Head Pain on Pillow/ Neck Stiffness and soreness
 

My concussion occurred a month ago when I slipped and fell backwards hitting the back of my head on a turf surface. There may have been some whiplash, I had a little bit of pain but it wasn't particularly bothersome. I've aggravated my neck several times since the initial injury and have developed some significant pain/stiffness in my upper back and neck. This stiffness/pain causes my head to hurt wherever it makes contact with the pillow. This has caused me to wake up after a couple hours and lose 5 or 6 nights of sleep when it's particularly bad.

I've been working with an athletic therapist and a masseuse who have done some hands on work which has relieved the tension/pain each time for a short amount of time. I don't know if the pain is returning on its own or if i've been re-aggravating it by accidental quick neck movements like drinking back vitamin supplements too quickly or falling backwards onto my pillow as i mentioned in a previous thread. I lost another night of pain last night due to the head pain on the pillow and I was wondering if anyone had any ideas or advice about the best b=way to deal with the situation. does it make sense to continue seeing the athletic therapist who seems to be fairly well educated about concussions?

I went to see a doctor at a walk in clinic today because i was wondering if there might be a need to do x-rays/imaging to see if there was any damage besides soft tissue damage. She said that she thought it was just muscle stiffness. Might it make sense to get a second opinion? Any comments would be appreciated.

You don't describe the head pain on pillow so there is no way we can comment on that. From what you have said, I don't think your issue is concussion related. I believe it is whiplash related. Do not throw your head back when taking vitamins. Instead, gently tip you head back if you need to.

Does your head really hurt or does your upper neck hurt or do you just get a headache ?

Hands on work does not mean much. There are some who do amazing hands on work and others who cause injury or exacerbate symptoms with their hands on work.

Most athletic therapists receive their concussion training in week end seminars like those required to be certified to administer ImPACT testing.

Without knowing what the hands on therapy was, there is no way to know if it is worthwhile. Many focus on range of motion. That is not always good. Others are just too forceful. It should not be painful unless he/she is doing myofacial release where the pain is momentary as the muscle lets go.

A walk in doc is 99% worthless. Very few have any valid concussion knowledge. Again, weekend seminars. The x-ray or imaging that can be done is not capable of diagnosing the subtle neck injuries common to your situation. When it can, it requires a very skilled image reader. Some times, it requires a full motion x-ray with a very skilled reader. A doc in the box is never going to request such an imaging.

It would be best if you keep all of your posts in the same thread. That way, we can scroll through past posts.

Have PTs check for trigger points in your muscles and scalp.. If they don't know much about them, find better PTs..
You or a friend could also check for them.. this chart is very helpful..
Pain Reference Chart
A web search will bring up many other TRP info sites..

Thank you very much for the reply.

During the day, the pain is mostly in my neck and a little bit in my upper back at times. I don't have pain in my head until I lie down on the pillow at night. When I do, I feel a dull ache directly where my head is making contact with the pillow and not really anywhere else.

I still feel some neck pain/stiffness when lying down but it's the head pain that's disruptive to my sleep. I sleep on my back and have tried to use a thin pillow or a rolled up towel under my neck but when my neck is very stiff and the corresponding head on pillow pain is very strong, I still can't fall asleep.

The athletic therapist that I'm seeing has done some pretty aggressive squeezing under my shoulder blades and around my trapezius. I believe what he is doing is looking for trigger points and doing myofacial release. But I'm not certain. He has also done some gentle moving/rotating the neck while holding my head in his hands and has done some light massage on the base of the neck as well.

Thank you very much for this information.

It sounds like the AT is doing classic therapies, not myofacial or other release protocols. The best therapies my PT used were not forceful except for her finger tip. When she did neck work, she used gentle traction with gentle mobilization. When she did release therapies, she would hold a point until the spams released. Then, the joints and muscles would settle down.

You still don't define the pain when you lay down. Is it at the surface, on the skin over your skull ? Is it behind your ears ? Is it below the bony part of the back base of your skull (occiput) where the C-1 vertebra connects to the skull ?

You can traumatize the nerves in the many layers of skin. These can be very tender for weeks. If your upper neck is radiating muscle spams and tension, the pain will be more behind your ears.

Do you have a recliner ? Sleeping in a reclined position with a thin pillow rolled up at the edges to support your head from rolling to the side may help you get good sleep.



