Drinking With a Concussion

You barely hit your head, you’re probably fine right? A few hours go by, and you notice that your head is pounding, you feel nauseated, and you are starting to get dizzy. Oh, shoot! Maybe that hit to the head was a bit harder than you thought. You go to the doctor, and they tell you that you have a concussion and should avoid alcohol while you heal. But why does that matter? 

Through this blog post you will learn the basic information on brain injuries and concussions, why drinking alcohol can slow your healing process or make your symptoms worse, and ways to help recover after a brain injury. 

What Is a Traumatic Brain Injury? 

Traumatic brain injury (TBI) is defined as a hit to the head by an external force that causes damage to the brain. The highest rate of TBIs comes from falls, but other causes include car accidents, being struck by or against (sports injuries fall within this category), physical violence or assaults, firearm injuries, and other unknown causes. 

There are different severities of injuries we can sustain from a TBI — mild, moderate, or severe. TBI severity is determined by a scale called the Glasgow Coma Scale, which is a list of symptoms medical professionals use to score or track symptoms.  Most TBIs fall within the mild range which is often referred to as a concussion. When we hit our heads, we can receive both focal injury or damage to a specific spot in our brain, or diffuse injury which is more widespread damage to multiple areas of our brain. Most concussions or mild injury have diffuse injury where there are fewer cells dying but widespread damage to neurons throughout a larger area of the brain. Moderate-to-severe TBIs often have a mix of focal and diffuse damage.

It is estimated that 2.8 million people sustain a TBI each year in the U.S. alone. This number is derived from patients that seek medical attention for their injuries so it is often thought as an underestimate as not everyone seeks treatment for mild TBIs (concussions). TBIs can be detrimental to our long-term health as they can have chronic symptoms associated with the injury. Keep reading to find out what happens in our brain when we bump our heads.  

How Do Traumatic Brain Injuries Change Our Brain? 

With TBIs, there are two forms of damage our brain receives. First is the primary injury, which is the result of the initial hit to the head. Primary injury can include cell death, damage, or shearing and tearing of parts of cells in the brain (neurons) called axons. As a result of the initial damage to the brain, we develop secondary injury, which is from the cellular and molecular changes to the brain from the primary injury. 

Secondary injury starts to develop after the initial incident and can last for years after we hit our head. There are many forms of secondary injury that can damage the cells in our brain and change the way our neurons communicate with each other. The secondary injury can affect neurotransmitters, impacting other cells in our brain known as glial cells, which help regulate normal brain function, and impairing a process called neuroplasticity, which allows our brain to change and adapt to situations. Let’s take a closer look at how secondary injury changes our brain. 

• Neuron damage or loss. The primary injury can cause immediate damage to our neurons. Over time, as other secondary injuries process and ramp up it can lead to the loss of more neurons. Unfortunately, once a neuron dies, it can’t come back to life. 
• Neurotransmitters. Several neurotransmitters are changed as a result of brain injury. Dopamine, known as our reward chemical, is initially increased after brain injury, but after about two weeks, levels of dopamine start to decrease. Dopamine is an important neurotransmitter involved in the reward center of our brain. Disruption of the dopaminergic system with brain injury can change the way we respond to rewarding stimuli.
• Glial cells. There are three types of glial cells in our brains —- microglia, astrocytes, and oligodendrocytes. Microglia are the primary immune cells in our brain and function to help clear damage after TBI. However, over time, overactivation of microglia after TBI or concussion can result in further damage to the brain. Glia overreactivity is one form of secondary injury and is linked to damage of the neurons and neurotransmitter dysfunction after concussions. 
• Neuroplasticity. Neuroplasticity is a term that, simply put, means our brain has the ability to meld and change based on environmental factors. Our brain does this through changing the neural pathways or “rewiring”. Neuroplasticity comes in handy after brain injury as our brain starts to heal because if cells or connections are lost due to dead or damaged neurons, new connections can be formed to restore function. Not every function lost is replaceable, but our brain is miraculous at recovering. 

Damage to our brain from TBI and concussion leads to a variety of symptoms. Let’s review some common symptoms of brain injury below. 

• Physical symptoms. Physical symptoms include headache, dizziness, light or sound sensitivity, nausea, balance and coordination problems, fatigue or change in sleep patterns. 
• Cognitive symptoms. Cognitive dysfunction such as memory problems, attentional deficits, learning impairments, .
• Psychiatric symptoms. Psychiatric symptoms include depression, anxiety, impulsivity, increased anger, or risky decision-making. 

Symptoms of brain injury depend on the location and severity of injury. Due to the complexity of the brain, TBIs affect people very differently. An injury of the same caliber and location on two different people may manifest in very different ways with different symptomology and even severity. Another complicated aspect of the symptoms of TBIs and concussions is that some symptoms may not appear until months or years after the initial injury. That is what makes TBIs complex to treat, predict, or understand. 

