PCS and head pressure (new poster)
 

Hi all - I've read quite a bit on this forum and already want to thank everyone for sharing their stories and tips. I've taken advantage of many of the resources that people have already provided and I thank you very much! Yet, I haven't come across specific advice for a particular symptom I'm having, and would appreciate any and all guidance/tips.

Here's the history:

I suffered what seems like a minor concussion in September 2013. I play rugby, and got hit around my right eye area by the crown of a teammate's head. I 'saw stars', and a friend came out and had me follow her finger, and said that my right eye wouldn't focus when she got to that side. That was it - no nausea, no blacking out, not even a bruise. I went to the doctor 2 days later because a headache persisted and I noticed that I felt pressure inside my head if I was shouting or talking loudly.

I passed all of the standard cognitive and balance tests with flying colors, and he told me I could go back to normal but to avoid contact until the headaches were gone. Luckily, I relayed this advice to a friend who worked as an athletic trainer, who very firmly told me that it was bad/inconsistent with return to play guidelines. I did everything I could think of - stopped working out, cut out caffeine, cut out alcohol, stopped watching tv, and took breaks from work whenever I could. Being at the end of a PhD program, I couldn't otherwise have complete cognitive rest.

My main symptoms were occasional trouble word-finding, making a lot of typos (well beyond the norm for me), occasional mood swings, headaches, difficulty concentrating, ringing in ears, sensitivity in loud environments, and pressure in my head. I saw a different doctor who ordered a CT, which was clean, and she essentially told me to wait it out. I've also been to a neurologist who didn't find any neurological issues and prescribed nortriptyline.

Fast forward to today: most of the cognitive issues are gone, though concentration and organization are still challenging. I've been working out a lot since January (still no contact), because I felt that being sedentary was worse for my mental health, and the doctors have approved of that though advised me to do more low impact things like biking and swimming when I'm able.

I still suffer, almost daily, from some physical symptoms. The main one of these is a feeling of pressure in my head after concentration/screen time/workouts/loud environments (especially if I have to talk loudly in the environment). The best way I can think to describe it is that when you're a kid hanging upside down on the monkey bars, you eventually feel pressure from the blood rushing to your head. Or, when you're on an airplane and have to pop your ears to equalize the pressure - that's what I feel regularly, especially after long hours at the computer, a hard running workout with lots of pounding, or generally if I just bend over to tie my shoes. When I have this and lie down to sleep, I can feel the pulse in my head very strongly. Basically, I'm wondering if anyone else experiences this and what you have been able to do to relieve it. Doctors seem to brush it off or ignore it whenever I've told them, preferring to keep trying to treat 'headaches' despite the fact that what I experience is not like a normal headache.

Often, when it's bad, my face also gets very red across my cheeks and nose. I really just don't know what to do for this because as I've said the doctors don't seem to have a vocabulary for it and ignore it. I know that I'm lucky to have only been suffering since September and that my symptoms are mild compared to some of what I've read from other posters, but it definitely impacts my life (making my work more challenging and slowing my progress, going out with friends to anywhere that plays loud music is really hard, and obviously playing the sport that I love is off limits) and I can't shake the feeling that it will never go away, which is not good for my general well-being. At first I was optimistic that if I just did everything right, it would heal in a few weeks, but in the past few months I've more or less lost hope. Pain-free concentration is pretty crucial to the academic career, and I would love to return to rugby but it seems like I shouldn't until the PCS is gone. I would love advice on anything that I can do to try to relieve this lingering symptom, especially from anyone who has used alternative medicine with success, because it's increasingly apparent that modern medicine is failing me.

I should add - this is my first concussion (that I know of), and I've never been prone to headaches or migraines in the past.

My concentration is limited right now.. head is pounding.. so forgive me if I ask questions you answered... First, Yes... I have the same feeling when I do too much but then after it results in a monster headache..

So, who all have you seen for this?

Does your neck bother you as well?