You might find better help from a Physiatrist (Physical Medicine and Rehabilitation) rather than an athletic therapist. A good Physiatrist may be able to better diagnose your injury. A good Osteopath may be helpful. Look for either who has good whiplash experience. The upper back and lower neck are difficult to diagnose and treat.

You may have suffered a minor concussion but your symptoms are neck/whiplash.

Did you look for the Post Reply button at the bottom left or top left of the thread ?

To Reply without quoting look for Reply button @ Left side above or below posts,
may display differently on tablets or phones..

I think that the pain is either on the skin or between the skin and my skull. I find it difficult to tell exactly.When I'm lying directly on my back with my head straight, the pain is where the base of my skull meets the top of my neck which I think is the occipital, as you mentioned. This is essentially where my head makes contact with the pillow. If I turn my head to the left or right, I feel the same kind of pain but higher up on the skin/skull because a higher portion of my head is making contact with the pillow.

It might be relevant to mention that the pain is not there every night. it seems to correspond with the times when my neck is especially stiff or sore. Each time that I've had a difficult night with that pain, I've seen either my AT or a PT or a masseuse and the next night has generally been better. The pain has returned after a day or more but again, I'm not sure if it's returning on its own or if it's because i've re-aggravated the neck.

I will look into finding a Physiotrist and an Osteopath who have experience with whiplash.

Aside from the neck pain/whiplash I am also dealing with the regular concussion related symptoms. Although it is unpleasant to have a sore neck and lose sleep, I'm most concerned with how the neck issue and poor sleep are affecting my brain recovery from the concussion itself.

If I had some other questions to ask, not related to the neck pain, should I ask them in this thread or ask a new one?

Thanks again, Mark. I really appreciate your input.

Keep your posts in the same thread. You may not realize how issues can be related.

It sure sounds like your pain in topical or skeletal. As I said, it takes a very long time for the nerves in the skin to heal. They can remain sensitive to touch for months.

Has your AT or PT mentioned the value of icing ? You have inflammation that is causing problems. Anti-inflammatory meds, aspirin, ibuprofen, etc. will help. But, you need to use them consistently.

If the pain returns after a period of being free from pain and stiffness, you are re-aggravating the injury. Poor sleep posture is often a cause but head movements can also be a cause. Some ATs and PTs push for range of motion. This can trigger symptoms. Many do best with minimal range of motion until improvement then start to work on regaining range of motion.

You really need to find that comfortable sleep position where you are not tempted to move to find a new comfortable position. As I said, in the early stages, I did best with a recliner. My wife commented that my facial expression when sleeping in my recliner was peaceful. When sleeping in bed, my face looked stressed. I felt more rested in the recliner. Some find an adjustable bed helps. More people have access to a recliner than to an adjustable bed.

What are your 'regular concussion related symptoms'?

Poor sleep can be causing them.

Thanks for using the Post Reply button.

I've been icing periodically but I will start doing it consistently. I've been taking ibuprofen pretty consistently. If I can't find a comfortable position lying down I'll look into trying to sleep in a reclined position.

My concussion symptoms have been a combination of dizziness, fatigue, lack of clarity/focus, light sensitivity, a deep dull head pressure, sometimes a little bit of nausea and headaches.

These are brought on or exacerbated by too much physical or mental activity. Screens have been especially problematic.

I was referred to a concussion specialist by my family doctor. She has been working with me to put in to practice the "return to play" protocol. During my first three weeks of recovery I slept pretty well but in the last 10 days about half or so of the nights have been significantly disturbed.

I've been doing a lot of self monitoring as per the return to play stuff but it's hard for me to evaluate how much progress has been made. The days after a poor sleep are particularly difficult to evaluate.

I've been pretty conservative with the short bursts of more strenuous activities like reading, exercise, and screen use. I wonder how much I should be pushing during those short activities and if I should be stopping immediately upon any increase of symptoms or if I should allow them to come on a little bit before stopping. I'm using screens for approx 15-20mins total throughout the day and not more than 7-10 minutes at one time. It would be great to find a way to slowly build up my ability to use screens as i use them a lot for work and recreational activities.

You should not be pushing into symptoms or trying to push through symptoms. Your exercise should never cause an increase in symptoms. Your exercise should be very low intensity until you have been free of dizziness for a straight week. If you increase your activity level and symptoms return, stop and wait for more clear time.

