Long-term effects of head injury and concussion
Some contact sports are now known to cause long-term problems secondary to repetitive head injury and concussion – including: football; rugby union and rugby league; American, Australian rules and Gaelic football; boxing and other martial arts, where there is repetitive striking of the head.
Other contact sports, like handball, basketball and water polo, do not cause repetitive head injury and concussion.
1. Definition and prevalence
Definition
- A head injury is any trauma to the head, including the scalp, skull, brain, or underlying tissue and blood vessels.
- A concussion is a type of traumatic brain injury (TBI) that occurs when the brain is temporarily affected by a blow, jolt, or bump to the head.
Prevalence
- Head injuries account for approximately 1.4 million A&E attendances annually in the UK.
- Concussions, or mild traumatic brain injuries (mTBIs), comprise 70-90% of these cases.
2. Cognitive impairment
Post-concussive cognitive impairments may persist for 6-12 months post-injury; affecting attention, memory, and processing speed. Severity correlates with injury severity.
3. Post-concussion syndrome (PCS)
5-20% of concussion patients develop PCS, characterised by persistent symptoms (>6 weeks) such as headaches, dizziness, fatigue, irritability, and sleep disturbances.
4. Neurological sequelae
- Chronic traumatic encephalopathy (CTE) – a progressive neurological disorder that can develop after repeated head injuries. Symptoms include mood changes, personality changes, confusion, memory problems, and movement disorders. Symptoms usually start gradually, often around 10 years after the injuries
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Epilepsy (post-traumatic seizures)
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Hydrocephalus
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Cerebral vasospasm
- Parkinsonian syndrome (‘punch-drunk syndrome’).
5. Mental health consequences
Head injury survivors are at higher risk of:
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Depression (20-50%)
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Anxiety (10-30%)
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Post-traumatic stress disorder (PTSD)
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Suicidal ideation.
6. Return to play/work
UK guidelines recommend gradual return to activities after concussion:
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Minimum 7-10 days rest
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Stepwise increase in physical/cognitive demands
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Medical clearance before returning to high-risk activities
7. Sleep disturbance
Concussion often disrupts sleep patterns, leading to:
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Insomnia
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Hypersomnia
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Fatigue
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Daytime somnolence.
8. Visual and vestibular issues
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Blurred vision
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Double vision (diplopia)
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Sensitivity to light
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Vestibular dysfunction (balance, dizziness).
9. Pituitary dysfunction
Head injuries may result in pituitary hormone deficiencies, particularly growth hormone and ACTH deficiencies.
10. Long-term prognosis
Most patients recover fully within 1-2 years. However, some experience persistent symptoms, cognitive deficits, or neurological sequelae. Multidisciplinary rehabilitation programmes improve outcomes.
Other resources
- Royal College of Physicians (RCP): Head injury (NICE guideline)
- Headway (UK Brain Injury Association)
