Is it Post Concussion Syndrome or Post Traumatic Migraines?
 

Two months ago, I was involved in a car accident where I hit my head twice. I has a headache afterwards and some neck pain but no other symptoms. About six weeks after the accident, I started to develop really bad headaches at the top of my head, nausea, dizziness, blurry vision and sensitivity to light (to the point of wearing sunglasses indoors!) My physiotherapist was convinced that I have post concussion syndrome so I went to see a neurologist, but he said that it can’t be PCS because the symptoms didn’t occur until 6 weeks later. He told me I have chronic migraines (my symptoms have lasted about a month straight now) and told me to avoid some common triggers and see if it gets better. He also told me that it’s okay for me to exercise, but my physiotherapist says not to do anything but rest. I don’t know who is correct here, and whether it is safe for me to workout. I feel light-headed and like I want to vomit almost all the time. I have not had an MRI done. What should I do? The neurologist told me he doesn’t have to see me again since he doesn’t think there is a brain injury. But my symptoms are daily and not going away and it has now been 2 months since the accident

im no doctor but i think its pcs. I was in car accident and i dont think i hit my head but i still got a concussion. Didnt have any symptoms til about 6 months after accident(or that i noticed). 2 and half years later still having symptoms. My symptoms are dizziness,fogginess,headaches,nausea,fatigue,and concentration. Maybe find another doctor.

It is not uncommon for PCS symptoms to be delayed like yours are. Either way, you situation is the same. You have headaches. The rest will be good and avoiding head ache triggers is important. Limit caffeine to one serving per day. Try to keep you blood pressure down to safe normal limits.

A CT scan would be appropriate if your head aches get very intense.

Exercise is OK if you can avoid triggering symptoms. This means your limit in pulse rate should be lower that your exercise target from pre-PCS. It is likely that your exercise limit is quite low. Maybe just a brisk walk or some low intensity spinning.

If you start to sense any symptoms during your exercise, stop. Note the level of intensity and use it as a limit for the future. You want to stay below that limit with a good margin of error. If 120 bpm is the limit before symptoms, then stay below 110 bpm or even 100 bpm.


Hope this helps.

My best to you.

Pcs?
 

I'm sorry to hear about your accident. Sounds like you're getting mixed messages. I'm no doctor either but sounds like you may have PCS.

First off, concussions don't always show up on MRI's or CT scans. They could both be negative and you could have had a severe concussion. Those test are mainly looking for an acute bleed in the brain. Just because it isn't bleeding doesn't mean that there has not been trauma.

Your symptoms show that you do have effects from trauma. Did you have migrane headaches before your accident? If not then I would have to say its PCS.

PCS symptoms don't always start immediately after trauma. Those that you mentioned I have had. This is really serious. Please go to a DR. that takes you seriously. You could have a long healing process and it is very important that you know so you don't reinjure your sensitive brain.

I experienced headaches that were both tension and migrane from my accident. Everyone is different, and to be honest my neurologist didn't explain it very well to me at first. Most people have a combination of these types. This is important to the doc because pain medications may be given related to what type of headache you have.

Also, don't exercise at all. Especially until you know what is going on. You will feel awful after and may cause more damage. It's hard not to do anything active but just wait.

There is a head injury survival download somewhere here on the site.

Best advice- you have to rest as much as possible and go to another doctor to get better medical advice!

Best Wishes.

I will repeat what others have said: I am not a doctor, but it surely sounds like PCS. That neurologist doesn't sound like he knows much about PCS.

I had migraines before my injury, but NOTHING like what I have now. I am almost 14 months post injury, and I still have headaches.

Did the neurologist give you anything to help with the headaches, besides telling you to avoid triggers?

They usually like to put you on medications that can help prevent the headaches. I have tried half a dozen of those medicines, and they all make me nauseous. Some of them also make me dizzy and more tired than I am already. But I am very sensitive to medications, and if they could find one that works for you, it could relieve your headaches.