If your concussion specialist is focused on return to play, she sounds like she may be a weekend ImPACT seminar trained specialist. They tend to focus on pushing for return to play at the expense of depth of recovery. Coaches want players back on the field as soon as possible so the specialists try to push.

You should not be trying to evaluate progress more than every 7 days or so. No daily assessment. They are worthless.

Days after poor sleep are bad because of the poor sleep. Accept that.

Do you use screens at work each day ? Have you tried reducing the brightness of the screen ? F-Lux.com works for some. Avoid fast moving screens like video games.

Learn to recognize the early signs of fatigue. Needing to reread a line of text, struggling to focus, any sense of 'What did I just do/read?' Take a break. Change activities when you start to fatigue.

Reading can be a problem if the lines of text are too long or the writing is too complex/descriptive. Think of activities like juggling. You can only juggle 2 or 3 balls. Reading with background noise/voices or other stressors is more than 3 balls. Multitasking is 5 balls. Expect to fail if you try to juggle too many balls.

You should not go to bed until you are ready to fall asleep. You should be able to get comfortable and fall asleep within minutes. If you start to toss, get up. Distract yourself and wait for that sleepy feeling and go to bed again.

You should start slowing down with activities at least an hour before your usual bed time. No conversations or heavy reading. Start dimming lights. Take care of anything that needs to be ready in the morning, especially by making notes so you can 'let go' of those thoughts.

You can find the specific ways for you to recover best. Don't expect others to find the solutions. The doctors and therapists who have never experienced prolonged PCS rarely get it.

My best to you.

I think that I was misleading using the term return to play. I just meant to say that we are employing a method of slowly returning to various forms of activity.
I'm actually not attempting to return to sports of any kind at the moment and the only physical exercise that I'm doing is short 5ish minute walks every hour or so. It's the mental activities like reading, playing piano, having conversations and using screens that I'm trying to slowly build up.

The concussion therapist has suggested what you said, of not increasing the time on the various activities until I am symptom free at the current amount of time spent on any activity. She had me do a bunch of self evaluation at first in order to determine how much I felt each type of activity affected me. I gave "points" to each activity and the idea is to limit the total number of points in a day so that I don't have any more symptoms at the end of the day than I did at the beginning.


The bulk of my days are made up of "0 point" activities like listening to podcasts, light stretching or organising, and mindfulness. I try to take a short walk and do a quick 5 minutes of sitting eyes closed rest at the end of every hour. Then every other hour or so I do a short bit of an activity that costs some points. For example, maybe easy reading for 10 minutes costs 1 point at the moment and if progress was being made then 12 minutes would cost 1 point in a couple of days.

I asked about pushing a bit more into the symptoms because I haven't noticed much progress and somebody told me that they felt an increase in their recovery when they started "going to a 5 out of 10" in terms of the onset of symptoms with various activities instead of a 1 or 2 out of 10. This went contrary to what my therapist said and that's why I was curious for another opinion.

Yes I've reduced the brightness on all my screens and I've experimented with different colored plastic dividers over my computer screen but I still have the very beginning of symptoms come on after 5-10 minutes or less in some cases.

Thanks again

It sounds like the Becky Moran points system from London. That is too 'one size fits all' for my taste and many others. Learning to recognize the early signs of nearing your limits so you can switch tasks is another system. The point system does not have adjustments for individual issues. Your bad sleep vs good sleep days will have different applications of points. Learning to recognize the early signs works whether you have had good sleep or not. It also works with those tasks and activities that do not fit the points system.

That makes a lot of sense. I'm putting your recommendations into practice.

Another big thanks.

What does this mean if you have these? I definitely do and my headache pain gets replicated if I pinch my neck muscles on both sides. I've been doing acupuncture with electric shock to try to loosen them. I've also done trigger point injections and 5 weeks of physical therapy. Nothing has worked.

I don't trust chiropractors so does that mean that there's nothing else left for me to try?

Physical therapy can be good or worthless depending on the skills and therapy done. Traditional PT protocols are range of motion focused and/or strengthening focused and not much help with many subtle neck injuries. As Jo*Mar said, If your PT does not know how to identify trigger points and such, find a different PT.

