Concussions - also known as mild traumatic brain injuries (mTBI) - are more than just sports injuries and are frequently misunderstood. They can result from motor vehicle accidents, falls, workplace incidents, assaults, or other trauma.
In a recent webinar, Dr. Wasif Hussain, a leading neurologist and headache specialist, shared evidence-based approaches to diagnosis, management, and recovery. Dr. Hussain brings extensive expertise from his neurology training at the University of Alberta, fellowship at the University of Toronto, eight years in clinical practice, and five years conducting Independent Medical Examinations (IMEs) in Alberta and Ontario.
Dr. Hussain’s session explored the evolving landscape of concussion care and essential knowledge for healthcare professionals, legal experts, and individuals navigating mTBI.
According to the Living Concussion Guidelines a concussion is defined as an acute neurophysiological event related to blunt impact or other mechanical energy applied to the head, neck or body (with transmitting forces to the brain), such as from sudden acceleration, deceleration or rotational forces. A concussion can be sustained from a motor vehicle accident, sport or recreational injury, falls, workplace injury, assault or incident in the community.
Dr. Hussain explained that “concussion” and “mild traumatic brain injury” are often used interchangeably, while “sports-related concussion” is typically reserved for athletic injuries. Importantly, a concussion is a neurophysiological event—specifically an acute one.
Diagnosis depends on clinical signs and acute symptoms. The 2023 American Congress of Rehabilitation Medicine (ACRM) criteria provide a structured framework to reduce variability. Core criteria include a plausible mechanism of injury (e.g., motor vehicle accident), brief loss of consciousness (<30 minutes), post-traumatic amnesia (<24 hours), and Glasgow Coma Scale (GCS) score of 13 or higher. Neuroimaging is helpful but not required for diagnosis; it is mainly used to rule out severe injuries. If a clear diagnosis cannot be made, the term “suspected mTBI” may apply.
Clinicians primarily rely on acute signs and symptoms because other data - such as balance impairment, cognitive or oculomotor deficits, and biomarkers - are often unavailable in Canada. Imaging, if performed, is usually normal, though small contusions may appear. Clinical signs can include immediate loss of consciousness (seen in <10% of cases), altered mental status (e.g., amnesia, disorientation), and neurological deficits (e.g., seizure-like activity, gait imbalance). Timing matters: symptoms appearing after 72 hours may indicate other causes, such as cervicogenic headaches from whiplash.
Headache is the most common symptom, affecting over 90% of patients. These headaches often resemble migraines and may lead to sleep disturbances, cognitive changes (such as poor focus or memory-like issues), mood changes, and vestibular problems. Factors that worsen headaches include neck injuries, medication overuse, stress, and poor sleep. Concussions are frequently over-diagnosed, leaving some individuals with a longstanding diagnosis that does not meet criteria - impacting treatment plans and benefit determinations.
Concussions can also unmask underlying brain disorders, such as Alzheimer’s disease, which may begin showing symptoms after the injury.
Post-traumatic headaches (PTH) are defined as headaches attributed to head trauma. They are complex and challenging to treat because management depends on headache phenotype - such as migraine, cervicogenic, medication overuse, tension-type, or Trigeminal Autonomic Cephalgic (TAC). Often, PTH involves a mix of these phenotypes, with migraine and cervicogenic types being most common.
It is critical to rule out secondary causes like CSF leaks, sleep apnea, and vascular issues. Migraines should be considered “migraine attacks” because they involve multiple symptoms beyond headache, including light and sound sensitivity, nausea, vomiting, dizziness, fatigue, sleep disturbance, depression, cognitive changes, and visual changes.
Most concussions resolve within days to weeks. However, 15–20% of patients experience prolonged recovery (>1 month), and about 1% have permanent symptoms, though data is limited.
Initial care involves 24–48 hours of rest, followed by gradual return to activity and concussion education. Management should be holistic, focusing on expectations, symptom control, and knowing when to seek help.
For prolonged cases, a multidisciplinary approach is essential - addressing headache, mood, and sleep. Occipital nerve blocks can be highly effective for occipital neuralgia and cervicogenic headaches. Unfortunately, many patients suffer for years without receiving appropriate first-line preventive medications. Primary care providers need more education on evidence-based treatments, as opioids are often prescribed, which can worsen headaches and lead to medication overuse.
Predictors of poor outcomes include initial symptom severity and the number of prior concussions. Early treatment is crucial for those with severe symptoms. Even with proper care, some individuals cannot return to work due to mental health barriers.
Concussion diagnosis requires careful history, clinical examination, and adherence to criteria - not all post-accident symptoms indicate concussion.
Management should be holistic, addressing interconnected symptoms rather than focusing solely on brain injury.
Early and appropriate treatment is vital, especially for persistent symptoms beyond one month. Unfortunately, long wait times and limited resources in Canada make this difficult.
This webinar was highly educational for Medylex’s network and reinforces our commitment to bridging medical and legal insights.
For Independent Medical Examinations with Dr. Hussain, please submit a referral or contact us.
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