[Hiker56]

Curious to hear what others have tried in combatting exhaustion. Constant headaches and exhaustion are my main two existing symptoms. I am thinking that I am probably depressed, as I get irritable easily, everything feels difficult/like it takes a lot of energy, and in general I find it hard to care about much.

I am on nortriptyline for sleep disturbance/headaches, though I am unsure of whether it's helping any more or not. For about 10 days while taking it, I felt like I had the energy to get things done, things were not overwhelming, etc. It was such a relief. Unfortunately, that effect has disappeared, despite an increased dosage.

I've also tried Effexor, but it made my headaches almost unbearable, to where I was almost completely disabled by the pain and considered going to the ER several times because I didn't know why I was suddenly in so much pain. After stopping it, I'm back to my more normal pain, which is usually 5-6 out of 10 on the pain scale. Every day. Constantly. Unless I'm sleeping, I always have a headache.

I guess I'm just feeling at a stalemate in my treatment and not sure what else to try. If anyone has ideas of medications that helped them with energy level, I'd be interested in hearing.

[Doozer]

Hi, welcome to the forum, sorry to read that you are in so much pain. You'll find some good advice here. What happened to you and how long ago? What have you done to help your healing? Drugs generally cover up a problem, not cure it. This can be helpful, but can also cause more problems from side effects, or by covering symptoms not allowing you to listen to your body when it complains that you are pushing your injury too hard. Medication in our Western countries seems to be rampant, but as my neurologist said, he questions how much help they actually are for this condition. Mark will be able to tell you more than me however.

Don't hesitate to ask whatever is on your mind.

[Mark in Idaho]

Hiker56,

Welcome to NeuroTalk.

There are many things that can cause and can help with headaches and fatigue. Without more information about your injury, diagnostics and treatment, it is hard to respond. Your daily lifestyle and activities can impact your symptoms, too.

Please feel free to tell us about yourself and your injury.

My best to you.

[Hiker56]

Originally Posted by Mark in Idaho

Hiker56,

Welcome to NeuroTalk.

There are many things that can cause and can help with headaches and fatigue. Without more information about your injury, diagnostics and treatment, it is hard to respond. Your daily lifestyle and activities can impact your symptoms, too.

Please feel free to tell us about yourself and your injury.

My best to you.

Thank you both. Doozer, I'm inclined to agree with you about the drugs covering up symptoms, not curing them... however, I'm not sure where else to turn with the headaches and exhaustion?

I had my concussion in Nov 2015, so I'm just past 3 months out now. It was a freak accident, I had been sitting under a piece of playground equipment, spinning my daughter on it. She got up and ran off elsewhere, and I sat there on the ground for a few minutes. She fell, and I got up quickly to help her, not realizing that the piece of equipment was rotated in such a way that it was directly over my head. I slammed my head into it as I stood up.

At this point I feel like I'm not satisfied with what my treatment has entailed, but I am looking for direction in going forward. Things I have tried: OTC pain meds (completely unhelpful, they don't touch the pain), 800 mg of ibuprofen (possibly slightly helpful in taking the edge off of my pain, but not convincingly), baclofen (used for a short time just to be able to sleep despite the pain), tramadol (made the pain worse), Effexor (made the pain worse), and Nortriptyline. I think I originally saw some improvements in the headaches after starting Nortriptyline but am not sure if it's helping much anymore or not. I can't tell.

I've also tried various home remedies for headaches, like peppermint oil and soaking my feet in hot water while using an ice pack on my head. Or relaxation techniques to reduce muscle tension/encourage deep breathing. No significant help from those either.

At this point it feels like my neurologist's main plan is just to try med after med and see if something helps. She did not think an MRI was needed, she said she didn't think it would show anything. I have not found her all that communicative, and would like to find someone who will engage with me a bit more in terms of figuring out a treatment plan.

I was previously very active before this and enjoyed climbing mountains, running, and generally being active. While I do a few light workouts a week, it's generally much more difficult due to the exhaustion factor. I stay at home with my two kids (both under 5). I do find that disturbed sleep is a huge trigger for worse headaches, as is PMS. Haven't noticed any other triggers at this point.

Hope I provided some helpful information. Thanks for your responses.

[Bud]

Hiker,

You weren't injured that long ago...for some of us it takes a bit longer than most before the body rights itself.