Just as there are good and worthless PTs, there are also great and useless chiros. It is hard to find the good ones. In my experience, only one in five have been worthwhile. Same as my experience with PTs.

Some DOs, Osteopaths, are good with neck issues. Again, you have to find the good ones.

In my experience, any treatment will show at least a temporary improvement after just a few treatments if not the first. More treatments may be needed for lasting results but the treatments should be spaced apart with self-treatment/postural discipline used to help the treatment last.

Therapists of all types tend to want to keep their calendars full and use up the patient's insurance and financial resources doing so. The "I want to see you twice a week for 5 weeks" at the first appointment is bogus in my experience. Been there. Had to deal with that type of treatment.

The good ones might say, "I want to see you twice this week then next Monday, we will re-evaluate."

I spent $8000 in the first year and a half trying to find worthwhile care. I found a PT who did myofacial release (sort of trigger point therapy) and some other protocols and I started improving.

Upper cervical chiropractic helped and is not like the twist the head and pop the neck form.

I'm going to Mayo Clinic tomorrow for 5-7 day stay. Will see what they say about it.

The proletherapy treatment I looked up seems interesting and Mayo Clinic released statement in 05 saying it may be beneficial. The quote I got for that treatment was $3,400 for 4 doses. Reviews from the provider are controversial with some people saying they are way worse after doing procedure.

If I'm going to pay a lot of $, I feel HBOT has best chance at making a meaningful difference. Just my instinct for all that I've read and the science behind it. That and Keto diet which I'll be trying after I get back from Mayo.

HBOT will not help if you have a neck issue. KETO will not either. The Prolo treatment cost sounds very high.

With all the treatments you have undergone, what have you done to help your neck heal ?

If you just treat the symptom but not the cause, you will forever be stuck treating the symptom.

I don't think it's just a neck issue but it is part of the equation.

I think I likely have diffuse axonal injury. I was in Tbone car accident. Car was prob going 60mph+ and my SUV went airborne and landed on its side.

The fact I have convergent insufficiency makes me think it has to be more than just my neck. There have been times where my neck didn't bother me but it got a lot worse after I had kids and hold to them a lot in awkward positions.

Massage has always given me some temporarily relief but I've felt like a completely different person ever since the accident.

I have constant head pressure/tension headaches and brain fog with sensitivity to light and sounds.

I try to use flat pillow to not put pressure on my neck muscles. I saw a dentist who said I had TMJ and I use orthodontic device that is suppose to fix that + help with neck muscles.

I went to certified atlas chiro for a month then I stopped going after it was apparent to me it was a scam.

Brain carrick doctors tried to adjust my jaw as they said that was out of alignment. My symptoms got worse after he did his adjustment.

You likely have two injuries. You have a brain injury and you have an orthopedic injury, neck etc. If the neck is symptomatic, it interferes with blood flow to the brain. This reduced blood flow makes any brain injury much worse.

Until I resolved my neck, my brain was always bad. Once my neck started to improve, my brain issues started to get better. If I allowed my neck to get strained, my brain issues would come roaring back. My wife could tell how my days were going to be by looking at my facial composure while I was still asleep and she had just gotten up from bed. If my face had a calm look, I would have a good day. If my face had a strained look, I would have a bad day. Usually, if my face had a strained look, I was sleeping with bad posture.

I have a much improved neck today but I know that if I mess up with sleep posture, I will mess up my day. I will be foggy brained and may get headaches.

It took me two years to get my neck in a reliably stable condition. A chiro and a PT helped me along the way by helping release muscle spasms or misalignment. But, most of the healing was from strict self-discipline.

I have had sensitivity to sound for 20 years. I've been sensitive to light for over 50 years. That is easy to deal with compared to my memory dysfunction and cognitive processing issues. The foggy brain is the biggest problem but getting proper sleep in proper posture is the best solution for that.

If you still have neck symptoms, I suggest you focus on resolving them and see how you brain issues are with a stable neck.

There have been many studies that discuss the issues of blood flow to the brain and brain stem being challenged by neck issues.

A family friend of mine is a highly regarded chiropractor. He did an assessment of me today and believes that my neck issue and to some degree, the concussion symptoms are related to a nervous systems issue in my upper neck at the base of my skull.

He is going to examine some x-rays and I am going to see him again on Friday. He wants to do adjustments and massage on my neck and wants to use an activator-like adjustment tool on my neck.

