You Hit Your Head: Why Alcohol and Concussions Don't Mix

You bump your head and think, "It's probably nothing." But hours later, you're dealing with a pounding headache, nausea, and dizziness. Suddenly, that minor hit seems more serious. A doctor confirms you have a concussion and advises avoiding alcohol during recovery. But why does that matter?

This article explains the basics of brain injuries and concussions, why alcohol can slow healing or worsen symptoms, and how to support recovery after a head injury.

What Is a Traumatic Brain Injury?

A traumatic brain injury (TBI) occurs when an external force strikes the head and damages the brain. Falls are the leading cause, but other common sources include car accidents, sports injuries, physical assaults, and firearm incidents.

TBIs are classified as mild, moderate, or severe, typically using the Glasgow Coma Scale to assess symptoms. Most TBIs are mild and commonly called concussions. Injuries can be focal (affecting a specific brain area) or diffuse (spread across multiple regions). Concussions usually involve diffuse injury with widespread but less severe neuron damage.

An estimated 2.8 million people in the U.S. sustain a TBI each year—and that's only counting those who seek medical care. Many mild cases go unreported. TBIs can have long-term health effects, including chronic symptoms. Let's explore what happens inside your brain after a head impact.

How Do Traumatic Brain Injuries Change Our Brain?

TBIs cause two types of damage: primary and secondary injury. Primary injury results from the initial impact and can include cell death, damage, or shearing of neuronal axons. Secondary injury follows, involving cellular and molecular changes that can persist for years.

Secondary injury affects neurotransmitters, glial cells (which support brain function), and neuroplasticity (the brain's ability to adapt). Here's a closer look:

• Neuron damage or loss: Primary injury harms neurons immediately, and secondary processes can cause further loss. Unlike some cells, neurons cannot regenerate once dead.
• Neurotransmitters: Brain injury alters key chemicals like dopamine, which affects reward and motivation. Levels may spike initially but drop after about two weeks.
• Glial cells: These include microglia, astrocytes, and oligodendrocytes. Microglia help clear damage but can become overactive, leading to additional harm.
• Neuroplasticity: This is the brain's ability to rewire itself. After injury, neuroplasticity helps form new connections to compensate for lost functions, though not all abilities can be fully restored.

TBIs produce a range of symptoms, which vary by injury location and severity:

• Physical symptoms: Headaches, dizziness, sensitivity to light or sound, nausea, balance issues, fatigue, and sleep changes.
• Cognitive symptoms: Memory lapses, attention deficits, and learning difficulties.
• Psychiatric symptoms: Depression, anxiety, impulsivity, anger, and risky decision-making.

Symptoms can appear immediately or emerge months or years later, making TBIs challenging to predict and treat.

Alcohol and Concussions

Alcohol and Our Brain

Alcohol is a depressant that slows the central nervous system. Initially, it triggers dopamine release, creating feelings of pleasure. It also increases GABA, an inhibitory neurotransmitter, and affects serotonin. With chronic use, the brain adapts by reducing receptor sensitivity, diminishing alcohol's effects over time.

How Alcohol Impacts the Injured Brain

After a concussion, the brain is vulnerable. Alcohol can worsen symptoms, delay healing, and increase the risk of alcohol use disorder. Here's how:

• Neuron damage and loss: Alcohol alone can damage the brain. Combining it with a concussion increases neuronal harm.
• Neurotransmitters: Injury disrupts dopamine, GABA, and serotonin systems. Alcohol exacerbates these imbalances.
• Glial cells: Heavy alcohol use can impair glial cell function, sometimes making them toxic and causing further damage.
• Neuroplasticity: Alcohol hinders the brain's rewiring ability, crucial for recovery after injury.

Drinking after a concussion raises several risks:

• Worsened coordination and balance, increasing fall or re-injury risk
• Poor decision-making
• Impaired memory and concentration
• Higher seizure risk
• Intensified depression or anxiety

Should I Drink Alcohol After a Concussion?

No. Alcohol can delay recovery, worsen side effects, and lead to dangerous situations like seizures or additional head injuries. A second brain injury before the first heals can cause severe damage or even death.

How long should you wait? It varies. Ideally, avoid alcohol until symptoms fully resolve—which could take weeks to years. Always consult a healthcare provider before resuming drinking.

If you do drink, moderation is key. Limit to one or two drinks, and arrange safe transportation, as coordination and judgment may be impaired.

Brain Injury and Alcohol Use Disorder

TBIs and alcohol use disorder (AUD) are closely linked. About 40% of TBIs involve alcohol. Brain injury increases AUD risk by altering the brain's reward system and promoting impulsive behavior.

Tips for Healing Without Alcohol

• Avoid alcohol: Especially in early recovery. Those with a history of alcohol misuse are at higher AUD risk after TBI.
• Sleep: Prioritize rest—it's essential for brain repair.
• Relax: Don't overexert yourself mentally or physically. Take time off work or school if needed, and pause if symptoms flare up.
• Light exercise: When appropriate, gentle activity can boost neuroplasticity and aid recovery.

Bottom Line

Concussions can cause physical, cognitive, and emotional symptoms lasting weeks to years. Avoid alcohol during recovery—it slows healing and increases risks. If you drink, do so in moderation (no more than one or two drinks) and always prioritize your brain's health.