[wdl6591]

Sorry, it's been so long to get back to you. Things have been a little disjointed.
I have suffered from depression and anxiety issues in the past brought on by extreme work stress. I had a breakdown in August of 2011. In October of 2011, while struggling with new medications I had a fall at home and spent 12 days in the hospital dealing with concussion, minor TBI, some minor bleeding in my brain and all of the other post concussion symptoms. Extreme sensitivity to light and motion (but oddly not sound), cognitive impairment, vertigo, fatigue, etc. Treated at Shepherd-Pratt Hospital Concussion institute in Baltimore by neuro-psychiatrist and neuro-psycho-social therapist. Treated at the Malcom Berman Spine and Brain Institute at Sinai Hospital in Baltimore by a neurologist on the staff of Dr. Crutchfeld, supposedly a leader in the field of mTBI and PCS. I showed improvement and was able to return to work (at a much less stressful different position at a different firm) in August of 2012. Now in October of 2013, I have had a headache for 24 months. I've used Depakote as a prophylactic for headache and have weaned off of that to a bare minimum due to other side effects. I use a rotation of Tylenol, naproxen, and Tramadol for pain relief to avoid rebound headaches. I've had Botox injections consisting of 30 injections in my face and scalp (sides and back of head) twice, 12 weeks apart and am scheduled to have a third series next week. The injections help with the severity of the headache, not the frequency which is constant. Most days a level 1/2 out of 10 on the pain scale. Flare ups to 3/4 levels are not uncommon and 7/8 levels much less frequently, which is a huge improvement. Depression and cognitive impacts are much improved. I feel like I'm 90 - 95% of who I was prior to the fall. I've tried acupuncture, diet, meditation, biofeedback, etc., all with minimal success. The only thing that I've come to realize about the medical community and PCS is how little they know about it. You read and hear so much about concussion prevention to sports, etc. and I've come to realize that the reason they care so much about prevention is that they are clueless about a cure.

[sospan]

How do you cope with the Tramadol ?

I have the UK version of Tylenol (co-codamol) for some severe pain in my knee.

On bad days the Tylenol isn't strong enough even at the highest dose so they tried me on Tramadol. A huge mistake I was burning up, even worse headache and my speech and memory went to bits. I was surprised I was prescribed it because all the side effects a the main PCS symptoms - balance, mood swings, poor memory and cognition etc - just the things I was trying to improve

[wdl6591]

I only use the Tramadol in the 100mg ER or 50 mg dosages. I try to limit taking it to 2 days max. Then I'll go to Alleve (naproxen) for 2 days, than to Tylenol for 2 , ibuprofen, than back to Tramadol. There is a phenomenon known as "rebound headaches" that occurs if you stay on one analgesic for any length of time. Your body begins to adjust and "need" the painkiller. When increased dosages are not received, headaches occur. That's how it was explained to me by my neurologist. I haven't really noticed any increases of mood swings, but then again I have them pretty consistently anyway. Cognitive impacts are difficult for me to assess, since I also have "brain fart" moments too often. Not funny, but if I don't try to find some humor in this somewhere I'll lose it altogether. Nothing really relieves my headache pain. The Botox injections have been the most promising that has happened in that regard in the past two years.