Student Athlete with Post Concussion Syndrome Looking for Suggestions
 

I apologize for how long of a post this is, but I am in need of some advice about what to do with my life this upcoming school year. I just want to give all the circumstances surrounding my injury so that hopefully someone can give me a helpful suggestion. I am planning to start my senior year of college this upcoming fall (next week).

Last January I received a concussion during basketball practice (I am a Division 3 basketball player) while colliding heads with a teammate. I sat out for 2 weeks before I was cleared to go back and play. A few days after being cleared I received a second concussion when a basketball came off the rim and hit me directly in the face. This is something that would not normally cause me any problems but probably because my first concussion was not completely healed I suffered a concussion. Again I was cleared to play 2 weeks after my second concussion. Luckily my season ended shortly after being cleared from my second concussion and I did not have any more head trauma. However, I shortly realized that I was not able to concentrate at school and often would get extremely mentally fatigued. I had a lot of trouble paying attention in class and would get tension headaches when trying to do homework. I saw many doctors and I considered withdrawing from all of my classes and taking the rest of the semester off. Instead, because there were only a few weeks left of my semester, I pushed through and finished out the year, while getting grades that were not as good as I normally would get. As soon as the semester ended and I came home for the summer I started rehab, which included physical and occupational therapy. I had 2-3 hours of therapy per week and focused on recovery from my concussion all summer long with hopes of making a full recovery for the upcoming school year. I made progress with my balance, vision, reaction time, stamina. etc. Three weeks ago, because I was still having trouble with tension headaches and had developed severe light sensitivity my doctor put me on amitriptyline (1x per day 25mg). The amitriptyline did not seem to help much. Just this past Sunday I banged the back of my head on a doorway and have felt slightly more mentally foggy ever since while continuing to struggle with light sensitivity and tension headaches. I'm suppose to go back to school and start classes next week, and I have a meeting with my doctor at the end of this week.

One question I have is, does anyone have any recommendations for medication that I can talk to my doctor about that may help relieve tension headaches better than amitriptyline (or in addition to amitriptyline)? Another question I have is would a focusing medication such as adderall or vyvanse help me in school? A third question is, should I take this upcoming semester off to focus more on my concussion recovery? I would really like to go back to school, but I am worried that the stress of school work and class will be detrimental to the recovery of my head. I am going to be starting my Senior Year and am suppose to be taking 5 400 level classes which would be necessary for me to complete in order to graduate on time. Finally a fourth question would be, should I even attempt to make a comeback and try to play basketball this year, in addition to my classes? Just looking for any suggestions that people have, would really appreciate anyone's knowledgeable input. Thanks!

Tommy,

Welcome to NeuroTalk.

1st. There is no medication that reliably treats your issues. Amitriptyline is usually only prescribed at low dose (10 mgs) for insomnia with headache. It's not surprising it has not helped.

Some have tried amantadine with some finding a benefit, others no benefit.

btw, amitriptyline is an anti-depressant so it is being prescribed off-label.

Many of us find that good brain nutrition is important. The vitamin regimen in the Vitamins sticky at the top has the suggested regimen. It is not a quick fix. It helps your brain heal slowly. A few weeks of consistent use should start to show improvement.

Regarding school. A heavy course load will delay your recovery but more likely result in lower grades. Can you spreed the year out to an additional semester so you work load is reduced ?

Some have tried adderall with varying results. It will not be helpful with continuing recovery. The recovering brain needs rest. Adderall just pushes the brain. Some have tried a cup or two of coffee in the am. Don't mess with too much caffeine.

I think your basketball career is over. You cannot afford the risk of another impact. You are at a point where you risk serious prolonged PCS struggles, maybe lifetime.

You will likely find you need to slow down in most of your life, classes, socializing, work, etc. So, take a lighter course load and try to learn how to learn with a PCS brain so that you actually have skills to take to a job.

Feel free to ask more. There are plenty of good people here.

My best to you.

Basketball
 

I would really consider returning to play basketball very carefully - and as you said, a ball in the head wouldnt normally give you problems, but it does now.

I am not an expert (and I dont know you or your medical records), but if it was me, I would wait until I have been free of symptons for a long time (years), and perhaps I wouldnt return.

I have had problems with PCS and concussions for more than 1½ year now, and I wish I would have taken it seriously from the start....

If you rest, dont stress (easy to say - i know), eat healthy, take vitamins (especially fish oil), have a good sleeping pattern, doing things you like, spend time with people you like and exercise in a ryhtm you can handle - then I think you should soon see improvements.

Return to school
 

A neuropsych is helpful. That person can give you an evaluation and then work with you to put together a plan to return to school.

Maybe a sports med doctor who does HRV and can help you with a return to play program.

Hang in there!

What is HRV besides a Honda car ?

It would appear that the Sports Medicine Docs and trainers are leaving Tommy a bit short of good care.

Thank you for your thoughtful response. After meeting with my doctor today, I have decided to stop taking the amitriptyline and I will be trying a new medication called topamax which is suppose to help with migraine headaches. I am still struggling with what to do about classes this semester, but I have a 2-3 week span to decide. The only problem with taking less classes and adding an extra semester of school would be the money situation because college is never cheap. As far as basketball is concerned I am not expecting to play this upcoming season, but a part of me has hope for a miraculous recovery that would somehow allow me to. I appreciate your response and look forward to posting more questions about my PCS problems in the future.

I actually had a neuropsych evaluation about 3 months ago. From this evaluation it was determined that occupational, vestibular, and cognitive therapy would benefit me, which I have been doing throughout the summer. I am schedule to retake the neuropsych evaluation soon to see how I have progressed. Not sure what an HRV is but I have dealt with many different doctors throughout this process. I am currently seeing a neurologist who is my main doctor for my concussion issues and has been trying to help me devise a plan for returning to school. Pretty sure that i will not be playing basketball this upcoming season but I still have some hope. Thank you for your concern.

The only HRV that I imagine it could be is
heart rate variability.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131496/
Heart rate variability interventions for concussion and rehabilitation

Tommy, I am surprised your doctor has not told you no more contact sports. This concussion is taking you so long to recover, your next will likely take even longer.

It's not like you have a chance to make a living playing basketball from a Div 3 program. I gave up contact sports in 10th grade after my third concussion as suggested by my neuro. Since then, I have suffered 11 more concussions over 40+ years. You want to end taking any obvious risks because life has enough risk of more concussions. Someday, you may hit that magic number of concussions that drastically changes your life permanently. I hit that number at 46 years old and had to give up most driving.

The risk is not worth it.

Was your neuropsych with a doctor or with a computer ? How long did it take ?

The neuropsych evaluation was done partly with a doctor and partly on a computer. I am learning to come to terms with the end of my basketball career, just a hard thing to give up.