Hyperbaric Oxygen Therapy for TBI and Concussion: What the Research Shows

Important: Hyperbaric oxygen therapy is not FDA-approved for traumatic brain injury or concussion. This is an investigational use. Evidence is preliminary. Insurance will not cover HBOT for this condition. All costs are out-of-pocket.

Veterans, athletes, and accident survivors make up a large share of people looking into HBOT for TBI and post-concussion syndrome. The research is real, but the picture is mixed. This page covers what the studies actually found.

What TBI and Concussion Are

Traumatic brain injury (TBI) ranges from mild concussion to severe injury with prolonged unconsciousness and lasting impairment. Common causes include sports impacts, blast injuries in military service, vehicle accidents, and falls.

TBI is a significant health issue for veterans. Studies estimate that 20% or more of veterans from recent conflicts have experienced TBI, often from blast exposure.

Concussion symptoms, including headache, cognitive slowing, memory problems, mood changes, and sleep disruption, can persist for months after injury. When they do, the condition is called post-concussion syndrome.

Why Researchers Are Studying HBOT for TBI

After TBI, some neurons in the damaged area are injured but not dead. This “zone of injury” contains cells that are struggling but potentially recoverable. The hypothesis behind using HBOT is that improving oxygen delivery to these cells may support their recovery and reduce neuroinflammation in the surrounding tissue.

HBOT may also stimulate neuroplasticity, meaning the brain’s ability to reorganize and form new connections. That’s particularly relevant for patients who are months or years past the initial injury.

The Department of Defense and the VA have funded multiple TBI trials because it’s one of the most common injuries among military personnel. That research funding reflects how seriously this question is being taken.

What the Research Has Found

The evidence is mixed, and it’s important to say that directly.

Harch et al. (2012) published a study of 16 veterans with chronic TBI showing improvements in brain blood flow, symptoms, and quality of life after HBOT (PMID: 22549035). But the sample was small and there was no control group, which limits what we can conclude.

Boussi-Gross et al. (2013) published a randomized controlled trial of 56 mild TBI patients who were 6 months to 5 years post-injury. The HBOT group showed improvements in cognitive and quality-of-life measures compared to controls (PMID: 24236054). This is stronger evidence, though still from a single center.

However, a DoD-sponsored trial called the HOPPS trial found minimal benefit of HBOT over sham treatment in blast-related TBI. That’s a significant counterpoint.

The overall picture: promising findings in some populations, inconsistent results in others. Protocol, timing after injury, type of TBI, and patient population all appear to influence outcomes. More research is ongoing.

Veterans and HBOT

The VA does not currently cover HBOT for TBI as part of standard care. Some veterans access HBOT through clinical trials or nonprofit organizations that offer subsidized treatment as part of research programs.

If you’re a veteran interested in HBOT for TBI, ask your VA provider about current clinical trial opportunities. The VA and DoD are actively investigating this question, and trial participation may reduce or eliminate your costs.

What HBOT Won’t Do for TBI

HBOT is not FDA-approved for TBI or concussion. Insurance won’t cover it.

It doesn’t reverse permanent brain damage. And it can’t replace standard TBI rehabilitation, including physical therapy, cognitive therapy, and occupational therapy. Those are the core of TBI recovery and shouldn’t be skipped while pursuing investigational options.

Frequently Asked Questions

Is HBOT covered by insurance for TBI? No. Insurance won’t cover HBOT for TBI or concussion. It isn’t FDA-approved for this use. All costs are out-of-pocket.

How long after a TBI can HBOT be used? Most research has focused on patients from 6 months to several years post-injury. The evidence for very recent injury is thinner. Ask your neurologist about timing.

Can HBOT help with post-concussion syndrome? The Boussi-Gross et al. (2013) trial specifically studied patients with persistent post-concussion syndrome and found improvements in the HBOT group. But that’s one study. Your care team should help you weigh the costs and potential benefits given your specific situation.

Where can veterans find HBOT for TBI? Some nonprofit organizations offer HBOT programs for veterans. Your VA provider can also tell you about current clinical trials. Do not pay out-of-pocket at a private clinic without first checking trial eligibility.

References

Harch, P.G. et al. (2012). A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. Journal of Neurotrauma. PMID: 22549035. https://pubmed.ncbi.nlm.nih.gov/22549035/

Boussi-Gross, R. et al. (2013). Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury — randomized prospective trial. PLOS ONE. PMID: 24236054. https://pubmed.ncbi.nlm.nih.gov/24236054/

See all conditions on the conditions hub. For a related brain-injury topic, see long COVID and HBOT. For stroke survivors, see the stroke recovery page. The what is HBOT guide explains how treatment works, and the cost guide covers what to expect to pay.

Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.