Understanding concussion in myalgic encephalomyelitis/chronic fatigue syndrome: Findings from the 2023 National Health Interview study 2025 Sirotiak+

[Andy]

ABSTRACT

Background
Although myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms (dysautonomia, dizziness, balance impairments) may theoretically contribute to an association with concussion, the nature of this association has not been determined. This study explored the association between ME/CFS and concussion, as well as risk factors for concussion, history of recent falls, and feelings of being dizzy or off balance.

Method
2023 National Health Interview Survey data were utilized. United States adults (unweighted N = 29,373) responded to items regarding sociodemographic factors, ME/CFS status, and history of concussion, falls, and feeling off balance or dizzy. Logistic regression analyses assessed the association between ME/CFS and concussion, falls, and feeling dizziness or balance problems within the past year, adjusting for sociodemographic factors.

Results
Individuals with ME/CFS had 4.89 times greater odds of reporting concussion in the past year compared to individuals without ME/CFS. Individuals with ME/CFS also had 2.86 times greater odds of having fallen within the past year and 5.88 times greater odds of reporting feeling dizzy or off balance in the past year.

Conclusions
ME/CFS status may be associated with concussion status. Healthcare practitioners should improve concussion screening and referrals for reducing concussion risk among individuals with ME/CFS.

Paywall

 

[Simon M]

I'm not sure much we can conclude from this. The problem with that survey is that it was of the general public, and we know if you ask the general public if they have ME or chronic fatigue syndrome, you're likely to get unreliable results. Louis Nacul found that for a British Columbia study using a similar approach, only about 40% met Canadian consensus criteria. And that's without a specialist exam to rule outpossible alternative explanations.

The age and sex profile of the sample are out of kilter with better defined, samples. I did raise these issues with Elizabeth Ungerwhen the survey came out, who acknowledge the issues and said they were planning further analysis, but I don't think anything happened.

 

[SNT Gatchaman]

Inclusion criteria —

ME/CFS status. Participants were asked ‘Have you EVER been told by a doctor or other health professional that you had chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME),’ responding yes or no. Participants endorsing this item were then asked ‘Do you still have Chronic Fatigue Syndrome (CFS) or ME?’ responding yes or no (45). Only participants answering yes to both questions, thus reporting current ME/ CFS, were considered to have ME/CFS in this study.

Head injury. All participants responded to two questions regarding head injury: 1) ‘During the past 12 months, as a result of a blow or jolt to the head, have you been knocked out or lost consciousness, been dazed or confused, or had a gap in your memory?’ or 2) ‘During the past 12 months, as a result of a blow or jolt to the head, have you had headaches, sensitivity to light or noise, balance problems, or changes in mood or behavior?’ Answer options included yes or no for each set of items. Participants endorsing at least one of these questions were considered to have had a concussion.

Fall history. Participants were asked ‘The next questions are about falling. By falls or falling, we mean unexpectedly dropping to the floor or ground from a standing, walking, or bending position. During the past 12 months, have you fallen at least one time?’

Balance and dizziness history. Participants were asked ‘These next questions are about dizziness or balance problems. Do not include times when drinking alcohol, using recreational drugs, or taking medications that cause dizziness. During the past 12 months, have you had a problem with dizziness, vertigo, lightheadedness, blurred vision when moving head, feeling like you are going to pass out or faint, or with unsteadiness or feeling off-balance?’

 

[duncan]

ME/CFS status may be associated with concussion status. Healthcare practitioners should improve concussion screening and referrals for reducing concussion risk among individuals with ME/CFS.

I am not sure this study tells us much of anything that isn't fairly obvious: ME/CFS patients with balance issues are at greater risk of falling than healthy controls.

That some of those falls may result in concussions is no more relevant than some may not, or some may result in a bruise to the arm or a sprained ankle.

The issue isn't the downstream effect of a concussion. It is all about balance; it's a balance issue. I come away with a vague and uneasy feeling they are more concerned with the potential for concussions in pwME. Concussions, brain bleeds, death - all can come as results from persistent balance problems.

Inclusion criteria —

I answered yes to all the inclusion criteria, and I still think their concussion focus is way off mark. I think it would have been off mark if they were looking for brain bleeds - which they did in me. They need to muster their collective attentions spans and figure out why our balance can be so precipitously bad as to cause ANY falls.