Any opinion on this idea and the risks given the concussion?

I have lots of experience with the activator. It can be very good but was not much help with C-1 for me. C-1 does not have facets like the lower vertebra. C-1 is held in place mostly by ligaments. One value of the activator is simply that it is gentle, especially when compared to the twist the head and pop the neck. The risk is low.

I bet the issue is more inflammation that interrupts blood flow that can impacts the brain stem (autonomic nervous system) and blood flow that supplies 25% of the brain. There may be some radiculopathy (nerve impingement) if you have neck muscle spasms. Radiculopathy would usually be C-1 to C-2 and lower, not C-1 to occiput (skull).

Ok that makes sense. Just to clarify, the activator might not be particularly useful with c-1, but the risk is low even if it's being used right at the base of the skull/upper neck?

In other words, the activator isn't likely to aggravate any brain swelling even if it's used right up there in that area?

And twisting of the neck type of adjustment might pose a slightly greater risk? And if so, this risk is just a general risk about doing those type of adjustments in the neck, or is it more risky in regards to the concussion specifically?

The twist the head and pop the neck is too aggressive for many subtle upper neck injuries. It's like using a shotgun to shoot an ant. It may help the lower vertebra but can cause inflammation higher up.

The activator does not force anything. It just sets the vertebra in motion with the muscles/tendons and ligaments pulling the vertebra into position. Even cranked up, it is gentle compared to the other. Low risk.

You don't likely have brain swelling. You have joint inflammation. It may put pressure on the blood vessels and reduce blood flow.

Chiro has little impact on the concussion other than allowing better blood flow by reducing inflammation.

You need to understand that you likely have two injuries. A concussion that has limited treatments available. And a neck injury that has many treatments available. But, you need to also take care of you neck. The chiro can't do his work if you don't follow up with good discipline to not aggravate the neck.

With the neck getting better, many concussion symptoms will be likely to improve.

Great explanation. More of my gratitude.

Follow up questions. You said that the activator wasn't great for c-1 in your experience. Does that mean that it's probably not effective in general for any upper neck issue? If so, and if neck twisting adjustments aren't a great idea in general, would it make sense to say that a chiropractor isn't the best option for dealing with an upper neck issue? Or can they be as effective with manual/massage techniques as other therapists/modalities?

Secondly, and sorry to dwell on this point, I wanted to check if it seems normal that my neck and head are still a little bit sore in the area surrounding where he worked yesterday with the activator and massage. You mentioned that it's low risk, but I just thought it would be prudent to say that he was using it at the very top of my neck/occipital and was angling it slightly "upward", or in other words, pointing it somewhat towards my brain.

Finally, you mention that there are two things at play in my case. Neck and concussion. The neck issues seems to be joint swelling causing a loss in blood flow etc. What do you think is the relevant physiological thing going on in the case of the concussion? For example, is it a bruise on the brain? More inflammation? I understand that the concussion doesn't really have active treatments but I was just trying to figure out how to conceptualize it.

jtoronto,

You are going to continue to struggle if you do not develop a way to keep track of and understand things you have been told.

I said C-1 does not have facets like the lower vertebra. It does not settle into those facets like the lower vertebra.

I did not say head twist and neck pop is not good in general. I said it can be too aggressive for people with subtle injuries that involve C-1. 'Popping' lower vertebra can stress C-1.

"Or can they be as effective with manual/massage techniques as other therapists/modalities?"

What are 'manual/massage techniques as other therapists/modalities' ?

It sounds like you think a chiro or therapist will fix your neck. They only reduce conflict,spasm, etc so your neck can heal. It takes weeks and even months for subtle neck injuries to heal.

"What do you think is the relevant physiological thing going on in the case of the concussion? For example, is it a bruise on the brain? More inflammation?"
Nobody can say. There are no diagnostics to define the physiology.

Conceptualize this. You break a bone. The doctor sets or aligns the broken bones. He fixes them with a cast that prevents you from misaligning those bones with excessive movement. Over time, the bone heals so the cast can be removed and you can start rehabilitating the bone and related joints. Over time, you regain most or all of the use.

The chiro or other therapist properly aligns your cervical vertebra. You work to not misalign them. Inflammation goes down improving blood flow to your brain. The chiro or therapist checks the alignment from time to time. You continue to work to not misalign them. The improved blood flow slowly helps your brain improve.

