One month post-concussion...when will this get better?
 

I sustained a concussion while playing in a rugby match one month ago. I had no idea I was even injured--but apparently my head hit the ground during a tackle. I just got back up and continued to play. The next day, my head hurt--it was even painful just resting it on a pillow or touching it to shampoo my hair.

For the first two weeks afterward it was difficult for me to drive a car, walk around or do much of anything due to pain and dizziness. Things got better the third week. Now in the fourth week I still feel dizzy and just not entirely normal. I ran a few miles a couple of days ago and it made my head throb. The next day, it was a challenge for me to just walk in a straight line and I am still tired after getting 9 hours of sleep every night.

My CT scan results were normal, so how long will these symptoms last? I am going CRAZY not being able to exercise and I'm about to just say, screw it, and run anyway, even though I know my head will hurt afterward.

LisaGH,

Welcome to NeuroTalk. Sorry to hear of your concussion.

I have good news and bad news.

The good news, What you are experiencing is quite normal.

The bad news, You desire to get back to exercising needs to take a back seat to your brain's recovery.

The brain does not recover like muscles and joints do. The brain needs total rest. No exercising. Minimal cognitive effort. Limit exposure to stimulation.

Without this full rest, you will likely ride a wild roller coaster as you try to recover.

Fortunately, you are very early in the recovery process. This means that you are likely to see good improvement if you start this rest program now.

Avoid caffeine, alcohol, MSG, artificial sweeteners, artificial preservatives, and high sugar content foods. Meat protein is good for the brain. Pork is best.

Adding some vitamins and supplements will help your brain.

B-12 (500-100-mcgs), a B-50 or B-100 complex tablet, D3, Omega 3's, magnesium and calcium, all of the anti-oxidants, and a few others I forget will help your brain flush the toxins and rebuild.

You very likely did not suffer a true concussion as a one time event. It is more likely that you suffered a number of subconcussive impacts that can cause as much damage or more than a single concussion.

You have some serious decisions to make. Your current condition means that your brain has reached the threshold of its tolerance for trauma. It will likely be more sensitive to impacts and even simple jarring that it has been in the past.

You can expect to go through this again, the next time you have a trauma, even minor trauma to your head.

You may also have a subtle upper neck injury. The muscles that connect the upper neck to the skull get damaged and spasm causing concussion symptoms to increase. You can feel them behind your ears. If they are tender, they need to heal, too. It is like a whiplash injury from getting rear ended in a car. Your upper neck may need some specialized chiropractic or PT therapy. Light traction and icing may help.

The next time you go running, run with foam ear plugs in. This will make it so you hear the impact of your foot plant. Try to learn to plant your foot with a softer impact. It is amazing how the foot plant impact can travel to the brain. You may be able to reduce the impact by running with your shoulders rolled forward.

There is one thing you need to remember. Any activity that causes an increase or return of symptoms is slowing or preventing your recovery. Your brain needs to be completely symptoms free for a couple weeks to finish recovering. Otherwise, it is like trying to continue running on an injured ankle.

For future consideration, subconcussive impacts are impacts that jar the brain but do not cause immediate symptoms. The symptoms may not even show up until a week later. Subconcussive impact are cumulative. They can cause far more long term damage than a single bell ringer. People tend to notice a full concussion and rest up a bit. they ignore subc0ncussive impact and continue with the activity and pile more subconcussive impact onto the first.

If or when you return to rugby and ding your head again, if you experience the same symptoms, you will need to consider if your brain can tolerate further rugby risks.

Heading the ball in soccer will also be a serious risk now that your brain is so sensitive to impacts.

If you continue to struggle with dizziness, you may need to seek treatment at a balance or hearing and balance clinic. There are therapies like the Epley Maneuver that can help orient loose particles/crystals in the ear than can be causing your dizziness.

If you do not develop head aches from exercise, you may be able to spin to maintain some fitness.

Hope you feel better.

My best to you.

Excellent question.

Problem is, no one knows.

Could be a few weeks, years, or longer.

Depends on history on head injuries, age, what you do during your recovery,

-and that wild card:

your brain itself.

Since everyone one's brain is different & incredibly complex it seems hard to nail down timeframe.

My pain less eased over the past 20 months. I have no idea what happens next.

Thank you both for your responses.

Mark, you raise a lot of very important points. After running this week and experiencing a surge in my symptoms, I've decided to completely rest. My doctor told me that I needed to be symptom free for 7 days and I need to listen to that. The week before I was demonstrating an exercise to my rugby team and it resulted in a headache. So I've learned my lesson and realize I just need to be patient now--extremely frustrating for an athlete to do :-(

The interesting aspect of this is that when I experience an increase in symptoms, it is only to one side of my head. The right side of my head feels completely normal. However, the left side (particularly the bottom left) feels as though it is has been freshly impacted whenever I physically exert myself. Does this mean anything?