There have been some studies done on vitamin B-2 (riboflavin) helping migraines, and I am trying that now. It seems to be helping to make my headaches more manageable, even though I still have them. You can google migraines and vitamin B-2, and you will get lots of information.

But there are other natural products that you might also want to look into like Petadolex (a purified form of an herb called butterbur). Also, some people have found relief using CoQ10.

I am also considering botox injections if nothing else helps.

I surely hope that you get some help for your migraines. They are so disabling! One thing that helps a little is an icepack on the back of the head before or during a migraine. (15 minutes on, then as needed)

The ice is supposed to slow down the pain signals (or something like that). I know that it helps along with medicine.

Exercise is probably the worst thing that I can think of doing when I have a migraine. But if you go to a physical therapist, they may be able to give you specific exercises to help you.

Good luck. Let us know how you are doing. I really do know how horrible those migraines can be.

I have also found cranial sacral physical therapy to be helpful for my headaches. But you have to find someone who is really good at it.

ShellyK

The web site for the TBI Survival Guide is www.tbiguide.com

Thanks!
 

Thank you all for your responses.

I was also very confused by my neurologist because the symptoms do seem like PCS to me, but he was absolutely sure that there’s no way that is what I have or that I even need an MRI. I had tension-type headaches before my accident (most likely due to some disc issues at the back of my neck), but never a true migraine with any nausea, dizziness, blurriness or sensitivity to light. All those symptoms are new.

I have been very frustrated with the way that doctors don’t seem to take this seriously. My family doctor is away until the end of April, and when I saw her stand-in, he banged on my knees and elbows with the rubber mallet and told me there’s no way it’s PCS because my reflexes are fine and told me I have the flu of all things (???) I’ve been getting mixed messages from everyone, but do feel that PCS is very likely.

The neurologist advised me that being on birth control pills could be triggering migraines, so I stopped last week and so far my headaches have actually been worse. I find the things that help are: drinking lots of water, physiotherapy for my neck, staying away from sunlight (not really something I can turn into a lifestyle!) and placing a heating pad at the back of my neck. But that is very temporary and the symptoms usually come back within a few hours. I have researched feverfew as a possible relief, but I’m worried because I have low blood platelets (always have) and I don’t want anything that could increase risk of bleeding. I will look into a B2 supplement. Right now I am taking a B12 supplement, but that’s because my numbers have always been low. It’s not helping with the symptoms.

My main concern right now is the exercise, because I have some weight to lose, and I don’t want to wait for possibly months before my symptoms go away. But I also don’t’ want to make my situation worse. Do you think light exercise such as elliptical, bike, yoga, stretching, squats, lunges, etc. are okay for me to try? I like the suggestion of giving it a go and seeing if my symptoms get worse, but that might be hard to tell as I’m dizzy and have head pain to start with. I would love to run, but that sounds like it would shake my head around too much. Any advice you can provide me with would be great!! (Until I see my family doctor at the end of April and hopefully she can refer me to another neurologist and for an MRI!)

Welcome to NeuroTalk:

For oral B12 supplements, the best results would be from using methylcobalamin (available inexpensively online) and taking at least 1000mcg (1mg) on an empty stomach daily.

If you are really low in test results, 5mg daily instead.

Using other forms, eating with it, or not taking enough will be much less effective.

MethylB12 is the activated form, and works best. It does not cost more than the synthetic older version called cyanocobalamin. Some people cannot convert in the body to the methyl form, and so see failure with cyano.

kayseeah,

Your doctors are clueless about concussion. They seem like they were trained in the dark ages. Their reasons you cannot be suffering from PCS are signs of their ignorance. Reflex tests are meaningless as is the comment about six weeks post injury. Reflex tests might show a positive result if they are repeated at least a dozen times or more. This sometimes causes neurological fatigue with the resulting positive response.

An MRI is almost sure to be negative. Unless you have disabling headaches with other concurrent serious neurological symptoms, you will likely be just wasting time and money.

