and family. My doctor

told me that I will not be able to play the sport I love ever again. I was very frustrated with

myself for letting this happen. The most heartbreaking part about it is that my final concussion

was diagnosed the fall of my senior year. At this time I was being looked at by college coaches

and I had the potential to play at the next level. Due to multiple concussions my childhood dream

was torn away from me. Recently I was also diagnosed with chronic headaches and migraines.

My physician told me that this was most likely due to all the head trauma I've experienced since

the 6th grade. Depending on the severity level of the head trauma, concussions have been
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scientifically proven to permanently damage the brain, which may cause health dangers and

diseases to arise overtime.

What is a concussion? The Center for Disease Control (CDC) says that, “A concussion is

a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body

that causes the head and brain to move rapidly back and forth. This sudden movement can cause

the brain to bounce around or twist in the skull, creating chemical changes in the brain and

sometimes stretching and damaging brain cells.” Concussions are experienced by millions of

people around the world each year. There are many different activities that put not only adults,

but children at high risk for concussions.

Individuals are at a pinnacle risk for experiencing a concussion when they are

participating in high contact activities. Some of these activities include: hard falls (typically in

children or the elderly), playing contact sports, lack of proper safety gear, vehicular accidents,

physical abuse, military services and experiencing a prior concussion. The brain plays an

extremely important role in how individual's function each and every day. When the brain

experiences a traumatic collision, an individual may experience a crucial lesion which could be a

detriment to their health. Most concussions are from sports. (Pathak)

Concussions in sports have become very frequent over time. The major contact sports are

football, boxing, and rugby. It is almost impossible to play these sports without receiving a blow

to the head. According to the CDC, “10% of all contact sport athletes sustain concussions yearly.

Brain injuries cause more deaths than any other sports injury. In football, brain injuries account

for 65% to 95% of all fatalities”. This statistic helps prove that the majority of people that play a

contact sport are very likely to sustain a concussion. A way that these athletes can help protect

themselves from head trauma is by wearing proper protective head gear to help cushion the skull.
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Figure One:

A study done at The Ohio State University, by the College of Public Health states that

football is the most prominent sport for concussions. This figure also compares the difference of

men and women that experience concussions and play the same sport. For example, this chart

shows that girls' soccer has a 12% concussion rate versus boys’ soccer who has a concussion rate

of 7%. Concussions not only happen in sports but they also happen in traumatic collisions such

as accidents. (Shepherd)

When vehicular accidents occur it's almost guaranteed that the victim receives a

headache. What the individual doesn’t realize is that this headache could possibly be a

concussion. The sudden head jolt can be a lot more serious than the individual thinks. If the

individual thinks it's just a regular headache it's very likely that they won’t go and see a medical

professional. Even people involved in slow-speed car accidents are still likely to suffer from a

concussion. For example, “A concussion occurs at roughly 90 to 100 g-force, which equates to

smashing your skull against a wall at 20 mph. One misconception is that the harder the hit, the

worse the outcome” (Bai). This proves that it doesn't take a lot of force to sustain a concussion.

The level of trauma is commonly diagnosed by a qualified doctor or neurologist.

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Concussions are diagnosed at three different levels and/or stages. Neurologist rank, or

grade, the severity of concussions based on loss of consciousness, amnesia, and loss of

equilibrium. Grade one is a mild concussion where the patient receives little to no symptoms or

symptoms for only 15-30 minutes. In a mild concussion, the patient typically doesn’t lose

consciousness. Grade two is considered a moderate concussion where the patient experiences

symptoms for longer than 30 minutes but no sudden loss of consciousness. Grade three is

considered a severe concussion which is when the recipient loses complete consciousness and

also experiences full blown emergent symptoms. (Pathak)

There are many different concussion symptoms that the patient may experience

depending on the severity of the impact. The typical mild or moderate concussion symptoms are

as follows: headache, balance problems, sensitivity to light, fatigue, difficulty concentrating and

falling asleep. The typical concussion symptoms for a severe concussion are as follows: memory

loss, ringing in ears, irritability/moody, slowed response, nausea, slurred speech, seizures and

depression. The list of concussion symptoms is extremely protracted, however; every individual

is different and therefore may experience all of these symptoms all at once or just a few. It is up

to the patient to successfully follow the doctors concussion protocol and treatments or the

concussion will intensify. (Pathak)

Concussion protocol is a necessity to fully recover the brain. Concussion protocol

consists of various different tests and assessments to see what level the brain is functioning at. A

healthcare provider, typically a doctor or physical therapist, will run different baseline tests such

as balancing, spinning in circles, closing the patient's eyes while performing activities and

exercise. These tests are meant to trigger the patients headaches to show the doctor the patients

pain tolerance and ability to complete numerous tasks. The patient's goal is to complete all of
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these activities headache free which could possibly get them cleared to resume everyday activity.