Pain just means you are sore. Is the massage painful? Did he tell you to ice after the adjustment and massage ? "Pointing the activator toward your brain" is a meaningless comment. Don't fret about everything.

btw, 'Highly regarded chiro' just means he is good at getting and keeping patients. This is usually defined by financial success and lots of touchy-feely systems to make patients feel like they are getting good care. I've known many successful chiros who were worthless to me. As my favorite chiro says. They are good at show and sell.

Thanks for the clarification.

The chiropractor went over some x-rays with me and they showed a significant loss of the curvature of the upper neck/spine. He wants to use the activator to adjust my c-1. He has also prescribed a set of flexibility and strength exercises for the neck and he has given me a cervical neck stretch pillow to use.

His practices seem to run contrary to what you have been saying. I am leaning towards discontinuing with him. I just wonder if the issue that the x-ray illuminates is one that is crucial to correct in order to progress with healing. Or maybe it is just a marketing tool and either that issue is common or is being caused by stiff muscles or some other factors. While the chiropractor admits that there are other ways to treat my neck related symptoms, he believes that chiropractic is the only way to fix the neck curvature problem and that problem and the resulting nervous system issues are the core of my injury.

I think if you go to any chiropractor, they are going to do X-rays, tell you spine is curved, and needs to be fixed. I truly wonder if anyone has ever gone into a chiro's office, gotten x rays, and they said, "looks good, I can't help you".

I'm not against alternative therapies and know mark disagrees that there are in fact honest chiro's that truly know what they are doing. i don't know how you find them and am 99.9% sure I've spent upwards of 10k on quackery. My Dr. at Rush University in Chicago agrees with me but I didn't consult with him first as I was desperate for relief.

I agree the neck component seems very important and makes sense a chiro would be the guy to go to. I can just echo similar experiences of being sore for days in certain spots and feeling very dizzy afterwards and just not right.

The AMA (American Medical Association) actually lost a law suit for their wholesale defamation of chiros. The AMA was enjoined from speaking against chiros.

The problem is many chiros focus on billings, not healing. Many have a philosophy that every health issue is chiro related. Others know the limits of chiro. I was doubter until nobody could help me until I tried a chiro.

Most chiros are good at the common lower vertebra (T and L) issues using a Palmer, Diversified or Gonstead protocol.

Gonstead chiros will often depend on X-rays or temperature differential. They are not looking for curved spines. They look for subluxated vertebra that have slipped out of position in the facets. Using X-rays is not the best diagnostic technique.

Many use x-rays as show and sell by drawing lines and saying, "We need to fix this." The good chiros only use X-rays to rule out conditions that make chiro risky, cracked vertebra, arthritis, serious disk herniation.

Leg check and manual toggling are better. In my experience, the gentle protocols work best but they take patience. Chiro adjusting thoracic vertebra can result in quick improvements for many with a quick pop. Neck adjustments often take longer because the aggressive adjustments can cause inflammation. The gentler adjustments slowly help the neck stabilize.

Even the best chiros only help your body heal. It take the patient's discipline to finish the healing process. Too many say, "I paid you money, why did you not fix me?"

jtoronto,

If the chiro does not have prior x-rays of your neck, how does he claim the loss of curvature ? Every neck is different. Chiro is about the relationship between neighboring vertebra. If they are properly aligned and seated in the facets, any curvature would usually be your normal.

Using the Activator on C-1 may help. It just didn't for me. It did not do any harm, though. No reason to not try but you will still need to be disciplined. I'm not a believer in using a pillow to stretch the neck if it puts one in an uncomfortable position. One wants the neck to find its own position by not straining it. Remember to ice your neck after each adjustment.

I've recently started experiencing some seemingly involuntary head/neck movements. They are like small twitching or jerking motions. It seems to me like they may be related to a few possible causes:

Neck spasms, eye twitches or anxiety.

I've read that whiplash injuries can lead to neck spasms.

I've been doing vestibular eye exercises and I think that I may be noticing these involuntary movements the most after completing the exercises when my eyes feel a little bit "tired" or "stretched".

Another likely cause is that I've developed a kind of fear of movement. As a defense mechanism I think that I may be unconsciously stopping myself from doing some quicker head or neck movements out of a fear of reinjuring myself. This may lead to what feel like jerks or twitches as my muscles tense or stop me when I notice myself starting to move in certain ways.

