DOC TALK WITH DR. PALOMERA AND DR. GIRLING: IS EVERY HEADACHE A CONCUSSION?
Two Sports Medicine Physicians discuss TOP patient questions: 
Dr. Palomera: Something you don't get asked, even though I know you could handle it, is,
IS EVERY HEADACHE A CONCUSSION? DOES EVERY CONCUSSION HAVE HEADACHES?
It's interesting because during the sports seasons for middle school, high school, and college athletes, especially during football and soccer season in the fall, we will have a significant amount of concussions. We see them in baseball, volleyball, and every sport. Basketball, as well. But, probably football and soccer are the big ones. And we've got quite a bit of referrals, like we should, asking, 'hey, is this a concussion? How bad is it? What do we have to follow?' When I look at it, unfortunately, a lot of them are concussions. The athletic trainers and coaches we work with, especially in the last 10 years with the way our thinking about concussions has changed, the way it's changed legislatively, there are some laws guiding us on how we bring them back, and so forth. It's really made people much more astute about looking out for concussions.
AND YOU'D BE SURPRISED, I WOULD TELL YOU PROBABLY WELL OVER 90% ARE TRUE CONCUSSIONS WHEN THEY COME IN. BUT, NOT EVERY HEADACHE IS A CONCUSSION.
The example I use with parents, especially, is, 'I have bumped my head on the cabinet, hit my head very in a very dumb fashion, on a car door, and had a little bit of a bruise to my head and a little bit of a headache.
BUT IT DOESN'T MEAN I HAD ANY COGNITIVE OR THINKING DYSFUNCTION, TROUBLE CONCENTRATING, TROUBLE WITH SLEEP, TROUBLE WITH EMOTIONS.'
People with concussions tend to get more irritable, and so forth. That's a distinction we make and sometimes it can be a little bit of a gray area because we can't MRI or CAT scan a brain and say, "There's a concussion."
Dr. Girling: So, if you've got an athlete or a loved one, somebody who maybe had some kind of trauma, you're not sure they've got a headache, and you know, something is going off alarm bells. Is this a concussion? When do they need to be evaluated?
Dr. Palomera: That's a little difficult to answer. Something that only lasts about an hour or two is not something I'm too worried about as long as they are stable. They're not having a lot of neurological dysfunction where there's just a lot of things going weird on mom or dad or kid within a couple of days. We will usually see them within two or three days. It's very uncommon to see them outside of a week after the head trauma because there's something really wrong. It's not just a headache. It is behaving oddly, looking like they're out of it, being more quiet than usual, sleeping all the time, but complaining that they're sleepy because they're not sleeping well. There's a lot of distinctions that go with it. We have a lot of guidelines that feed us, but there's no hard fast rule. Not only on how to diagnose it or what symptoms you need, but how to treat it.
Dr. Girling : Well, the trainers play a big role in this too.
Dr. Palomera : Right. Trainers and coaches. We have a lot of schools around San Antonio with athletic trainers, but a lot of smaller schools within 30 miles have coaches that get comfortable with sports medicine issues so they become the athletic trainer and the team doc. Luckily, through their organizations, through a lot of stuff online, there's a lot of education. They've become really really good at it. I think the reason why we diagnose a lot of concussions and have athletes sent to us when it's suspected they have a concussion is because these guys know what they're looking at. These guys know when it's not just a headache. 'This looks strange. This looks weird. This looks a little bit more complicated than we usually see.' That kind of education supports us. Part of our job is to educate parents. We probably see a few 100 concussions a year from different levels of sport. I personally think we see more than we used to because the suspicion level is much more appropriate. This injury doesn't get blown off as much as when I was younger.
FORTUNATELY, WE HAVE GOOD TURNOUTS WITH THE MAJORITY OF CONCUSSION CASES.
Sometimes an image is indicated but unlike a break or a fracture, where you need the imaging regularly, you really don't in a concussion case because you really follow the symptoms and what's going on with it.
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