For children in school the concussion protocol is much different.

Concussions in children are top priority for most physicians and doctors. This is because

the doctors are worried that traumatic brain impact in children may have a long lasting effect for

the rest of the patient's life if it's not treated properly. The most important step to recovering from

a concussion is getting enough sleep. To ensure the patient does this the doctor may write the

child a lengthy school not excusing them from absences or early dismissal. In this school note

the doctor may also list accommodations for the child so that their symptoms don’t get worse.

Some of these accommodations include: being excused from tests and homework, wearing

sunglasses, having a water bottle in class to stay hydrated, taking over the counter medicine

when needed, and limited screen time. All of the activities listed are all factors that may trigger

intense headaches especially in school. If this concussion protocol is followed the symptoms

should go away and the patient can resume daily life as normal. If the different types of protocol

are not followed, the patient may experience life long difficulties.

Traumatic brain injury (TBI) may cause either long or short term effects on the brain such

as thinking, sensation, language and emotions depending on the severity of the injury. TBI is a

“brain dysfunction caused by an outside force, usually a violent blow to the head” (Bai). Severe

TBI may also cause epilepsy and put people at high risk for diseases such as Alzhiemers and

Parkinsons. A degenerative disease that's been under great scientific research and review recently

is Chronic Traumatic Encephalopathy (CTE). CTE is a disease that forms when an individual

experiences too many major head injuries. (“What Are the Potential Effects of TBI?”)

CTE was discovered by Doctor Harrison Martland in 1928. Martland studied professional

boxers and soon realized that something wasn't right. He described a group of boxers as having
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“punch drunk syndrome”. Martland made the conclusion that military veterans, athletes or

people with a history of repetitive head trauma have developed a degenerative disease called

CTE. He found that this disease can start to form in individuals' brains as early as 17 years old.

This disease causes individuals to be bipolar, have constant mood swings, form dementia, and

develop paranoia. (“What Is CTE?”)

Since 1928, this topic has been researched and tested a lot. The Nigirian-American

physician, Bennet Omalu, not only raised awareness for this disease, but he also changed modern

medicine and lab studies for the better. Omalu worked alongside Martland in this case and took it

over after Martland had passed away. Omalu made the astonishing discovery that the majority of

players in the NFL will end up with CTE one day. It wasn’t until famous NFL star, Mike

Webster, passed away unexpectedly from a heart attack that questions about this disease started

to arise. Omalu was fixated over the death of Webster so much he wrote a lengthy article about

degenerative CTE in 2004. It wasn’t until 2007 that the public took him seriously enough to be

on national news. Omalu’s fame as well as the fame for CTE sky rocketed across the world after

that day. Unfortunately, the only downside to Omalu’s study is that scientists aren’t advanced

enough in technology to detect CTE while a person is still alive.. Scientists have outlined that

CTE is a possibility of multiple severe concussions but unfortunately, the degenerative disease

cannot be diagnosed until the individual passes. This is because scientists have to run various

complicated tests on the brain that cannot be done while a person is still alive. (Laliberte)

Multiple severe concussions may also play a role in chronic headaches and/or migraines.

When the initial impact of a concussion occurs, the injured individual may receive an instant

headache or feel unstable. For some patients, the headaches go away after 4-7 weeks but for

other patients, they are forced to live with agonizing headaches for the rest of their life. A study
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in, “ 2018 showed that 2 or more head injuries can lead to more frequent and severe headache

and migraine attacks as well as total post-concussion symptoms” (Bullock). This study proves

that multiple concussions may result in more frequent migraines for the rest of an individual's

life. The span of time where the patient still experiences symptoms after being cleared from a

concussion is called, Post-Concussion syndrome.

Post-Concussion syndrome is when the patient experiences concussion symptoms longer

than the expected recovery time. “Although post-concussive symptoms spark at about 10-20% of

patients after a head injury, studies prove that headaches may affect anywhere between 59% to

more than 90% of individuals who encounter a concussion” (Bullock). The discovery that

Bullock presented shows that the majority of people who are diagnosed with a concussion

experience post-concussion syndrome. Some patients have reported that these symptoms will

continue for up to 2 months after the doctor has cleared them. This statistic is shocking

especially because when a doctor typically clears a patient, it's because the patient has fully

healed at 100%. It's alarming if patients are being cleared before their symptoms go away

completely. The average female is more likely to experience Post-Concussion Syndrome than the

average male (“Concussion and Migraine”).