Be patient and listen to your body.

Some pills can bring on fatigue so see if that is a possible side effect for someting you are taking.

Bud

[Doozer]

The brain tends to heal very slowly, so don't get tied up in knots about this taking a while. It's highly likely that something is aggravating your headaches, the usual suspects are brain stimulants like tv, smartphones, continuous noise, light, caffeine, sugar heavy foods or sweeteners. You need to figure out what your triggers are, which can be hard so soon after injury as the brain tends to be much more sensitive. A supplement regime can be helpful, take a look at the supplement sticky on this forum. Also, an anti-inflammatory diet may help slowly reduce your pain, high doses of fish oil and/or eating meals countains oily fish can help, along with other foods known to reduce inflammation and aid healing.

Nerves take a long time to heal. Keep your chin up and concentrate on your recovery. Relapses are normal. Getting down about it is normal. We have all been there and are still there. You aren't alone.

[Mark in Idaho]

Hiker56,

If your only symptoms are headaches and fatigue, you could have an upper neck injury. It can disrupt blood flow and cause muscle spams that contribute to headaches. It can also interfere with sleep quality, no REM sleep, that can cause the fatigue.

Upper neck injuries are usually very subtle. They require gentle diagnosis and treatment, sometimes, just gentle treatment assuming a subtle upper neck injury. This can be a PT doing gentle traction and mobilization. It must be followed with good head and neck posture during rest and sleep. No thick pillows that lift the head. A good indicator is tenderness at the bony spot behind the ears. Lack of tenderness there does not rule out an upper neck issue. Some have found help at upper cervical chiropractors such a NUCCA trained chiros.

The traditional 'twist the head and pop the neck' chiros are often too aggressive for the subtle injuries suffered.

Some headaches are the result of vision issues. A behavioral optometrist can diagnose and treat these issues. You can find a local clinic at this link,
https://nora.cc/healthcare-locator.html

Don't be upset with your neuro. They often are not as knowledgeable with Post Concussion headaches and one would expect.

There is a lot of good information in the Vitamins sticky at the top. More than just vitamins. Links to NUCCA etc.

[Hiker56]

Can PT's diagnose an upper neck injury? My neck is sometimes a bit sore, but not terribly so.

I do have vision changes as well...I forgot to mention that. Fortunately, I saw an optometrist who is very familiar with TBI (he runs several of the local hospitals' vision/TBI clinics), and he was very helpful. It changed my prescription quite a bit. Ironically, my vision is actually better than before the concussion. I have joked that I only need to get 4 more concussions before my vision returns to 20/20 Before the prescription change, my eyes would fatigue quite quickly when reading (my right eye was doing most of the work focusing). I haven't really tried reading again since my prescription change.

I do really appreciate the reminders to be patient, that it's somewhat normal for all this healing to take a long time. I am trying to be a little bit more patient with my fatigue level. I also appreciate the reminder to be looking for headache triggers... but you're right, I can't really tell what is triggering me right now (aside from disturbed sleep and PMS), as I have a constant headache.

[Mark in Idaho]

It is difficult to diagnose an upper neck injury specifically other than by the ways already mentioned. But, you already mention neck pain. A PT may try to check you with range of motion movements. These can be helpful before treatment starts but should not be done during following treatments for a few weeks or even months. Each range of motion assessment can inflame the area being treated. Treatment should be very gentle. It should be just enough to maintain mobilization of C-0 to C-1 and C-1 to C-2.

Mine has stabilized but never healed. I can move my head and feel/hear the grating. These joints have very little cartilage to lubricate movement.

The important issue is to be sure they are not locked and the ligaments have an opportunity to strengthen/tighten so as to hold the joints in position.

Increase vision acuity can add stress to the brain as it stitches each image together. Some optos will prescribe a detuned prescription so the eyes can relax as the brain does not need to work so hard to stitch the fuzzier images together. My optometrist detunes my normal prescription just a bit because it offers a more comfortable vision. He showed me the difference with his testing equipment until we found a comfortable level. Some PCS sufferers do well with a pair of glasses that correct to 20/40 for those 'relax my eyes' time.

You should try limiting the amount of time you spend reading and doing screen work to see if it helps with your headaches.

I would get to point where I fatigued and needed to reread a line of text. This was a sign I needed to take a break.