A concussion, medically classified as a mild traumatic brain injury (mTBI), is caused by a blow or jolt to the head that temporarily disrupts normal brain function. Symptoms often include headache, dizziness, memory problems, and fatigue, sometimes leading to post-concussion syndrome. Hyperbaric Oxygen Therapy (HBOT) is a treatment where a person breathes pure oxygen inside a chamber pressurized to greater than normal atmospheric pressure. Traditionally used for conditions like decompression sickness, HBOT is now being explored as a potential intervention for the lingering effects of a concussion.
The Biological Mechanism of HBOT in Brain Injury
HBOT is theorized to address the metabolic and physiological damage that occurs in the brain following a concussive injury. The high pressure forces oxygen to dissolve directly into the plasma, dramatically increasing the amount available to the body’s tissues. This hyper-oxygenated plasma can reach areas of the brain that are hypoxic, or low in oxygen, due to reduced blood flow and swelling following the trauma. Supplying this extra oxygen may help restore the energy supply to brain cells struggling due to the post-concussion metabolic crisis.
The increased oxygen concentration also exerts a powerful anti-inflammatory effect on the injured brain tissue. HBOT modulates the release of pro-inflammatory cytokines, which contribute to prolonged brain swelling and secondary damage. Reducing this neuroinflammation may mitigate symptoms like chronic headaches and cognitive fog.
The hyperoxic state is also believed to stimulate cellular repair and regeneration processes. Increased oxygen levels can promote neuroplasticity, the brain’s ability to reorganize itself by forming new neural connections. HBOT appears to stimulate angiogenesis, the formation of new blood vessels, and may mobilize stem cells to aid in the repair of damaged neural pathways. These regenerative effects are considered beneficial in chronic post-concussion syndrome.
The Hyperbaric Oxygen Therapy Treatment Experience
Undergoing HBOT involves entering a specialized pressure chamber where the ambient pressure is gradually increased. Two main types of chambers are used: monoplace chambers, built for a single patient and pressurized entirely with 100% oxygen, and multiplace chambers, which accommodate multiple patients who breathe pure oxygen via a mask or hood while the room is pressurized with compressed air.
A typical HBOT session, often called a “dive,” usually lasts between 60 to 90 minutes. The session includes a compression phase, a treatment phase at the prescribed pressure, and a decompression phase where the pressure is gradually lowered back to normal. For neurological conditions, a common protocol involves a block of 40 daily sessions to maximize cellular and regenerative effects.
Patients must be carefully screened before beginning HBOT due to potential side effects and contraindications. The most common side effect is ear barotrauma, discomfort caused by pressure changes in the middle ear, similar to air travel. Temporary visual changes and sinus pain are also possible, but these usually resolve after the treatment course is complete.
The only absolute contraindication for HBOT is an untreated pneumothorax (collapsed lung), as pressure changes could cause a life-threatening tension pneumothorax. Relative contraindications include claustrophobia, active upper respiratory infections, or a history of pulmonary conditions like Chronic Obstructive Pulmonary Disease (COPD). Careful medical oversight is required to ensure patient safety.
Current Research and Medical Consensus
Despite the compelling biological mechanisms, the use of HBOT for concussions remains a subject of ongoing debate in the medical community. The Food and Drug Administration (FDA) has approved HBOT for 14 specific conditions, such as severe burns and non-healing diabetic wounds. However, the FDA has not approved HBOT for the treatment of concussions or for general cognitive improvement.
Consequently, its use for concussion recovery is considered “off-label” or experimental, meaning the risks and benefits for this specific indication have not been fully established. The clinical trial landscape is complex, partly due to the difficulty in designing an effective placebo control. In many studies, the control group receives a “sham” treatment, involving minimal pressurization while breathing regular air, making it hard to distinguish the physical effect of oxygen from the psychological effect of the pressurized environment.
Some rigorous, randomized controlled trials have shown no significant difference in cognitive function or post-concussion symptoms between the true HBOT group and the sham-treated group. This has led many neurological and sports medicine organizations to recommend HBOT for concussions only within the context of controlled research studies.
Conversely, other studies, particularly those focusing on chronic TBI patients, have reported significant improvements in memory, attention, and overall quality of life. While individual patients may report improvement, the overall medical consensus is that the evidence is still mixed and inconclusive. More large-scale, methodologically sound trials are necessary to definitively confirm HBOT’s efficacy as a standard treatment for concussion.