Mild head trauma clinic

Mild head trauma clinics offer one-off sessions for people who sustained an injury to their head without causing brain damage.

The clinics have the purpose to help the person cope with post-concussion symptoms and prevent secondary psychological problems. They include the discussion of the injury event, exploration of  ongoing symptoms and re-evaluation in the context of the person’s life situation. Furthermore, they offer psycho-education, reassurance and signposting to additional health management services.

Who is this guide for?

This guidance is for people who experience persistent difficulties following a mild head trauma.

Information in this brochure includes a description of mild head trauma symptoms, why they may persist and how vicious cycles between unhelpful thought patterns and actions can develop. Furthermore, tips about overcoming some of these symptoms and additional support are provided.

People can sustain mild head traumas as a result of road traffic accidents, falls, assaults or other injuries involving a blow to the head.

This aims to cover a range of difficulties which may be relevant to some people and not to others.

Mild head trauma symptoms

A mild head trauma can occur following a blow to the head. This may cause short-term confusion, disorientation or dizziness. Loss of consciousness may happen for a few seconds or minutes. Many people who suffer such mild injuries may choose not to go to hospital or seek medical care as the injury may not affect them in a substantial way.

Sometimes, following mild head trauma, people develop a number of symptoms. These include:

  • physical difficulties such as headaches, dizziness and fatigue
  • emotional difficulties such as irritability, anxiety and depression
  • cognitive difficulties such as problems with concentrating and remembering things.

The experience of a potentially highly dangerous event alerts the body’s stress or arousal system. This may lead to a range of difficulties which get associated with fear of having damaged the head or brain. Permanent damage to the brain under these circumstances is very rare.

It is important to be aware that mild head trauma symptoms are relatively common. A lot of people may get headaches or forget things from time to time. However, the combination of prior experiences of headaches or forgetfulness with the stress of having had a sudden unexpected life event, like an accident, may aggravate the situation resulting in mild head trauma symptoms.

Following a sudden, unexpected life event, the body tends to absorb information from the environment so as to make sure that any signs of danger are not missed again. This can activate our fight/flight or threat system, placing our brain on ‘high alert’.

This is an understandable and normal reaction and will usually go away with time. It is important that you remind yourself of this fact.

What if some symptoms persist?

Some people experience symptoms for longer. This can be because these symptoms can interact with each other, which can make them more troublesome. For example, after just a few days, if someone experiences a headache that won’t go away (physical), they may feel more irritable (emotional), have less patience, and begin to worry that something might be seriously wrong with their brain (cognitive/thinking skills).

Eventually, they may have problems concentrating on anything else, find it hard to pay attention and to remember information (cognitive/thinking skills). Thus, a vicious cycle may develop where physical symptoms (e.g. head pain or dizziness) trigger intense fears (that there might be something seriously wrong with the head/brain) leading to constant worries (which distract the attention and ability to focus, leading to the impression of forgetfulness).

Vicious cycle of mild brain trauma symptoms

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Another example might be that worries about changes to your lifestyle may substantially exacerbate the situation. For instance, if someone is unable to return to work straight away because of an injury (physical), they may begin to worry (emotional) about financial issues, about job security or about meeting their social and family responsibilities. The intensity of such unhelpful thoughts (cognitive/thinking skills) may lead to increased muscle tension which is often experienced in the neck, shoulder and back area resulting in tension-type headaches (physical). Additionally, sleep problems (physical) are a common consequence of distress and worry which further increase difficulties with concentration and thought processing (cognitive/thinking skills).

Many of the described symptoms and difficulties are common in everyday life for everybody (we all get tired, stressed, and forget things from time to time). However, people may notice these difficulties and worry about them more when they are feeling stressed. After a mild head trauma, it can be easy to forget that memory and concentration lapses, feelings of fatigue or even exhaustion happened before the accident.

As mentioned earlier, the different head trauma symptoms interact and complex patterns or vicious cycles may develop which may be harder to resolve. In such cases, it is vital to find proactive coping strategies to disrupt these unhelpful patterns and to improve well-being.

Emotional difficulties

It is common to experience a variety of emotional difficulties following a mild head trauma. Apart from simply not feeling well physically and being in pain, you can often experience additional worries such as the following:

  • feeling unsafe or vulnerable in the world
  • believing the world is unpredictable
  • fear of unexpected harm
  • anxiety, nervousness
  • fear of severe health problems
  • frustration and irritability
  • guilt
  • low mood
  • uncertainty about the future e.g. work, family
  • loss of control.

These symptoms are a natural response to the sudden, unexpected traumatic event which can fade completely with time. They are also the common consequence of many different types of stressful experiences or critical life events.

Fears and anxiety

The emotional impact of mild head trauma may be experienced as fear or increased anxiety about certain situations e.g. being around people or returning to driving, particularly if these are related to the accident. When people feel more stressed, worried or anxious, they often become ‘better’ at noticing the things that might go wrong (this is called hypervigilance).

Avoidance of anxiety triggers

Avoiding situations that make you feel anxious can in fact keep your symptoms or anxiety going. A good example of this is travel anxiety, where people avoid using the kind of transport associated with their accident. The stress and anxiety which might be triggered by travelling results in a ‘prediction’ that this type of transport will cause another accident

People may also avoid reminders of events around their injury, or avoid talking about it with friends or relatives. While avoidance is an effective way of reducing anxiety and distress in the short term, it can cause substantial disruption over the medium and long term. For example, if a person no longer drives as a result of an accident, they may find their life becoming increasingly restricted and less pleasant.

