Chronic Migraines or Occipital Neuralgia - 5 concussions
 

Hi! This is my very first post here, I've read a lot, but I have some questions of my own.

A brief history on myself:
I'm 17. I've had 5 concussions. One each year for the past 5 years, basically. They've all been "mild" but they've all taken me a really long time to completely recover from. My fourth one took me about 14 months to fully get over.

I was hospitalized during concussion 3 and 4 for really bad migraines and was treated with DHE. That helped the pain going away for about a month, but it always seems to come right back.

During concussion 4, I was diagnosed with ADHD that was most likely derived from so many head traumas as well as being diagnosed with POTS.

This most recent concussion I got a little over a month ago, I was standing in the goal kicking balls out - I'm the manager for the school soccer team since I'm not allowed to play contact sports anymore - and someone shot the ball straight into my face. I didn't lose consciousness or anything like that.

My headaches don't seem to be getting any better at all, I know it's only been a month, but they're pretty unbearable. I've seen several different neurologists and "concussion specialists" and I've tried all kinds of different medicines, but nothing seems to lessen the pain.

The first four of my concussions were all "sports-related" and they were all traumas to the back of my head, a couple of them giving me whip-lash as well. My headaches are generally more on the right side of my head, like right on my hairline in the front and near the bottom of the back of my head. I also occasionally will have a "shooting" pain go up the back of my head. These headaches are generally pretty on-going, I'll have times where I feel fine, but I'll have headaches still multiple times a day, and they're worsened when I try to do school work or read or anything like that. My neck hurts incredibly bad all the time. I feel like I've had whip-lash for the past two years or something, it's always really stiff and aches and it feels like it just needs to be popped, but it never pops. I also am super sensitive to sunlight. I can't be outside without sunglasses or else I get an awful headache, the glasses take a little bit of the edge off. I'm also nauseous quite often in addition to an ability to concentrate and remember minor things.

I've done as much "research" as I could, and I can't decide if I think this sounds like Occipital Neuralgia or just chronic migraines or Post-Concussive Syndrome or something totally different..

Please please please help! And sorry I wrote so much...

-Mack

Hi Mack, you've got a lot to deal with. Please bear in mind that I'm not a doctor and I can't diagnose you. I can identify with what you have written above. I have occipital neuritis from past neck traumas. Its also been referred to as occipital neuralgia, but thats incorrect since the trauma explains my problems. One diagnostic tool is using occipital blocks to see if you get relief. If you do, albeit temporary, it helps the doctors diagnose you. Since you've been seen by neuros, have any of them suggested this to you? Have you discussed the headache and shooting pains with them? There are other treatment options if meds don't help but you need to discuss this with them. Please keep me posted of how you're doing and what your docs come up with. Take care, ee

I responded to your post in the "Chronic Pain" section of NeuroTalk, but I'll repeat my response here so you don't need to check the other location:

The shooting pain that follows the line from the back of the head to the hairline is very typical of occipital neuralgia. This may be due to direct injury to the nerve (usually originating at the second cervical vertebra - C2) from a concussive incident, or it may be a result of a whiplash event. This second outcome is often generally referred to as "cervicogenic headache", which may include any of the cervical nerves.

For what it's worth, occipital neuralgia and other cervicogenic headaches can be caused by trauma that is not visible in an MRI. The diagnosis is often one of exclusion of other things (including migraine.) Shooting pain is almost ALWAYS an indication of neuralgia, so don't let it be brushed off as migraine variant. Migraine medicines rarely have any effect on neuralgia. One exception is amitriptyline, which is often used as treatment for nerve pain and as a migraine preventitive drug.

What medications have you tried? The most effective drugs for nerve pain include anti-depressants and anti-seizure medications. I can give you a list to discuss with your doctor.