A fasting/low calorie type of diet with proper nutritional supplements (B-2, B-6, B-12, niacin, Omega 3's, folic acid) may be more tolerable. The brain can survive on low calorie consumption by using the ketones from the liver.

You neck condition may be a leading cause of your headaches. Continue to get treatment for your neck, including some light traction is possible.

Keep in mind that the vast majority of doctors are clueless about concussion.

There are two drugs that are sometimes used for PCS headaches. Amitryptiline (Elavil) in small (10mgs) doses and cyproheptadine (Periactin) if you can tolerate it. For me the Periactin causes serious depression.

Hope you find some relief. I live with headaches and know how they can effect your daily life.

My best to you.

Thank you for the help, Mark. I appreciate it! Yes, it does seem that my doctors don't know what they are talking about. I am hoping that my family doctor will at least take me seriously, but I have doubts. I think the MRI, for me, is just more of a "peace of mind" request, and I don't think an unreasonable one considering the extent of my car accident. (I'm actually surprised that nobody gave me a head scan right after! My car was totaled.)

Do you, or does anyone else, know the best TYPE of exercise for me to try right now? I am getting married within a few months and really want to look and feel my best.

Thank you.

Similar situation
 

Hey, I read your post. I was involved in an accident. I was body surfing at the beach and a big wave slammed me head first into the sand. It doesn't sound like much, but it was a BIG wave and caused 8 bad discs. Over time my discs got worse and I began to get migraine headaches. I've never had them before and the only cause (for me) could be the bad discs in my neck. Migraine meds sometimes help my symptoms. If you are experiencing sensitivity to light and sound, vomiting and the headaches then it may be migraines and they may have been brought on by the trauma. Ask your doc for migraine meds and also buy some excedrin migraine, which can sometimes help if taken early on when you first notice symptoms. Also it helps to try and sleep off the symptoms and it sometimes helps to get a hot shower during an attack.

I will definitely ask about what medications might be helpful with my symptoms. I'm just hoping they don't have any extra side-effects!

In general, what is the difference between PCS and post-traumatic migraine? Is there a distinct characteristic that gives one away from the other?

I don't know the difference between the two. I just know that I almost had to self diagnose my migraines before my docs could figure it out. Once I came up with migraines there was an "ah hah" moment and we started prophylactics for it and migraine meds, which all seem to help to some degree. I get severe migraines, so the meds only work on the not-so-bad days, and only when I catch them early. I have no info as to the other conditions at all, I was just speaking as to the fact that migraines can and do indeed occur as a result of head/neck trauma because in my case it happened to me.

kayseeah,

The condition of your car has nothing to do with your concussion. Unless you are experiencing severe head aches and serious cognitive difficulties, an MRI is a waste of money. They do not have the resolution to show the minute damage done in a concussion. If you had a brain bleed, your symptoms would be very severe.

If all of a sudden, you have an extreme head ache or serious confusion, go to the ER.

If you are serious about getting an image done, a CT scan would be appropriate. It is quick, a lot cheaper, and will show if there is a bleed. If an MRI is your demand, you will probably do best with an MRI/MRA. This shows the vasculature in your head. A plain MRI will not show blood vessels very well.

With PCS, you treat the individual symptoms, not the Syndrome.

The kind of exercise you probably want to do to be in shape for your wedding is probably out of the question. Slow weight training will probably help you maintain muscle tone. Unfortunately, women seem to think that loose muscle is flab or fat. No, it is just relaxed muscle.

Slow weight training is a form of weight training where you use a weight that is a bit heavier that a rep weight. You lift/move the weight/resistance slowly through the range of motion. The slow movement puts more intensity on the muscles without creating an aerobic effort. If you can do the slow weight training without causing your pulse and BP to rise, you will likely be OK.