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Depression and low mood

People sometimes become depressed when unpleasant things happen to them. Traumatic accidents or prolonged experiences of negative health symptoms are associated with the release of stress hormones which cause depressive symptoms (amongst other disturbances). These symptoms and difficulties can create concern, upset and worry. Individuals may wonder if they will ever improve. In addition, there may be a number of ways in which a person’s life has changed (e.g. people may go from working to not working, from financial security to financial uncertainty). Often, the effects of these changes can result in losing or restricting opportunities to do enjoyable, rewarding things. This can contribute to someone becoming and staying depressed.

When people are low in mood, they tend to have negative thoughts about themselves. These thoughts may not be an accurate or helpful picture of the situation. They maintain the negative feelings about themselves or feelings about being stuck. Sitting around doing very little can maintain low mood and provide extra opportunity to worry and ruminate about problems and concerns.

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Irritability

Irritability is another sign of heightened arousal originating from the traumatic incident. The body has become more receptive to surrounding signals in order to check for unexpected danger. This has led to information-overload, resulting in a range of posttraumatic symptoms including irritability.

This is not just an unpleasant experience; it also interferes with the ability to get along with others. Many people, who are affected in this way, comment that they used to be very laid back and feel as if their personality has changed. This sometimes triggers the fear that other people might reject them or that one might be aggressive with others without meaning to be.

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Physical symptoms

Headaches

Headaches which develop some time after the accident and persist are most commonly tension-type headaches or post-traumatic migraines

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Sensitivity to noise and light

Increased sensitivity to bright light or loud noise can be a sign of an overactive nervous system. Following an accident, the nervous system is likely to absorb more sensory stimuli to make sure that potentially dangerous signals are not missed again. This means that the sensory systems are highly sensitised which can also increase tension or the likelihood of headaches.

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Dizziness and vertigo

 Dizziness and vertigo are also very common head trauma symptoms. They are associated with micro changes to our vestibular system. This system is responsible for helping us to balance; information is sent to the brain from our visual processes, our inner ear and proprioceptors in our joints.  Our brain then has to make sense of all this information and make adjustments to keep us balanced.  If any part of this system is disturbed, we sometimes experience feelings of dizziness, loss of balance or vertigo.

You may be referred to a specialist in Vestibular Rehabilitation who can carry out an assessment of your ‘dizziness’ and balance.  They will select relevant exercises to help you manage your symptoms.  You will probably be advised to do these exercises several times a day.  You are likely to experience some dizziness as you perform these exercises.  Remember that you are in control of your symptoms, if the dizziness becomes too much then stop and allow the dizziness to settle. You may need to do the exercises a little more slowly at first but do not skip them - regular practice will optimise the recovery of your balance system.   Think of a ballet dancer, most people feel dizzy when they spin around; however, with practise a ballet dancer can perform multiple spins at speed without becoming dizzy as their brains have learnt to adapt.  This is similar to the training you are doing to your vestibular system whilst performing these exercises.

 Before you start any exercises prescribed by your therapist, set aside a few minutes to practise relaxation.  Start by making sure you are breathing slowly. Keep your shoulders down and your chest still, and breath by just letting your stomach go in and out. After you have been breathing slowly for a few minutes, follow each of your exercises, and once you can do this, practise staying relaxed while carrying out the vestibular exercises.

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Sleep problems

Difficulty falling asleep and/or disrupted sleep throughout the night can have a profound effect upon our ability to function during the day. People with sleep disturbances often report problems with memory and concentration. They might feel irritable, stressed and have low energy levels. Some people might experience nightmares or disturbing dreams about feeling out of control, being chased or being in danger. Sleep problems are most likely to be related to worry, stress, anxiety and low mood. Discomfort or pain may aggravate the situation.

Here is an example of a vicious cycle of sleep difficulties:

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Fatigue and reduced energy levels during the day

Some people who experience frequent mild head trauma symptoms can be disappointed or feel guilty that they cannot perform their daily activities or fulfil their responsibilities to the standard they were once used to. Instead of slowing down or letting go of those expectations, they try to squeeze as many tasks into symptom-free periods as they can, or try to catch up with unfinished activities. Later, they find that fatigue is so severe that they have to rest for long periods.

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This cycle can interfere with people making changes in their life.

The boom and bust trap

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Cognitive difficulties

Cognitive, or thinking, difficulties include problems with short-term memory, attention and concentration, reduced thinking speed or diminished ability to problem solve.

There are a number of reasons why you may be experiencing cognitive difficulties after a mild head injury. It is important to remember how your cognitive, emotional and physical systems are all linked.  The stress of the accident, the resulting symptoms and life changes often cause people to forget that lapses of memory and attention are very common for everyone.

Short term memory problems are usually related to problems with attention; if you find it difficult to attend to information it will be difficult for you to remember it later. After a sudden, unexpected injury, the brain can go into a ‘high alert’ or ‘danger’ mode, which means the attention systems are set to focus on and look out for danger. This can then interfere with your brain’s ability to attend to usual, everyday information and in turn, lead to forgetfulness.

In other words, when your brain is trying to take on all the information in your environment to check for potential danger, it can struggle to focus on the information you would like it to. For example, you might find yourself becoming distracted easily, it might be difficult to focus in busy environments and you cannot recall information that you would usually remember.

Other mild head trauma symptoms can also interfere with thinking. For example, pain, anxiety and fatigue can all impact on your ability to process information. The brain only has the capacity to be able to focus on so much at one time. Therefore, if it is telling you that you have pain, or focusing on worries (e.g. about the symptoms you are experiencing) then it will not be working as effectively on processing other information or problem- solving.

You may have extra responsibilities following a head trauma in addition to your usual activities, for example, visiting health clinics, having meetings with employers, or seeking help from solicitors. These sorts of additional responsibilities can also add to the load on cognitive systems and lead you to feeling overwhelmed.

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Produced by the Acquired Brain Injury Rehabilitation Service.
Graphics by Sofia Angus.
Acquired Brain Injury Rehabilitation Service