A concussion is a mild traumatic brain injury that can have a variety of symptoms. In a recent paper published in Neurosurgery, Stanford researchers, led by pediatric emergency physician Angela Lumba-Brown and neurosurgeon Jamshid Ghajar, identified five subtypes of concussions and recommended a different initial treatment for each one. While the categories are not mutually exclusive and share some symptoms (most concussions initially include headache, and sleep disturbances and neck problems are common), researchers hope identifying the symptoms particularly characteristic of each subtype will ultimately lead to more effective treatments for all concussions.
Cognitive
Symptoms: Attention issues, impaired reaction time and problems with memory.
Treatment: Neuropsychological assessment and follow-up.
Ocular-motor
Symptoms: Headache, eye strain, difficulty with reading and screen time, sensitivity to light, trouble focusing, blurred or double vision, eye pain or pressure, and difficulty judging distances.
Treatment: Dynamic vision training with an optometrist.
Headache/migraine
Symptoms: Nausea, vomiting, and sensitivity to light, sound or smell.
Treatment: Headache management.
Vestibular
Symptoms: Dizziness, fogginess, light-headedness, nausea, vertigo and disequilibrium. Movement may exacerbate the symptoms.
Treatment: Balance and vestibular-ocular training with a physical therapist.
Anxiety/mood
Symptoms: Nervousness, emotionality, being overwhelmed, sadness, irritability, fatigue and feelings of hopelessness. A history of anxiety or migraine may predispose someone to this type of concussion, as may concurrent stressful events.
Treatment: Counseling, including cognitive-behavioral therapies.
Charity Ferreira is a contributing editor at Stanford. Email her at stanford.magazine@stanford.edu.