My honest recommendation would be to just focus on fitting your wedding dress. Do the minimums to fit the dress and focus on recovery. It will be better to be able to enjoy your wedding because you do not have a head ache than to look great but feel miserable.

The stress of the last few months before a wedding will be tough enough on your brain. You don't need to add to the stress level. Pushing things may end up causing you to experience the shortness of temper that is common to PCS. Bridezilla with PCS will not be a good memory.

My best to you.

The wedding and excercise
 

Hi Kayseeah,

You're getting married! How exciting and what a bad time to have the symptoms that you are having to deal with!

Before my sister's wedding she was in a panic about having to lose 28 lbs in order to fit into her wedding dress. She didn't lose that much weight, turned up in a wedding dress that fitting fine and everything went absolutely fine. She was just panicking about being on display and feeling self-conscious about it. Now it's a family joke.

I am presuming that someone has proposed marriage to you the way you are now and that isn't conditional on your being any lighter by the time of the wedding. So, I would say that as long as he is happy (or possibly she - I am not sure what your local laws are) then that is the main thing, so don't panic about losing tons of weight. You will look just fine and your friends and family who love you, love you just the way that you are.

If you decide that you really want to be doing some exercise, I would say:
1. Don't do anything that jerks your head around. (I think that you already know this.)
2. Don't do anything that puts any strain on your neck, like shoulder stands or bending your neck excessively.
3. Don't do anything that makes you feel at all unwell.

There are some people who think that aerobic exercise might actually help the symptoms. I have not found that it makes much difference, but it didn't make the symptoms any worse when I have raised my heart rate. I have tried this using the cross-trainer and cycling (or a cycle machine) and found that this was fine. Note that with these exercises the head is pretty stationary. I found that jogging was not at all good.
So, there you are.
Cross-trainer or cycle, don't jog, don't jerk your head.
Don't worry about the dress; you'll be fine.
Wishing you both every happiness,
CS

Thank you!
 

Thank you all for your responses! It is so nice that finally I found this site where other people can relate to what I'm going through. Your advice is very much appreciated.

I visited a walk-in doctor this weekend due to severe headaches and nausea. He is a very good doc that I have been going to for a while, but obviously cannot order any testing, etc. I was happy to hear that he also agreed it is a mix of PCS and migraines that are being caused by my neck situation. Well, not "happy", but you know what I mean. Just nice that he took it seriously.

He gave me a sample of a migraine medication, Relpax, to try. Has anybody taken it? Had any side-effects?

As for the exercise, I don't have a lot of weight to lose before the wedding. I'm 5'6", 135 lbs, just wanted to tone up a bit and feel "fitter", if that makes sense. I have an elliptical and a stationary bike at home, so I will try both of those and stop if I develop any severe symptoms/worsening of symptoms.

Thank you for the information about the MRI/CT scan. Maybe I should just ask for the CT scan, then, since it will be a lot quicker. I live in Canada (Ontario) so both would be covered by our provincial plan, but it can take a few months to get an MRI done, or to be referred to a neurologist.

Again, thank you all for your responses!

Hi again everyone.

Just an update on my situation, as well as a new question if anybody could help. It’s been about five months since my accident now, and most of my symptoms have started to go away, minus really bad migraines here and there. I’ve even been able to start up running at a slow pace and not have many symptoms. Here’s my question: I am scheduled for a CAT scan tonight (it took this long!) and, on Saturday, I accidentally bumped my head against a glass door (sideways). I have been having migraines before the new hit, and I was totally fine the day after, but yesterday (Monday) around lunch-time, I started getting severe headaches, neck pain and nausea/dizziness. I’m wondering if there’s a chance that the second hit somehow made my PCS symptoms all come back again, is that possible? (Otherwise I am assuming its a migraine) I know that it could just be a regular migraine but again I am not sure, and I guess now it’s a good thing the CAT scan took so long because it will be able to show any “damage” from the second hit as well. How long do CAT scan results usually take, just in case the second hit was something serious?

Thanks!