On any meds ?

rugbyphd,

First, I seriously doubt this is your first concussion. This may be the first that had lasting symptoms. Many people suffer concussions that clear within 24 hours with only an occasional head ache. If you have a passion for rugby, I bet you have had a fair number of 'dingers'

You said "a hard running workout with lots of pounding". You should not be doing such work outs. Tr running with ear plugs in and you will get a better sense of the impacts your brain is being subjected to with each foot plant. Maybe you can try to light runs on grass or an artificial surface track that absorbs your foot plant.

Your academic load should be the only stress on your brain. Even that should be minimized. Since you can not stop your phd program, you should stop the other activities that strain your brain. Take breaks for the computer screen and keyboard as often as possible. If you find you need to reread a sentence to understand it, that means your brain has hit OVERLOAD. Take a break with your eyes closed for 10 to 20 minutes.

Your friend and her 'follow my finger' may have had good intentions but she does not know what to look for. The 'follow my finger' is called a horizontal gaze nystagmus test. The intent is to see if the eye can smoothly follow the finger. A positive for brain injury or intoxication would be the eye jerks as it moves from side to side. Any such tests should be done by a trained person on the sidelines. Conservative return to play guidelines would require the player to sit out the rest of the game and not return to play until all symptoms have resolved. Any symptoms that return during or after activity would mean the person has not healed enough to return to play.

So, focus on your studies and required work and give your brain as much rest as possible.

I would encourage you to give up on rugby. With the academic and career work load of a PhD, your next concussion could be career ending. You need to protect your intellect. I speak from experience. Losing memory functions can negate the value of a high intellect or knowledge. I still have a high intelligence but my memory limitations severely limit the ways I can express that intellect.

My best to you.

I can definitely relate to that feeling (limited concentration)! Thank you for your response. Mine very rarely results in a huge headache - just that feeling of pressure and pounding. If it's been particularly taxing - like 2 weeks ago I was preparing for a conference and so working at the computer programming/writing for ~12 hours/day all week - I will go to bed with it and wake up with it.

So far, I've seen 3 separate doctors. The first was a GP who basically said "you'll be fine in a few days. go back to all exercise and work except avoid contact" - fortunately, a knowledgeable friend told me to ignore that advice.

The second was another GP, who I've seen a few times. She seems relatively knowledgeable about concussions and actually has a son who went through this. She really pushed cognitive and physical rest (obviously), and ordered a CT after the first ~2 months. She also acknowledged the reality of my world, which makes cognitive rest very hard to come by.

Finally, I saw a neurologist. He did a host of neuro tests, said I had a mild concussion and PCS and was optimistic that by my next appointment I'd be doing much better (that appt is in 2 weeks).

GP2 gave me low dose amitryptiline, and Neurologist changed it to nortryptiline because the first med made me really drowsy in the AM.

My neck has not bothered me at all.

Mark - Thank you so much for your thoughtful response.

I can't guarantee that I've had no previous concussions, and I've been playing sports for as long as I can remember (I'm 28; rugby for ~10 years). That said, I've had some very good coaches, all of whom have emphasized how to protect your head and are very cautious when it comes to head injury.

Also you are absolutely right re: return to play; to clarify, we followed those guidelines. During the game, when my friend clumsily issued the horizontal gaze nystagmus test (thanks for the vocab!), she did immediately pull me out. She said that my right eye jerked and declared that this was a failure, so I exited and did not return to play. I should add, she's a former EMT so has some training in basic first aid and such.

I was in a car accident almost 2 years ago, where I was in the passenger seat and we were struck from the side. I definitely had whiplash and neck pain for a while - I saw a chiropractor and massage therapist for that. I genuinely hadn't thought about that again until now, but it's possible that the history of whiplash could be contributing to my PCS or could have caused a minor concussion without me knowing it?

