[PTczech5]

Greetings fellow neuro talkers,
I am new to this forum and have been browsing posts for couple hours now but haven't found one that address's some of my questions and problems. I will start with my background. I am 24 year old female who is about to finish her doctorate in physical therapy so I am we'll educated on many of these issues, but far from a pro. I do a lot of research on my own as my school works with an evidence based approach. In high school I received 3 concussions playing soccer, basketball, and in a serious car crash. In my undergrad I also competed in collegiate soccer where I received two more concussions within 2 weeks. Finally, about 10 months ago I received another concussion during summer ball.
My first question is if anyone truly knows or has come across any evidence based research in terms of how long post concussion syndrome can last. I know that multiple concussions can have a cumulative effect. Symptoms that I have been experiencing regularly since my 2 serious concussion during undergrad in 2010 include; intermittent dizziness, headaches, sleep disturbances closely resembling insomnia, and troubles concentrating. The dizziness and concentration I can manage ok, however the headaches can be very debilitating and I am at my wits end with the doctors. My second question, is what kind of long term headache meds have people with long lasting post concussion headaches been using with pros and cons. I am just really in need of some advice as I feel drs and others perceive me as a crazy or hypocondriac as my symptoms have lasted so long thanks

[poetrymom]

Hello and welcome to NeuroTalk.

Your question about how long does PCS last is one I am sure we have all researched, and there is no good answer. I call this the Zen medical condition, because the answer to "How long will this last?" is yes.

I think everyone has a different timeline based on previous concussions and the severity of them too. I honestly don't think there is a chartable timeline for this which is so aggravating.


Because of your multiple head injuries, or sub conconcussions, you may be in for a longer haul and may have to be very careful head movements etc to avoid bringing on PCS symptoms.

Other people will weigh in here -- and check out the vitamin thread. This is an extremely important and helpful thing you can do for yourself.

Sincerely,

pm

[Mark in Idaho]

PT,

Welcome to NeuroTalk. Please, just because your school is teaching you to a PhD level, understand that there are scads of MS PT's who you will do well to match the skills of after 5 or 10 years of practice. I have been treated by a dozen PT's and just like chiros, the gifted ones are in the very small minority. Hope you can develop to be a gifted PT.

This giftedness idea is important because it means you can rise above classroom skills. That is the problem with concussions. Very few professionals have anything more than minimal classroom skills.

Unfortunately, it appears you have had not proper traing or information about concussions as you went through your sports career. Getting a second concussion within 2 weeks of a previous concussion means someone put you at serious risk.

With your history, there is no statistical data that means anything. Soccer means you have not only suffered concussions but you have also suffered a large number of sub-concussive impacts. These are symptomless head impacts from heading the ball and such. The statistical data that is available shows a 9 point IQ differential between those who routinely head a soccer ball and those who do not.

I believe you need to seriously consider how your continued studies are contributing to your prolonged concussion symptoms. The standard for recover is quiet rest. This means only enough stimulation to keep good blood flow through the brain. No pushing the limits cognitively or physically.

Most PhD programs include a research thesis. If you will need to complete a research thesis, here is a subject. Most concussion subjects with long term symptoms will also be found to have Atlas to occiput instability. As you know, this joint is a very unstable joint compared to the lower vertebra. It has minimal chondyle/facet depth to center the atlas in the occiput. The common indicating symptom is tenderness and spasm behind the ears. Icing this area can be helpful.

You may need to consider this for yourself. The vehicle collision caused concussion very likely damaged this joint leaving it even more unstable with your concussion history.

When you discuss your concussion with doubters, it helps to be able to break down your symptoms and possible causes. People tend to disregard the blanket concussion catch all. The Vitamins sticky at the top also has links to the Brain Injury Survival Guide. It has some good information about the various symptoms.

As a PT student, you want to be careful about how you consider your own condition. In my decades of being treated by PT's of all stripes and skill sets, they almost all had a focus on routinely checking ROM. ROM has little to due with joint strength/health, especially when it come to the upper neck. Pursuing ROM may defeat the need to rest the joint and protect the soft tissue so it can heal in a disciplined use protocol.

Just like the struggling brain needs activities that do not push it or stress it, the same can be true for the upper neck injuries from concussion traumas. I have a chronic upper neck instability. I have full ROM but must be careful to not use that full ROM is a quick fashion. If I need to look to the side, I start my rotation at the shoulders. This slows the rotational speed and reduces the ROM needed at the upper neck.

Enough already. When doubters speak up, let them know the old axiom. When you have seen one brain injury, you have seen ONE brain injury. No statistical analysis will change that.

btw, From your comments and history, I bet you are a Type A personality. This is a big trigger of concussion head aches. There is a serious need to be able to let go, especially of those things that we have little influence over. And, we do have very little influence over concussion symptoms other than to accept them and try to slow down.

Now, I have probably stepped all over your instructors ideas. Real life experience will trump classroom and book work every day. But, I don't mean to degrade their or your efforts. There is usually a wealth of good information found when we are open to mixing class, book and experiential understanding. Books are usually so limiting.

Next head ache, try icing the back of your head/neck. 15 on, 30 off, repeat. 1 part rubbing alcohol with 3 parts water in a zip lock bag will freeze to a crushable/moldable ice pack. Make three and you will be able to rotate them as you need. And, try to maintain good head/neck alignment when you are icing or relaxing.

My best to you.

[mouse1]

I cannot answer your first question, but I imagine it depends of the nature of injury/injuries, and how much rest you are able to get, I needed 5 months off work and a phased return to work.

One case of PCS cannot really be compared to another. I am nearly 8 months on and now have infrequent headaches, fatigue and sore eyes. The symptoms diminish but it takes a long time.

I am working, leading a full life and more recently exercising for 30 minutes three times a week in the gym. It is all progress.

To answer your second question, I have found Cymbalta very helpful in preventing headaches. It seems very strong at first, causes nausea, constipation and in my case diarrhea. Most of these symptoms should settle in two weeks. Without the Cymbalta I wouldn't be were I am now. If I have a headache which will not go I use Imigran and it goes away instantly.