Early one morning, as I sorted laundry on the floor in front of my stacked washer and dryer, the dryer door silently swung open to a 90-degree angle. I stood up quickly and whacked my head square into the metal door.
Ouch. Immediately, I felt lightheaded, and a large bump swelled on top of my head. But I didn’t bleed or pass out. I even considered going on the bike ride I’d planned that morning before thinking better of it. I largely carried on with my day, feeling a bit fuzzy-headed. It wasn’t until the next day, when I still felt out-of-sorts and my neighbor said I looked pale, that I walked to an urgent care clinic. The doctor confirmed what I had suspected: I had a concussion.
Before last spring, I thought I had a reasonable understanding of concussion, which is a mild traumatic brain injury (TBI). Sports, falls and car accidents are frequent causes, and researchers are looking more closely at intimate partner violence as well. But I’d never thought about freak head injuries and lingering symptoms until I spent the better part of a year recovering from what one friend described as my laundry trying to kill me.
‘No definitive answers’
A concussion, caused by a blow to the head or whiplash, occurs when the brain rattles or twists within the skull and brain cells stretch and shear, causing a chemical change. It’s a complicated injury.
“We sometimes see a person who survives a gunshot wound, in which the brain doesn’t rotate, and their outcomes tend to be better,” said Kristen Dams-O’Connor, director of the Brain Injury Research Center of Mount Sinai in New York.
Every concussion is unique, so symptoms and recovery time vary between individuals, even if they were hit with the same force on the same part of their head, experts say. Many people, for instance, could have collided with their dryer door and forgotten all about it by breakfast, my doctors told me.
Although our understanding and awareness of concussions have significantly advanced awareness in the past 20 years, the field is still in its infancy. When I interviewed almost a dozen experts, I heard a lot of “no definitive answers” and “research is still emerging.” Among my questions: What determines who is more likely to get a concussion and have prolonged symptoms?
“That’s the million dollar question,” said Marilyn Kraus, medical director of the Concussion and Traumatic Brain Injury Clinic at George Washington University School of Medicine and Health Sciences. “I’m humbled by how much we don’t understand about this.” Kraus said determining how to treat symptoms long-term and appreciating how they drive each other is probably more art than science.
After a concussion, one-third of youths develop mental health issues
Women, whose necks generally aren’t as strong as men’s, are more likely to get concussions, as are children and the elderly, who are at greater risk of falling. Some people are more vulnerable because of their risk tolerance or environment: Maybe they’re popping wheelies on their bike or live in a violent neighborhood. Other individuals may be more susceptible because of preexisting conditions, such as psychiatric or vestibular issues that affect balance.
Tom McAllister, lead principal investigator for the Concussion Assessment, Research and Education (CARE) Consortium, a partnership between the NCAA and Department of Defense, said there is a significant overlap between the parts of the brain injured in a TBI and those affected by depression.
“If you have a psychiatric illness before a head injury, you’re at a higher risk of a concussion,” he said, “and brain injury is a pretty significant risk factor for developing depression, anxiety and PTSD.”
Studies also show that previous concussions and a history of migraines, motion sickness and sleep disorders can prolong or complicate recovery. I checked the migraine and motion sickness boxes. I’d also had another concussion, decades ago. But then, I recovered in a couple weeks, typical for about 80 percent of patients.
“It feels like there’s a disco ball behind my eyes,” I told my mom two weeks after my injury. I had pushed through my symptoms for a work deadline, and soon, I could barely look at any kind of screen. My mom worried I’d further damaged my brain and convinced me to go to the emergency room, where doctors observed my eye movement and coordination, asked me questions and confirmed the earlier diagnosis. My discharge papers instructed me to stay off screens, nap when needed and visit GW’s concussion clinic. So I returned home, turned off my computer and started healing.
In the past, post-concussion protocol involved cocooning in a dark room with no stimulation until symptoms subsided. But today, the accepted treatment is to avoid physical activity for 24 to 48 hours, then begin moderate exercise. Studies show that strict, prolonged rest can actually be detrimental to recovery. But overdoing it is also problematic. It can take time to find the right balance between rest and activity.