Alcohol and Concussions

Alcohol and Our Brain 

Alcohol is a depressant, meaning it slows down our central nervous system. When we first drink alcohol, dopamine is released giving us those feelings of pleasure or reward. The depressant part of alcohol comes from the increase in release of a neurotransmitter called GABA, or the inhibitory neurotransmitter in our brain. Serotonin, or our happy brain chemical, is also impacted by alcohol with rises in serotonin as we first drink. Over time, our brain adjusts to chronic alcohol use by decreasing the amount of receptors for each neurotransmitter affected by alcohol. This means that when we drink we will not feel the same effects we once did with the same amount of alcohol. For a more detailed look at alcohol and the brain, check out this blog. 

How Alcohol Impacts the Injured Brain

When we have a brain injury such as a concussion, our brain is extremely vulnerable to the effects of alcohol. Because our brain is trying to heal after injury, drinking alcohol can make our symptoms worse, slow down our healing, and increase our chances of developing alcohol use disorder. Below, let’s review how alcohol can impact the injured brain. 

• Neuron damage and loss. Alcohol use alone can cause damage to the brain. Drinking alcohol while having a brain injury or trying to heal from a concussion can lead to further damage or death to our neurons. 
• Neurotransmitters. Having a concussion changes our neurotransmitter systems. Dopamine, GABA, and serotonin don’t work as effectively and need time to recover after we sustain an injury. Adding alcohol to the mix further disrupts our neurotransmitter systems and can make the side effects of alcohol more intense (we’ll touch more on this soon).
• Glial cells. Glial cells respond to our TBIs by reacting and helping clear up damage and debris. They can also help by regulating neurotransmitter levels. High amounts of alcohol can decrease the efficacy of glial cells, which can sometimes create them to become toxic and lead to further damage to the brain. 
• Neuroplasticity. Our brain becomes extremely plastic after injury within a few weeks to help gain back any networks of neurons lost. However, drinking alcohol may decrease plasticity factors in our brain. Drinking alcohol impairs neuroplasticity from helping us recover after concussions. 

So we see that driving with a concussion can hinder our physiological recovery, but what kinds of effects or risks are associated with drinking alcohol after a concussion? Let’s review it below. 

• Worsen our coordination and balance and potentially lead to another injury
• Decrease our ability to make decisions 
• Impair cognitive functions such as memory or the ability to focus
• Increase our chances of having a seizure 
• Intensify our symptoms of depression or anxiety

Drinking after a TBI before we are healed worsens our chances of healing and puts us at risk for making ourselves worse.

Should I Drink Alcohol After A Concussion? 

It is not advisable to drink while concussed. As we learned above, drinking after a brain injury can delay our recovery, make our side effects worse, and even lead to life threatening situations such as having a seizure or sustaining another brain injury. In fact, sustaining a second brain injury before the initial one heals increases our chance of severe brain damage or even death. 

How long should we wait to drink alcohol after sustaining a head injury? That is a tough question to answer because it truly varies across individuals. Ideally, we should wait until our symptoms subside before drinking alcohol again. This can take anywhere from weeks to years after the initial injury. Always check with a medical professional before drinking after sustaining a concussion. 

If we choose to drink after a concussion, we should drink in moderation. Having more than one or two drinks can really hinder our recovery and put us at risk for severe side effects. We also need to make sure we have a plan in place for transportation or a helper if we drink after a concussion since our coordination, balance,  and decision making can be questionable.

Brain Injury and Alcohol Use Disorder

There is a bidirectional relationship between TBI and alcohol use disorder (AUD). It can be unclear what comes first — brain injury or AUD. In reality, about 40% of all TBIs sustained involve alcohol. In some cases, misuse of alcohol leads to TBIs, but of course not every brain injury is the result of alcohol. 

When a person sustains a TBI, their chances of developing alcohol use disorder increases. But why is this? As we’ve talked about several times throughout this article, TBI changes our brain. One of those major changes happens in the reward center of our brain and makes us more vulnerable to developing addiction. Brain injury can also make us more risky and impulsive, which can drive drinking behavior and relapse. 

Tips for Healing Without Alcohol

• Avoid alcohol. It is best to avoid alcohol in the early stages of TBI recovery since it can slow the healing process. You might want to avoid alcohol if you have a history of AUD or alcohol misuse since you are at a greater risk for developing AUD after TBI.

• Sleep. Sleep is very restorative for our brain. While trying to recover from a concussion, it is extremely important to prioritize sleep.

• Relax. Don’t push yourself too hard mentally or physically. This doesn’t mean you need to lock yourself in a dark room and only sleep after a brain injury, but taking time off work or school may help speed recovery. A good rule of thumb is to take a break if you start to notice physical or psychological symptoms associated with your injury. 

• Light exercise. At the appropriate time, light exercise can help your brain heal after TBI. Exercise is known to increase neuroplasticity, which is important during the recovery from TBI. 

Bottom Line

Mild traumatic brain injuries or concussions can lead to physical, cognitive, and psychiatric symptoms that can last anywhere from weeks to years after the initial injury. Drinking alcohol after TBI is not recommended because it can slow the healing process or make things worse. It is crucial to drink in moderation and not to exceed more than one or two drinks while we are recovering from a concussion.