It's hard for me to tell exactly what the cause is. Has anybody had a similar experience? I find it to be problematic because sometimes the movements lead to feelings of dizziness or nausea.

My opinion is it is due to number 4. You are overly anxious and trying to hold your head and neck still. This causes the nerves to misfire causing the twitching.

If I try to hold my hands still to do fine manual work like replace a battery in my wife's iPhone with its tiny screws, my hand(s) start to twitch.

There is no reason to be afraid of turning your head.

I think that this is related to my third point, which is probably the most likely candidate.

I think that at least part of it is that I'm unconsciously trying to hold my head still and that I'm reacting to movements that I start to make - especially bigger or faster movements.

I was probably trying to keep my head still, as you suggest, for a good deal of time and have ingrained some learned behaviours.

I don't think it's simply that I'm trying to hold my head still anymore - at least not on purpose - because I am now actively and consciously trying to undo these learned behaviours and force myself to move more naturally. These "twitching" movements often happen as I begin to move my neck, seemingly as an ingrained defense mechanism.

But sometimes there are small twitches that seem to come out of nowhere and I wonder if it's possible that these are related to the neck injury or perhaps just caused by anxiety in the body.

Number 3 would be right. I was count no 3 as the no 4.

More of an anxiety induced response due to your focus to move your head and neck smoothly. It is sort of like nystagmus except in your neck muscles rather than eye muscles.

That makes sense.

I've been struggling the last little while with quite a lot of symptoms and I was wondering what others do when they are overstimulated. I'm also curious if the vestibular therapy that I've started could be part of the reason for my increase in symptoms.

About 10 days ago I started doing some vestibular eye exercises that were prescribed by a vestibular therapist. I do three exercises:

I place a post-it note with a letter on it a meter or two in front of me. I keep my eyes on the letter and rotate my neck back and forth relatively quickly while keeping the letter crisp in my vision. I do both side to side and up and down for 30 seconds each with about 3 changes of direction per second.

In the second exercise I use two post-its and keep my head still while I quickly move my eyes back and forth between the notes. I do side to side and up and down for 20 seconds each.

The last exercise involves closing my eyes and turning my head to the side and attempting to bring it back to the starting point. I do left and right 10 times each.

I do a set of these three exercises three times a day and I think I'm starting to see some improvement in balance.

I've started having more headaches in the past week. I even have some headaches upon waking. Headaches have not been a particularly big issue for me before this point (although brain-pressure and brain-fatigue have been).
I've also had a lot of the brain pressure and fatigue. This symptom is usually the most indicative symptom of my having done too much mental activity, but I'm finding it coming on with less activity.

Some days I feel pretty overstimulated with many hours left in the day to go even though I'm pretty conservative in my activities. I'm trying to figure out what to do when most activities seem to exacerbate symptoms. I don't want to spend too much time sitting in the dark and potentially affecting my sleep as sleep has been a big issue for me. I also don't want to put strain on my symptoms when I'm feeling stimulated.

I would never be able to turn my head side to side 3 times a second. It would be too rough on my neck and cause other problems. I timed myself and I can do one head turn to one direction per second. I know that I cannot do it any faster. Just 10 turns in 10 seconds has caused my neck to tense up. The noise in my neck is quite noticeable. A headache is developing.

The up and down movement would also be rough on my neck.

There is no practical need to move your head any faster. Maybe you can do it at a slower rate for a while then build up to the faster rate.

If you want an enjoyable way to do the second exercise, try doing jig saw puzzles. They require a lot of back and forth and up and down eye movement as you look for pieces that fit. I do three jig saw puzzles a day at Jigsaw - MSN Games - Free Online Games
There are others that use larger puzzles on larger screens.
I use the edge and arrange functions as I do the puzzles.

I'm able to turn my head three times a second because the movements are relatively small - only about 20 degrees in each direction. The therapist says that for the purposes of getting the vestibular stuff back in order, the movements don't need to be big at all.

Jigsaw puzzles are a good idea, thanks.

For me, even 20 degrees at that speed is a struggle and noisy. Is your neck noisy?

But, I have had mild nystagmus in my left eye for decades.

My neck is noisy but I find that it's not noisy - or only mildly - at that 20 degree range.