So I think the cognitive haze CAN be explained by upper cervical neck injury. If the blood flow is compromised from injury that is exacerbated by exertion you would feel mental fog etc.

I passed the physiological PCS test at buffalo. They think my symptoms stem from a combo of vision issues and neck issues. Doesn't totally explain the head bump relapse or why higher heart rate exercise does SEEM to bring worse symptoms but then again I can get dizzy from a slow walk around my neighborhood or a trip to the super market (visual input overload). As for my exercise regime still don't know what to do. Was doing recumbent bike in heart rate of 130s and 140s with varying degrees of symptoms that I can't pinpoint to specific causes. I have a high heart rate by the way so 130s is my recovery zone! I'm not even aerobic at that.

Was happy to find I tolerated some push-ups and air squats with no brain symptoms. Overall from my visit to the clinic feel like I got some answers - first doc who said i needed a vestibular consult, since my balance has been fine i was never previously referred- but the answers seem to have only prompted more questions....

It sounds like you may also have some neck issues ...don't give up asking questions because if we don't keep at this hunt we will never get answers...

Hi Canadoc,

I have been lurking on this forum for a couple weeks, but I recently decided to make an account because I noticed that your concussion history and PCS symptoms are remarkably similar to mine. In particular, I feel like I am suffering from a heightened susceptibility to head trauma such that I experience headaches, dizziness, and cognitive dysfunction as a result of "minor bumps" to the head. These lingering symptoms are severely exacerbated whenever I perform physical activity or intensive cognitive focus, which is devastating for me because I am (or was) an avid athlete and highly ambitious law student. The worst part is that my susceptibility to head trauma has increased steadily over the years, and now my symptoms seem to spiral out of control with the mildest of head bumps. I don’t have an answer to this problem, but I’m happy to share my story and brainstorm solutions with you.

My first experience with a prolonged PCS recovery happened from a series of concussions that I got while playing football in high school in the fall of 2006. I felt 95% better from the football concussions after 6 months of rest, but I got another series of concussions in college, and have been battling PCS on and off since then. I struggled with my PCS symptoms in college from 2009-2011. These PCS symptoms mostly cleared up after graduation and I started working as a paralegal from 2011-2013 with relatively few problems. I thought I was over my PCS and decided to play a game of volleyball in Spring 2013, and I sustained a minor bump on the head which re-triggered all of my old symptoms. I quit my job in Spring the of 2013 and spent the Summer of 2013 resting and rehabbing by doing vestibular exercises and easing back into cardio exercises on the elliptical machine while closely monitoring my heart rate. I wanted to be as close to 100% healthy as possible for starting law school. The Fall 2013 semester of law school was a highlight for me. I continued vestibular exercises, worked out on a regular basis, and studied 10-12 hours a day with the help of Adderall. My Fall 2013 GPA put me in the top 3% of the class and I earned a premiere summer internship. I was thrilled because I thought I had regained my health and I thought my life was back on track.

In late February 2014, everything fell apart again after an extremely minor bump on the head. I just bumped it on the headboard of my bed in the middle of the night, and I couldn’t work out or study for more than 30-45 minutes without getting a crushing headache, dizziness, and mental fog/fatigue. I felt really dizzy in class and had trouble concentrating and problems with my memory so I decided to take a leave of absence from school. It is so embarrassing and difficult to explain to doctors and friends about how a minor bump triggered all of these crippling symptoms.

My current neurologist does not think I got another concussion, but she explained it to me as a temporary reoccurrence of post-concussion symptoms that I will work through by continuing with the therapies that have helped me in the past. I am trying view it that way. However, deep down I know that I have developed such a heightened sensitivity to head trauma that it not only prevents me from participating in my love for sports, but also may prevent me from being able to exercise in a fulfilling manner or even have a legitimate career. It’s depressing to think about, so I try to focus on exploring different angles to improve my PCS problem.

Here are things that have helped me in the past: vestibular therapy, visual ocular therapy, occipital nerve block injections in my neck and head (improved symptoms for a few days), slowly returning to physical activity with a heart rate monitor and focusing on cardio (Currently, I can get my heart rate up to the 140-150 range on the elliptical machine without provoking my symptoms too much, but I absolutely cannot do push-ups, heavy lifting, or any actual jogging/running), getting a neuromuscular massage (MRI and X-Ray revealed no serious damage to my brain, but I do have a “mild compression deformity of the superior endplates of the C4 and C5 vertebrae in my neck” which indicates cervical issues such as cervicalgia of muscles and underlying compression which may be contributing to my headache and dizziness symptoms), adderall for focus and energy as needed, an OTC drug called Migralex has helped me with headache symptoms in a much more effective manner than regular motrin, advil, or Tylenol.

