Insomnia triples athletes' risk of concussion (5/2/19 Newsletter)

May 2

Welcome to the Concussion Alliance Weekly Update Newsletter! If you like this newsletter, forward it to a friend and suggest they subscribe.

Education

There are a couple more days to sign up for the University of Calgary MOOC (massive online open course): Concussion: Prevention, Management, and Treatment. Registration is open until May 6th. The seven-week course is free, and a certificate is available upon completion.

The Concussion Legacy Foundation (CLF) has a concussion reporting certification program for sports media professionals; Bob Costas is one of the Media Project Fellows who has passed the certification test. CLF provides a media toolkit and certification after passing a quiz which tests "your knowledge on the basics of concussion, how to properly describe concussions, what should happen during in-game concussion evaluations, and what to expect after a concussion is diagnosed."

Sports

In a recent study by Adam C. Raikes et al., published in Sleep Medicine, insomnia and daytime sleepiness were connected to increased risk for sports-related concussions. As reported by Reuters Health, the researchers surveyed 190 NCAA Division-1 athletes for insomnia and daytime sleepiness, and found that “moderate-to-severe insomnia more than tripled athletes’ risk of concussion, and excessive daytime sleepiness - even just a few days a month - more than doubled it.” This connection was true regardless of what sport the athletes played and whether or not they’d had past concussions. The study concludes that treating insomnia and daytime sleepiness in athletes could reduce concussion risk.

The most recent example of concussion management in high-level sports seems to have the potential for important rules changes in soccer. On April 30th in the UEFA Champions League semi-final, Jan Vertonghen received a blow on the back of the head from a teammate while jumping for a ball. He received medical attention and then was allowed back onto the field only 6 minutes after the injury. He lasted only seconds on the field; he nearly collapsed as he walked off. This incident demonstrates the danger of allowing a player to continue after an injury to the head, which puts them in danger of a second impact. Since this incident, FIFA has said they are prepared to discuss potential concussion-related rules changes in light of this dangerous reminder of inadequacies in concussion treatment at the highest level of soccer.

Cannabis

Headaches are the most common symptom after a concussion, with the most common type of headache resembling a migraine, according to the American Migraine Foundation. Migraine medications are sometimes given to concussion patients, but what about medical cannabis? In a study published in Neurology, researchers found that 88.3% of patients with chronic migraines who were given medical cannabis reported a reduction in headache frequency, along with improvements in sleep, anxiety, and mood. Researchers Laszlo Mechtler et al. found that significantly more patients taking the 20:1 (THC to CBD) ratio reported headache reduction than those taking the 1:1 (THC to CBD) ratio.

Diagnostics

In an April Statement, five Canadian Chiropractic organizations submitted a collaborative set of recommendations for improving Canada’s concussion response treatment. A recently published guideline by Parachute Canada restricts assessment and diagnosis to solely physicians and nurse practitioners; these Chiropractic organizations argue that a chiropractor can act as a team’s first responder to provide timely access and response for concussion assessment and diagnosis.

Intimate Partner Violence

An article published in the Journal of Aggression, Maltreatment, and Trauma discusses how dentists could provide an additional line of defense for identifying head and neck trauma caused by domestic violence. The researchers Timothy W. Ellis et al. found that up to 75 percent of head/neck trauma occurs with oral injuries. The researchers posit that if the specific oral injuries obtained from head and neck trauma can be identified, dentists will be able to recognize potential TBIs and victims of domestic violence, thus “opening another avenue for patients to gain access to proper care or needed assistance,” according to UANews.

Legislation

In Washington State, Governor Inslee signed legislation that addresses the possibility that foster children may have suffered traumatic brain injury from an abusive relationship, and that behavioral issues may be related to TBI. The new legislation requires the Department of Children, Youth, and Families to evaluate screening tools for TBI "for children going into the state’s foster care system." These screening tools will "allow for treatment actions following the identification of a TBI," according to KPQ News. The department must report back to the Legislature by December 1, 2019.

CTE

The Tragic Consequences of the NHL's Science Denial is a new video in a documentary series produced by The Atlantic, about the former National Hockey League player Todd Ewen; Todd committed suicide in 2015 after experiencing severe neurodegenerative symptoms. His wife Kelli Ewen submitted his brain to an NHL affiliated neuropathologist, who made the determination that Todd did not have CTE. The NHL then used this finding as part of their public relations campaign. In disbelief about the results of the pathology report, Kelli submitted Todd's brain to the Boston University CTE Center, which found that Todd had stage 2 CTE.