Traumatic Brain Injury and Concussion

A traumatic brain injury (TBI) is damage to the brain caused by an outside force, such as a blow to the head, a fall, a car accident, a sports collision or a blast. Doctors often grade TBI with the Glasgow Coma Scale: a score of 3–8 is severe, and 13–15 is mild TBI, which is commonly what people mean by a concussion. Most people recover from a concussion within days to weeks. For some, though, symptoms last more than three months, a condition called post-concussion syndrome (PCS). Common symptoms include headaches, balance problems, poor sleep, fatigue, forgetfulness, trouble concentrating, irritability and anxiety. These lingering symptoms can affect work, school and relationships long after the injury, and effective treatments remain limited. That gap is a major reason researchers are studying new approaches, including hyperbaric oxygen therapy.

Potential mechanisms of HBOT in TBI and Concussion: Summary findings from human hyperbaric oxygen studies

Human studies of HBOT have measured several changes in the brain that may help explain how it could support recovery, though these findings are still being confirmed. The most consistent signal involves blood flow. In a small study of patients with mild to moderate TBI, HBOT was associated with better cognitive function along with increased cerebral blood flow and oxygen metabolism. A study of firefighters with mild TBI found increased blood flow in and around the hippocampus, a region central to memory. In a randomized trial of severe TBI, patients treated with HBOT showed higher brain blood flow and oxygen uptake. Researchers have also looked at brain structure: in a sham-controlled trial in children with post-concussion syndrome, clinical improvements correlated with MRI microstructural changes in several brain regions. After moderate to severe injury, one study reported reduced hematoma volume, lower levels of blood markers of brain damage and higher levels of markers linked to regeneration. Another found that some blood markers of oxidative stress fell after treatment. The Israeli research group behind many of these trials has also published studies proposing that HBOT may induce new blood vessel growth and nerve fiber regeneration in TBI patients.

A 2024 review in Frontiers in Neurology explores how hyperbaric oxygen may encourage neuroplasticity, the brain’s natural ability to repair and rewire itself, by boosting energy production in brain cells, supporting the growth of new blood vessels and nerve connections, increasing a key brain growth factor (BDNF), and reducing inflammation. The authors propose that these effects may help explain the improvements in memory, thinking and quality of life reported in some studies of people with concussion and brain injury, while noting that more research is needed to fully understand how and for whom it works.

If you would like to learn more about any of these studies or many others, please review the list below or contact the Nardella Clinic.

Citation list

Clinical trials and reviews reporting benefit

1. Weaver LK, Ziemnik R, Deru K, Russo AA. A double-blind randomized trial of hyperbaric oxygen for persistent symptoms after brain injury. Sci Rep. 2025;15(1). doi:10.1038/s41598-025-86631-6
2. Hadanny A, Catalogna M, Yaniv S, et al. Hyperbaric oxygen therapy in children with post-concussion syndrome improves cognitive and behavioral function: a randomized controlled trial. Sci Rep. 2022;12(1). doi:10.1038/s41598-022-19395-y
3. Harch PG. Systematic review and dosage analysis: hyperbaric oxygen therapy efficacy in mild traumatic brain injury persistent postconcussion syndrome. Front Neurol. 2022;13:815056. doi:10.3389/fneur.2022.815056
4. Harch PG, Andrews SR, Rowe CJ, et al. Hyperbaric oxygen therapy for mild traumatic brain injury persistent postconcussion syndrome: a randomized controlled trial. Med Gas Res. 2020;10(1):8-20. doi:10.4103/2045-9912.279978
5. Hadanny A, Abbott S, Suzin G, Bechor Y, Efrati S. Effect of hyperbaric oxygen therapy on chronic neurocognitive deficits of post-traumatic brain injury patients: retrospective analysis. BMJ Open. 2018;8(9):e023387. doi:10.1136/bmjopen-2018-023387
6. Boussi-Gross R, Golan H, Fishlev G, et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury: randomized prospective trial. PLoS One. 2013. PMCID: PMC3829860
7. Ablin JN, Lang E, Catalogna M, et al. Hyperbaric oxygen therapy compared to pharmacological intervention in fibromyalgia patients following traumatic brain injury: a randomized, controlled trial. PLoS One. 2023;18(3):e0282406. doi:10.1371/journal.pone.0282406
8. Doenyas-Barak K, Kutz I, Lang E, et al. Hyperbaric oxygen therapy for veterans with combat-associated posttraumatic stress disorder: a randomized, sham-controlled clinical trial. J Clin Psychiatry. 2024;85(4). doi:10.4088/JCP.24m15464
9. Miskin BM, Fox LA, Abou-Al-Shaar H, et al. Hyperbaric oxygen therapy for the management of mild and moderate traumatic brain injury: a single-center experience. World Neurosurg. 2023;176:e357-e370. doi:10.1016/j.wneu.2023.05.062
10. Hadanny A, Efrati S. Editorial: Hyperbaric oxygen and the brain. Front Neurol. 2022. doi:10.3389/fneur.2022.1078544
11. Bin-Alamer O, Abou-Al-Shaar H, Efrati S, Hadanny A, Beckman RL, Elamir M, Sussman E, Maroon JC. Hyperbaric oxygen therapy as a neuromodulatory technique: a review of the recent evidence. Front Neurol. 2024;15:1450134. doi:10.3389/fneur.2024.1450134

Moderate to severe and acute TBI

12. Chen Y, Wang L, You W, et al. Hyperbaric oxygen therapy promotes consciousness, cognitive function, and prognosis recovery in patients following traumatic brain injury through various pathways. Front Neurol. 2022;13:929386. doi:10.3389/fneur.2022.929386
13. Daly S, Thorpe M, Rockswold S, et al. Hyperbaric oxygen therapy in the treatment of acute severe traumatic brain injury: a systematic review. J Neurotrauma. 2018;35(4):623-629.

Ongoing trials

14. Hyperbaric Oxygen Brain Injury Treatment (HOBIT) Trial: a multicenter, randomized, Phase II adaptive trial in severe TBI. ClinicalTrials.gov NCT02407028.
15. Hyperbaric Oxygen Treatment for Veterans With Traumatic Brain Injury. University of South Florida. ClinicalTrials.gov NCT06581003.

Health Canada Compliance Notice

Health Canada regulates the approved use of HBOT for 13 specific medical conditions. While HBOT is recognized for the 14 conditions outlined by the Undersea & Hyperbaric Medical Society, any additional uses must be assessed through a comprehensive consultation with our qualified naturopathic doctors. Patients are encouraged to discuss their health concerns and explore whether HBOT is appropriate for their care.