A bit of history: I have never had a concussion before. I am 33. In excellent health. I am mostly resting during recovery. My doctor said I only need to worry about limiting physical activity but that I should have no problem with reading, watching films, etc.

Hi Lisa,

I'm sorry to hear about your concussion. I was 33 and also in excellent health when I got my first concussion from an auto accident. I used to be a very active person too. That was 20 months ago and I'm still not able to work full time with limitations or even drive very much. I couldn't do either for about a year.
I gained a lot of weight and I'm still crawling in my skin to be more physically active, but I have decided that a normally functioning brain is more important to me, so I continue to rest as much as I can, I still get symptoms when I don't, although they are fewer now than they ever were. Actually, I have a theory that if I hadn't been in such excellent health that I wouldn't be doing as well as I am now.

Most Dr.'s don't really *know* what anyone with a concussion will have problems with. Some experts speculate with some evidence that concussions are caused by microscopic damage to areas of the brain that are too small to show up on MRI's and CT scans. Without being able to open up your skull to see which areas are damaged through a microscope - you don't really *know* whether movies or reading will affect you.

I don't think that means that you should stay away from them - but try to see if you experience symptoms after engaging your brain and then make a decision based on that. You might be able to tolerate one movie and then feel tired, so make a one movie limit or something like that.

My own Primary Care Physician has told me to do what I feel like doing. Being an active person, I was very used to "pushing" myself through feeling tired, but now I have had to learn to recognize that feeling tired is a warning sign my body and brain are giving to me and if I push through it I get worse.

But everyone's concussion is different.

It's true that your brain is trying to repair itself and it needs rest in order to do that. It will take all your reserve energy resources and even some of your normal energy levels to repair itself - that's why you are experiencing symptoms after trying to run, because you don't have enough energy to heal your brain and do all of those things. And cognitive functioning takes energy too, so depending on how much energy you try to use and how much of it your brain wants to use to heal itself, trying to use your brain to do things might very well give you some problems.

Try your best to overcome your urge to be active and forgive yourself when you are unable to.

Thx for the input all...I am hopefully getting better after three months but it is a long and inconsistent road - some days are great and finally symptom free, others are weeks of pain and complete inability to do anything...and yes I have pain most often on the right side of my head, although all over it and have neck pain too - it's very strange!

LisaGH,

You may have never had a diagnosed concussion but if you have been playing rugby and/or soccer for the better part of 33 years, your brain has had many impacts, either sub-concussive or mildly concussive. Many concussions will not manifest symptoms for a few days. By then, the impact is not remembered in connection with the symptoms. The symptoms may also be confused with a hang-over or other ailment.

You may not even remember the head contacts made during a maul or ruck. During periods of high energy or effort, short term memories may not get stored, especially if there was jarring to the brain.

One of the problems with concussions is there is often no or poor memory of the seconds just before and during the impact.

Good points, Mark. Thank you.

I was feeling better today so I ran a couple of miles. This resulted in a very low grade throbbing in my head, followed by a headache. Again, very very mild. I'm not in any kind of pain.

Is it safe to continue exercising? Are these headaches a big deal or just something I have to live with?

Any time you cause a return of symptoms, it suggests that your brain has more healing to go.

I suggest you try running with foam ear plugs in. That way, you will feel the impact of your foot plant. Learning a smoother running gae and foot plant will go a long way in limiting your relapses.

But then, it sounds like you plan on returning to playing rugby. Good luck with that.

I've actually decided not to play rugby. I don't want to risk sustaining another concussion. However, I am the strength and conditioning coach of the team. I recently asked my team to complete player assessments, indicating what injuries--if any--they've had.

One player (21 years old) indicated that she had "mild concussions" after every game last season and they were "not a big deal."

Another player (also early 20s) indicated that she hit her head 5-6 times in the last game--which resulted in her throwing up for most of the day and having a headache. I asked her, "Do you think you may have sustained a concussion?" And her reply was, "I don't know. I guess. I didn't really think about it."

Clearly there's a lot of education that needs to happen about the seriousness of head injuries--especially within the context of women's sports. It's amazing to me that these girls don't think concussions are a big deal. I hope to take what I've learned through my experience, my research and all of your commentary on this board to the field with me while I coach. This forum is an excellent resource and I appreciate what everyone has shared here.