“Shockingly, females are more at risk especially if they have pre-existing migraines or a

family history of migraines which makes an individual even more susceptible to developing a

post-traumatic headache” (“Concussion and Migraine” ). The American Migraine Foundation

found that, “From 2001- 2007, 2.5% of male and 9.5% of females had at least one medical visit

yearly for headache or migraine.” This statistic supports the claim that women are more

susceptible to migraines because females go to the doctor more for injuries relating to headaches

and migraines. Just in United States citizens, “migraines affect about 7% of men and 17% of
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women in adults” (Concussions and Migraine). This statistic helps outline the exact percentage

of women vs men that experience migraines frequently. Why is this?

Women are more likely to experience headaches and migraines because of their

hormones. The main hormone that women could blame for migraines is estrogen. Estrogen

contributes to cognitive health, bone health, the function of the cardiovascular system, and other

essential bodily processes. When estrogen levels fluctuate, it can contribute to an increase in

chronic headaches and migraines. If estrogen levels continue to increase by a significant amount

each and everyday headaches could potentially get to the point where they’re unbearable. Most

women are prescribed estrogen supplement control medication by their doctor to help keep the

levels at homeostasis. If women are already susceptible to migraines because of their hormones,

that makes their post concussion symptoms that much worse. (Nagar)

Minor concussions are less likely to leave lasting impacts on the brain. Minor concussion

symptoms usually resolve themselves within 7-10 days if the concussion protocol is followed

properly. The concussion protocol is different for every patient but the main thing that a doctor

will “prescribe” is plenty of rest and replenishing fluids. Minor concussions generally have the

same symptoms as severe concussions; they are just on a different pain level scale. Even if the

concussion is classified as a minor injury, it still makes an individual more susceptible to another

head injury. (Allen)

When an individual is diagnosed with their first concussion the doctor will typically warn

them that another concussion is likely to occur. This is because it takes a long time, possibly up

to a few years for the brain to officially recover from the impact. When the initial impact occurs,

the brain is literally rattled and could possibly even “jump around” in the skull. Even something

as simple as a light run in with an object could be enough to affect the brain. The doctor will tell
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the patient that as long as they are smart and careful with activity after being medically cleared

that their brain will be able to fully heal. For most individuals, this is almost impossible. The

average person is usually clumsy and will run into things on complete accident. What they don’t

realize is that continued brain trauma could potentially set them up for long term damage.

(Bullock)

Studies show that an individual who has already experienced one concussion is, “1-2

times more likely to receive a second one. If that individual has had two concussions, a third is

2-4 times more likely, and if they've had three concussions, then they are 3-9 times more likely to

receive their fourth concussion” (“Second Impact Syndrome: the Dangerous Effect of Multiple

Concussions” ). This statistic goes to show how susceptible an individual is to receive another

concussion after the initial impact. This statistic also proves how dangerous and likely a

concussion is. The second diagnosed concussion is referred to as Second Impact Syndrome

(SIS).

Second Impact Syndrome happens when two or more concussions occur in a “relatively

short period of time and the second concussion is inflicted before the first has fully healed

causing the brain to lose the ability to regulate pressure which could cause rapid and severe brain

swelling.” When the brain swelling is so intense, the pressure will begin to build up and push

against the skull which triggers an immediate headache. Something dangerous about brain

swelling is that it could possibly decrease blood flow. When blood flow decreases in the skull,

the brain cannot function as it normally does which may lead to severe disability and possibly

even death. Second Impact Syndrome is a perfect example of what could possibly happen if too

many concussions occur in one person. The dangers of SIS should also push the patient to follow

their personalized concussion protocol superbly. Not only can multiple concussions cause SIS,
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but they can also affect the patient's emotional state. (“Second Impact Syndrome: the Dangerous

Effect of Multiple Concussions'' ).

“Several concussions may trigger depression, anger, memory loss, and other symptoms

that make you feel unlike yourself, which increases the risk of suicide. Brain damage from a

single concussion could cause lasting emotional symptoms that won’t resolve without

treatment.” This statement is alarming considering that repeated concussion history is putting

lives in jeopardy. Depression from concussions is most often seen in athletes especially when

they are told that they can no longer participate in their sport. The downside of depression from

concussions is that most doctors will often overlook how the patient is feeling. This is supported

when Allen states, “Many doctors will ignore emotional symptoms or tell you it’s all in your

head. And while you may find helpful coping mechanisms from a psychologist, you won’t get

treatment that fixes the root cause (if it’s from a concussion). That cycle of being told you’re

crazy — or that no one can help you — only makes symptoms worse.” This is upsetting

considering that Doctors aren’t actually helping people get better. This falls in line with frequent

misconceptions about concussions. (Allen)