I've tried to scale back on the hard running workouts (it's sprint intervals that are the worst), and focus more on swimming, slow jogging (though good point about changing the surface), and biking when the weather allows. I just find that I get moodier, lethargic and anxious when I can't exercise - which is how things went for the first 3.5 months.

I've also found that if I'm having trouble concentrating or have other symptoms while I'm working, a midday gym break actually helps. The neurologist suggested that this might be due to the fact that I get cognitive, if not physical, rest while exercising, which is otherwise very challenging for me. Even when I try taking breaks, etc., I find that I have trouble 'turning off' my brain, so true cognitive rest is almost impossible for me.

It's definitely important for me to maintain memory function (and I know that I've lost a bit since the concussion) - because you're right, an academic career absolutely requires this along with intellect for success (same with concentration). I quite honestly don't know what I'd do if I couldn't pursue an academic career, and so I know I need my brain. I'm already behind on the dissertation because last fall was so challenging for me, and I can't afford to lose any more.

Edit: To be more specific on medication, currently nortriptyline dosage is 50mg.

As much as you do not want to hear this... I am with Mark on giving up the Rugby thing... and right now, any more than walking and maybe, and I stress maybe some weight lifting... save your brain for your studies...

I was working out daily.. one to 2 hours.. .and now I can not walk a mile without repercussions BUT everyone is different. This is my first concussion that I know of....

Are you feeling any different from the neuro apt that you had 2 weeks ago? if not, you may want to call and just make mention to the nurse that you are not making any improvement... I had the same thing happen and my balance therapist suggested I call.. I did.. my neuro wanted to see me and see exactly what was going on and why i was not making any progress.

Sounds like you have some anxiety going on as well.. which I think based on what I have read and my own personal experience is perfectly normal...

As for another alternative... have you looked into an osteopath? someone that does cranial sacral therapy... small movements that will help reset the brain and your head in general... I started seeing one about a month ago... I have been twice.. I go again next week.... they offer a different look on the brain that a MD... just a thought..

If this does not make sense, I am sorry... head still hurting... ask questions...

Thanks, Sarah. Honestly, it helps so much to know that people understand what I'm talking about - I've been starting to feel like I'm just making it up even though I know that I'm not! It doesn't help that friends/family constantly ask me what the timeline for full recovery is...

I was starting to think about an oseteopath while reading the forum. I made an appointment for one on Thursday (luckily our student health center has one and she had availability so soon). Have you found it to be helpful? I've never heard of cranial sacral therapy before, but I'l certainly bring it up if she doesn't. Thank you!

I don't think much has changed since the neuro appointment, other than that the nortryptiline, as promised, doesn't leave me drowsy/dizzy in the morning. It does seem to have a different side effect, as I occasionally get a weird muscle spasm/stutter on the right side of my lower lip while speaking - definitely not something I've had before. I might be able to move the appointment up by a week or so.

I did have one completely symptom-free day last week, which I hadn't experienced in months (I had 2 or 3 in November), so that might count as improvement?

You are in good company!!!

My new favorite is when my kids and husband look at me like I have 3 heads when I ask the same question in a 5 minute span.. or my 5 year old says... Mom, are you listening... write this down...

This may sound confusing but try and picture this... this is what my osteopath told me yesterday... There is a coating on your skull.. and attached to the coating are like parachute strings that connect to the brain... then there is the fluid... so when you get your bell rang and the brain moves the strings try and correct the movement but depending on how bad the movement was they can not always correct... so the strings stay in that set place... this causing havoc on various systems in your body... so yesterday he told me that my right and left hemisphere were not even and i had a torque to my brain... so he moved it back to place... YES, for the record, THIS DOES SOUND CRAZY TO ME TOO! however, I could feel which way he was manipulating the brain... and honestly... I am so tired of trying every drug under the sun I will try anything at this point!

As for your good day... GREAT... but... you should have 3-5, some will say 7, good days before increasing activity. So, just keep that in mind...

Hope the above does not sound too crazy... but if you are like me... you want to do anything to feel good again everyday...