New concussion treatments go beyond just resting in a dark room
After my ER visit, vertigo, fatigue and brain fog continued for more than a month, so I mostly cleared my work calendar. I scheduled one phone interview and completely forgot about it. We rescheduled, and I had to break the call in half because I struggled to concentrate. Small tasks were daunting, continually reminding me of my limitations.
At the concussion clinic, physical therapist Mike Taber helped me set up a schedule to regulate my screen time, starting with five minutes followed by a 30-minute break. Over several appointments, he prescribed challenging eye exercises, daily walks and small-dose exposures to high-stimulation destinations like grocery stores.
Often I’d show up for appointments with an assortment of head pain, concerned that I’d pushed too hard or reinjured my head. “Nothing you’re going to do will damage your brain,” Taber assured me. “It’s normal to have setbacks, but don’t freak out.”
At Taber’s suggestion, I charted my symptoms, sleep, exercise, stress and headache medication, grateful for improvement over time. I recorded milestones: playing a board game without dizziness, visiting two stores in one day, driving several hours without a nap. One weekend around the six-month mark, I drove a long distance and stayed up late, yielding relapse symptoms — including tenderness at the impact spot. Some days I had headaches or vertigo and wasn’t sure whether to attribute them to the concussion. Experts later explained to me that this line of thinking — that any symptom I experience could be traced to the concussion — creates a vicious cycle.
Certainly, having an open-ended recovery timeline can be disheartening. That is why Kraus sometimes tells her patients complete healing may take as long as two years.
“Some people hear the concussion diagnosis and think they’re doomed,” Dams-O’Connor said. “They’re not prepared for the fact that the vast majority have full recovery within a few days or weeks. It’s that hollow in your heart, that feeling in your belly that you have a headache after a stressful day or vertigo on a bumpy road, and now you worry it’s from the concussion. Our minds play tricks on us.”
These days, I remain vigilant with my sleep and feel lousy if I spend too long at the computer or behind the wheel — which may or may not be related to my concussion. I go days without thinking of my injury.
But I never open my dryer door mindlessly. And I wonder if I ever will.
How to treat your injured noggin
Some people get a concussion and do nothing to treat the symptoms. I tried numerous treatments and therapies. The good news, experts say, is that people in both camps recover. “But you’ll heal faster with interventions,” physical therapist Mike Taber said.
If you have symptoms — especially longer than a few weeks — these suggestions may be helpful.
Komal Patel, assistant professor of neurology and rehabilitation medicine at George Washington University, said the brain heals while we sleep.
“Set times to go to sleep and wake up, and stay consistent,” he said. I kept a pretty strict sleep schedule and felt noticeably worse when I made exceptions.
Relax your brain through meditation, yoga, deep breathing, journaling, art therapy, aromatherapy and walking in nature. For headaches, Patel recommended a natural supplement called MigreLief and over-the-counter medications. Preventing stress, eating healthy meals, staying hydrated, exercising and abstaining from alcohol also promote recovery.
Stay active. I started with walks and physical therapy and eventually added light weightlifting, swimming and stand-up paddleboarding. Explore concussion-specific rehabilitation beyond PT: The George Washington clinic offers occupational, cognitive and speech therapy to help patients with visual fatigue, sleep/time management and work reentry. I found an incredibly relaxing acupuncture, and it often cleared the fog from my head. My acupuncturist showed me several pressure points for DIY massage.
Blue-light filtering eyeglasses can help with eyestrain, as can computer settings that warm the display colors. The f.lux app works the same way. Use something more reliable than your brain to manage screen time (I bought a set of colorful sand timers).
I scheduled a call with my therapist to talk about feelings of isolation associated with having an invisible injury and grief over not being able to do of the things that make me feel like myself — with no end in sight.
She suggested Elizabeth Lesser’s book, “Broken Open: How Difficult Times Can Help Us Grow.” I also read “Coping With Concussion and Mild Traumatic Brain Injury: A Guide to Living With the Challenges Associated With Post Concussion Syndrome and Brain Trauma,” rereading one multiple times: “Perhaps the greatest impact of concussion is psychological. An unexpected, unexplained inability to function can shake you to the core.”
Ask for help when you need it, and seek support from people who have recovered from concussions. What one friend told me was critical in my mind-set: Recovery doesn’t follow a straight trajectory — there will be ups and downs along the way.
The Centers for Disease Control and Prevention has more information on concussions for adults and for children and teens at CDC.gov.