One of the most frequent misconceptions about concussions is that the trauma from

concussions won’t occur long term. Although this may be true for the people who experience

only one concussion, this is not the case for the majority of people. Even if the patient receives

multiple minor concussions it could still have a huge influence on their brain. Studies have

proven that the average person won’t take a concussion seriously until it's too late. Another

misconception is that you have to lose complete consciousness to suffer from a concussion. This

theory has been proved to be a myth by many medical professionals. As stated previously, there

are 3 different levels of concussions and only one of the levels deals with loss of consciousness.
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Scientists have made the conclusion that individuals who suffer from only one

concussion will most likely have no long term effects as long as the protocol is followed. When

there's only one traumatic impact on the brain, the brain is likely to recover completely but this

scenario isn’t likely. It is almost inevitable that an individual will receive another concussion

after the first brain trauma. This is because after the first initial blow to the head, the brain is

more susceptible to suffer more trauma because the brain isn’t fully healed. Individuals who

experience multiple concussions are at pinnacle risk for long term brain diseases. Diseases such

as Chronic Traumatic Encephalopathy (CTE), Second Impact Syndrome (SIS), Traumatic Brain

Injury (TBI) are the serious long term effects from multiple concussions. Multiple concussions

can also impact people emotionally such as being diagnosed with depression and anxiety. Since

I’ve personally been diagnosed with 4 concussions by a medical professional, it is likely that

some of these outcomes are a possibility for me. I’ve noticed that I’ve started to develop some of

these long term symptoms, for instance; chronic migraines and frequent fatigue. After doing

research, I now know that all of my concussions could be the major factor in my chronic

migraines.
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Works Cited:

Allen, Mark. “Multiple Concussions: Long-Term Effects and Treatment Options.”

Post-Concussion Treatment Center, CognitiveFX, 5 Apr. 2019,

www.cognitivefxusa.com/blog/multiple-concussions-effects-and-treatment.

Bai, Nina. “With Dangers of Everyday Concussions Revealed, Scientists Race to Find

Solutions.” With Dangers of Everyday Concussions Revealed, Scientists Race to Find

Solutions UC San Francisco, UCSF, 17 Mar. 2021,

www.ucsf.edu/news/2018/10/412006/dangers-everyday-concussions-revealed-scientists-r

ace-find-solutions.

Bullock, Greg. “Post-Concussion Headaches.” TheraSpecs, 28 Sept. 2019,

www.theraspecs.com/blog/post-concussion-headaches/#:~:text=There%20is%20also%20

likely%20a,as%20total%20post%2Dconcussion%20symptoms.

“Concussion and Migraine.” Living with Migraines , American Migraine Foundation, 16 Nov.

2019, americanmigrainefoundation.org/resource-library/concussion-and-migraine/.

Laliberte, Richard. “How the Discovery of CTE Shifted Thinking Behind Concussion Protocol.”

Brain and Life Magazine - Trusted by Neurologists, Aug. 2018,

www.brainandlife.org/articles/when-bennet-omalu-md-identified-a-degenerative-brain-di

sease-in/.

Nagar, Charulatha. “Why Women Have More Headaches Than Men.” Northwestern Medicine,

www.nm.org/healthbeat/healthy-tips/why-women-have-more-headaches-than-men#:~:tex
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t=Women%2C%20you%20can%20blame%20hormones,are%20more%20prevalent%20i

n%20boys.

Pathak, Neha. “Concussion: Symptoms, Causes, Diagnosis, Treatments, & Recovery.” WebMD,

WebMD, 25 Aug. 2020,

www.webmd.com/brain/concussion-traumatic-brain-injury-symptoms-causes-treatments#

:~:text=Types%20of%20Concussions&text=Grade%201%3A%20Mild%2C%20with%20

symptoms,for%20just%20a%20few%20second.

“Second Impact Syndrome: the Dangerous Effect of Multiple Concussions.” Revere Health, 21

Dec. 2020,

reverehealth.com/live-better/second-impact-syndrome-dangerous-effect-multiple-concuss

ions/#:~:text=Research%20shows%20that%20someone%20who,to%20receive%20their

%20fourth%20concussion.%E2%80%9D.

Shepherd . “ Football and Concussions .” The Ohio State University: College of Public Health, 5

Dec. 2017, u.osu.edu/groupbetaengr2367/.

“What Are the Potential Effects of TBI?” Centers for Disease Control and Prevention, CDC, 25

Feb. 2019, www.cdc.gov/traumaticbraininjury/outcomes.html.

“What Is CTE?” Concussion Foundation, Concussion Legacy Foundation, May 2019,

concussionfoundation.org/CTE-resources/what-is-CTE#:~:text=CTE%20was%20first%2

0described%20in,then%2050%20cases%20were%20confirmed.