Dietary interventions can reduce persistent headache frequency and severity after brain injury, including concussion (7/31/25 Newsletter)
In this newsletter: Opportunities, Sports, Pathophysiology, Self-Care
Writers: Anni Yurcisin, Marina Oljaca, & John Lin
Editors: Conor Gormally & Malayka Gormally
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Opportunities
Wednesday, August 13, 6 pm EDT: A webinar, Getting Things to Stick: Strengthening Memory and Habits after Brain Injury, presented by Stephanie Wagner, Director of Learning & Development at Healthy Minds Innovations, and hosted by the nonprofit LoveYourBrain. Register in advance: there is a sliding scale fee starting at free.
Wednesday, August 27, 3 pm EDT: A live webinar for healthcare providers, Empowering Patients and Families Through Brain Injury Education, presented by Monique R. Pappadis, MEd, PhD, FACRM, and Wendy Waldman, BSW, CBIST; hosted by the Brain Injury Association of America. “In this webinar, healthcare providers will learn how to better support brain injury survivors and their families by using compassionate, trauma-informed approaches that recognize how educational needs change.” Register in advance (registration is $50 and gives ACBIS continuing education units).
Sports
Non-concussive head impacts can negatively affect the brain: effects of heading the soccer ball
A recent study by Nathan Delang et al., published in Sports Medicine, examined the acute effects of non-concussive head impacts—in this case, heading the ball—in 15 male soccer players. Non-concussive head impacts, which are head impacts that don’t elicit clinical symptoms, are very common in sport, with >99% of all impacts in sport being non-concussive, but there has been a lack of data on the effects of these impacts. The authors found that the impacts subtly altered brain chemistry and nerve function and slightly increased levels of two proteins associated with brain injury, glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL). This study used MRI and Electrical Properties Topography (EPT) to analyze the brain; EPT imaging revealed reductions in white matter conductivity, particularly concentrated in the mid-to-posterior white matter regions of the brain. And, while the individual findings are relatively minor, they show that heading the ball can cause subtle disruptions to the brain, even without clinical symptoms. The authors urge players to “exercise caution when performing repeated non-concussive impacts in sport”.
The study recruited 15 adult male soccer players to perform two tasks: a “heading” task, which involved returning a ball shot from a machine with the player’s head, and a “kicking” task, which used the same mechanism but with the player’s feet. Each player performed both tests with a week in between. After each task, researchers performed MRI and EEG scans, collected blood samples, and administered cognitive tests. The authors found that heading reduced tissue conductivity (how well electrical signals flow through the brain) in 11 clusters throughout various lobes of the brain. They also found a slight increase in both GFAP and NfL, two proteins associated with neurodegenerative brain diseases, when measured 24 hours and ~7 days post-heading. Finally, they found reduced brain wave power in the left parietal/occipital cortex after heading. However, no changes were seen in cognitive function as displayed through testing.
The changes displayed through a repeated heading task appear to be subtle and did not generate cognitive function decline. However, the slight increase in GFAP and NfL proteins, as well as reduced electrical conductivity in the brain, are relevant to future research looking at these non-concussive hits to the head. Further research may be needed to determine the clinical significance, but Delang et al. demonstrate the importance of studying both non-concussive and concussive impacts on the brain.
Pathophysiology
Difficulty in concentration in the acute phase after concussion is strongly associated with greater odds of persisting symptoms after concussion
A recent systematic review and meta-analysis by McIntosh et al. found that difficulty concentrating in the acute stage of concussion (the first 72 hours) showed the strongest association with persisting symptoms after concussion (PSAC). Additional factors associated with greater overall odds of PSAC were a medical history of mood (depression, anxiety) or sleep disorders, loss of consciousness or amnesia, and female sex. Published by JAMA Network Open, PSAC is defined by the study as symptoms such as headache, dizziness, nausea, or vomiting that persist for 30 days post-concussion. These symptoms can negatively impact daily living and return to life (RTL). The systematic review included 15 studies with 592,406 adult participants and investigated the association between unique factors and the overall odds of PSAC at 1, 3, and 6 months after concussion. Medical history of depression, anxiety, or sleep disorders was associated with the greatest odds of PSAC at 3 months, while difficulty concentrating in the acute phase of concussion was associated with the greatest odds of PSAC at 1 and 6 months. In an article for Medscape, the investigators clarify that evaluating specific acute symptoms “may be more important” than looking at the “sheer number of symptoms” following concussion.
Across all the studies reviewed in this systematic review and meta-analysis, the mean participant age was 29.3, with 42.2% female participants and 57.8% male participants. The researchers evaluated diagnoses of concussion with commonly-used definitions: a Glasgow Coma Scale of 13-15 (indicating a mild traumatic brain injury) and whether there was loss of consciousness within 30 minutes or posttraumatic amnesia within 24 hours.
Limitations of the study included between-study variability and a lack of consensus in diagnostic criteria for PSAC. Additionally, the timing of concussion evaluation and threshold for symptom severity could have introduced bias. The prevalence of PSAC could have also been influenced by the recruitment setting, as studies investigating 1-month outcomes had a larger variability in recruitment locations.
Self-Care
Dietary interventions can reduce persistent headache frequency and severity after brain injury, including concussion
A study conducted by Daisy Zamora et al. discovered a correlation between a diet consisting of high omega-3 fatty acids and low omega-6 linoleic acids (the diet is labeled “H3L6”) and a reduction in persistent post-traumatic headaches (pPTH). The study authors define pPTH as a frequent aftereffect of traumatic brain injury (TBI) that develops most commonly after mild TBI (concussion), with pPTH symptoms persisting longer than a year for over 40% of patients. In this study, published in the Journal of Neurotrauma, 122 military health care beneficiaries (active-duty personnel, veterans, etc.) who experienced pPTH were randomly grouped into a diet high in omega-3 fatty acids and low in omega 6 linoleic acids (H3L6), and a control group with a diet that is typical of U.S. fatty acid intake; both groups followed their diet for 12 weeks. Initially, participants in the study had, on average, 22 days of headache per month with an intensity of 3.5 out of 10. Zamora et al. found that the H3L6 diet led to a significant reduction in headache frequency and pain compared to the control diet. Over the 12-week period, the H3L6 diet resulted in 2 days less of headaches and a “30% reduction in the average headache pain intensity” compared to the control group. The study authors noted that the H3L6 diet increased plasma levels of DHA (docosahexaenoic acid) – an omega-3 acid that elicits antinociceptive properties, or the blocking of painful stimuli. The H3L6 diet also decreases levels of arachidonic acid, an omega-6 acid correlated with inflammation. The authors also noted that there were no statistically significant differences in adverse effects between the two groups.
Currently, pharmacological treatments for pPTH offer only limited relief. The biochemical effects that are linked with the benefits of the H3L6 diet illustrate the importance of dietary adjustments after traumatic brain injury to care for pPTH. With dietary interventions being low-risk and effective in providing health benefits, the study authors offer suggestions for future research, including studying dietary substitutions and types of supplements to optimize recovery and minimize symptoms in a broader population.
You Can Support Concussion Patients
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