The brain is the most important organ! It is a 3-pound supercomputer that regulates the patrol officer’s ability to see the suspect and take the appropriate action to keep the community safe. It enables SWAT to conduct skillful crisis negotiations with barricaded suspects and save the day. It allows ICAC teams to know when to execute search warrants to bring the pedophiles into the light of day. It controls what cops think of political leaders who reopen closed cases against other cops. It also controls how they feel about it. It regulates how police play and replay OISs in their heads, how they shoot at the range during quarterly quals, how hungry they are at Code 7, what their blood pressure is at any given moment, how they slept last night and every other bodily function.

Because the brain impacts all bodily functions, headaches, migraines and concussions can be debilitating for sworn and civilian personnel, and the cause and treatment can often seem elusive. It may be helpful, therefore, to consider the symptoms, causes and treatment. Organizational recommendations are also offered.

Symptoms

Every cop has experienced the dull pain of a tension or stress headache. It’s a constant ache often on both sides of the head. It can feel like a band pressing tightly around your head, sometimes like your head is in a vice clamp. Headaches generally do not last longer than a couple hours and generally do not prevent an officer from performing the duties of the day. 

Migraines demand more attention than a headache. You will likely experience throbbing or pulsing pain (and typically on one side of the head), light and/or sound sensitivity, nausea or vomiting. Some officers experience an early warning detection system known as an “aura” — restricted or blurry vision with stars or zig-zags — signaling that their migraine is imminent. Migraines typically last up to 72 hours if left untreated.

Concussions are considered mild traumatic brain injuries (TBIs) and therefore need to be taken seriously. After a bad blow to the head, your brain sloshes around your skull. It gets bruised, and this hurts. Some symptoms are common with migraines (e.g., light and sound sensitivity, significant vision difficulties), but symptoms go well beyond that to (typically) include dizziness, balance problems, confusion, brain fog, difficulty focusing or concentrating, grogginess, memory impairments and even significant personality change. Most concussions resolve within 30 days, and so officers tend to be IOD for a month. But symptoms can last months or longer.

Causes

Law enforcement officers are an at-risk group for concussions and repetitive head injuries. Getting your bell rung on duty is a job hazard.

Consider that one-third of all law enforcement line-of-duty deaths from 2011–2020 were due to TCs. Think about the motor officers who have been hit by moving vehicles. Think about what happens when suspects intentionally ram their vehicles into your black-and-white.

Consider the bricks, bottles and other hard objects regularly thrown at police officers during riots. Officers in Kenosha, New York, Orlando, Philadelphia and Memphis have felt those bricks. Officers in San Francisco, Los Angeles, Baltimore, West Chester Borough (PA), Austin, Tampa and Jacksonville have felt those bottles. U.S. Border Patrol as well as officers in Seattle, Fresno, Chicago, Phoenix and El Paso have felt those rocks.

Consider the 140 officers who sustained head injuries (including concussions), broken ribs and other serious injuries during the Capitol riot. Consider what might have happened to the brains of those officers who died by suicide in the aftermath. Suicide is the top cause of death tied to TBIs.

Consider the blows to the head during physical altercations with combative suspects. Officers in Detroit, New York, Pawtucket (RI), Newton (MA) and Provo (UT) have felt those punches.

Consider what sometimes happens during flashbangs, explosive forced entries or even intentional bomb squad detonations. Officers from the Pennsylvania State Police, Philadelphia, Montgomery County (MD), Portland, Fort Worth, Mobile County (AL) and Lake City (FL) have felt that blow back.

Consider what happens when
you take a hard fall to the ground. Head injuries can cause bleeding in the brain tissue. Symptoms can develop immediately or very slowly over hours or days. So even if you feel OK immediately afterward, you don’t know if you’re a ticking time bomb for hemorrhage or worse. So it’s always critical to notify the supervisor and get checked out by the MD before responding to the next call.

Treatment

Relax in a dark, quiet room. This is (generally) good care for headaches, migraines and concussions.

Tension headaches are easily treated with OTC meds (e.g., Advil, Tylenol, Motrin IB). Cognitive behavioral therapy, biofeedback, massage and acupuncture are alternative treatments that help.

Try hot and cold compresses to the head or back of neck for migraines. Ice packs anesthetize or numb the pain. Heat relaxes tense muscles, and that’s why hot showers feel so good. Sip a caffeinated beverage; this can enhance the pain-relieving effect of acetaminophen and aspirin. There are prescription meds (and even preventative meds) you can take. Talk to your doctor.

Diagnosing concussions tends to include neurological examination, cognitive testing, imaging tests and observation. Treatment includes significant physical and mental rest to allow the bruised brain to recover. At least for the first few days, limit sensory exposure, physical exertion and mental activities that require effort. Yes, this includes no screen time. Then continue to mentally and physically rest until such activities do not provoke or worsen symptoms. Work closely with your neurologist MD specialist to know when you are OK to return to light duty, full duty, or studying for promotion exams and extracurriculars.

Organizational recommendations

Sports medicine and military research offer management recommendations for protecting officers’ heads. These include mandatory seat belt use, protective head gear during training and on patrol, appropriate footwear to minimize slips and falls in inclement weather, and trainer awareness and oversight to mitigate forceful blows to the head.

Professional sports teams and high-level college programs have dedicated medical teams that make it easier to track and diagnose concussions among those athletes than in other populations. Consider creating a dedicated medical team at your agency. Keep in mind that concussion protocols are based on research of mostly men (greater than 80%). About 40% of the studies had no women at all. The research is imbalanced. Female brains are not male brains, so they cannot necessarily be treated the same.

The NFL has a Head, Neck and Spine Committee that reviews the concussion protocol each year to ensure players are receiving care that reflects the most up-to-date medical consensus on the identification, diagnosis and treatment of concussions. Consider creating such a board of independent and law enforcement-affiliated physicians and scientists (including advisors for the union) in your department. Your department committee should also adopt concussion screening, follow-up and return-to-duty guidelines.

The FBI has a Law Enforcement Suicide Data Collection (LESDC) surveillance program to help agencies better understand and prevent suicide. The data collected includes circumstances immediately preceding the event, general location, demographics and occupational category. Likewise, consider creating a concussion surveillance program in your department to identify frequency and causes, and thus better target prevention training.

The National Transportation Safety Board (NTSB) tracks every civil aviation accident in the U.S., as well as significant accidents in other transportation modes — rail, transit, highway, marine, pipeline and commercial space. They create the industry standard “Most Wanted List” — the top reasons why such accidents happen in each mode and how to better prevent them. Some air support divisions at police departments adopt this wise approach. Likewise, consider a concussion “Most Wanted List” at your agency, and then train personnel to better prevent such traumatic injuries.

Finally, encourage your officers to adopt a new weapon — brain health! This means encouraging them to adopt a brain optimization program that includes taking measures now to protect their brains from future injuries — nutrition, regular physical exercise, targeted nutritional supplements and new learning.