Here are things that did not really work for me in the past: acupuncture, topomax (made me drowsy with no improvement in symptoms), low-dose of doxepin before bed (just made me drowsy the next day), prescription painkillers, therapy with a psychiatrist, cranium sacral massage.

Things that I am currently exploring: I am starting Mark’s vitamin routine this week (last week my blood test showed that I am low in vitamin D and vitamin B). I am also scheduled for a sleep study, but I doubt that they will find anything game-changing. Finally, I am considering trying Imitrex.

Please let me know if anyone has suggestions, ideas to research, or things to brainstorm that I could try. Obviously, I want a “cure” for this problem more than anything else but I know the chances of finding one are slim. About a month ago, my pain specialist put me on a course of methylprednisolone steroids over 6 days. I took 6 pills the first day, 5 pills the second day, 4 pills the third day, etc. Immediately after taking the first 6 pills on the first day, I felt 100% better for the rest of the day. I didn’t even realize that it was possible for my head to feel that painless and for my mind to feel so mentally sharp. Unfortunately, that feeling wore off and my symptoms returned after I finished the course of steroids. I know that I cannot take a high dose of steroids indefinitely, but maybe I can find an alternative or more natural solution to mimic the anti-inflammatory effect of the methylprednisolone. Any ideas?

Best wishes to all who have this problem! I know how it can be absolutely devastating, and it’s good to know that we’re not alone in walking this path.

Welcome to NeuroTalk. That is a lot of information.

Migralex is an expensive way to take buffered aspirin. I combine aspirin and Tylenol for a strong pain relieving effect. Have you tried using ice packs to help with neck inflammation and head aches ?

I have not tried combining aspirin and Tylenol. Whenever I take Tylenol it helps with the headaches, but only for a short period of time. I will try combining aspirin and Tylenol this week.

I have not tried using ice packs. I will give it a go after my vestibular & physical therapy tomorrow.

Thanks for the suggestions, Mark.

Your right, we sound like a pair of book-ends! Thanks for sharing your story. If this stuff sounds like group therapy, it's because it is! There is clearly something therapeutic about this site when personal struggles are so easily understood by others.

In my little world of medicine, there are many symptoms I can push through or medicate when I'm having a bad day(s)...which usually follows that wee bump to the head. However the one that I find tough is the reduced cognitive stamina.....feeling mentally exhausted by noon but knowing I have a full afternoon of patients to see. The only thing that helps is a few weeks of healing. Drugs don't seem to have a great place here.

I've been fortunate to be able to work knowing full well that things could have turned out very different. I am humbled when I read people's daily struggles on this blog. When I'm discouraged about not being able to exercise (as I once could), I'm quickly reminded of the many PCS sufferers who barely to make it through a day. Getting discouraged is effortless when you see your career path face, what seems, so many insurmountable hurdles. I'm sorry to hear that your semester has been derailed by a trivial head bump (I completely relate to your story and symptoms). With regards to your law degree though, sometimes seeing the finish line is not the immediate priority. It's like the spiral staircase of a house. You don't have to see the second floor to know you're going to get there. You just have to see the next step and trust you are going in the right direction. We both live day to day with the uncertainty of when the next minor bump will turn our lives upside down again. I constantly remind myself that things always improve with time. Hopefully, your symptoms will settle quickly. But it is what it is. Something as important as being patient during the recovery from the physical and cognitive symptoms is maintaining a hopeful and positive mental attitude in the wake of disappointment. All too often, that little voice in our head gravitates to the "dark side". Tonto once explained to the Lone Ranger that there were two barking dogs in his head. The one he fed the most barked the loudest.

Although I've spent a lot of time researching PCS and consulting with colleagues, the effort has been more to understand my symptoms as opposed to find a solutions. Thus far, accelerating the return of cognitive stamina after an injury remains elusive. Stay tuned and keep in touch. Canadoc

hey there i have had 10 concussions and they have had the same result bt this one i just recently had is so far the worse but i was told if you drink alot water and take supliments such as vitamin c and d and fish oils you can get back to no headaches... if that doesnt work i was told a mri is good or a neuroligist

i hope you feel better concussions suck!

Thanks for the encouraging note, Canadoc. I know that staying positive is paramount in order to recover, and I am fortunate to be experiencing slow and steady improvement. I have found that woodworking is a great activity that I can pursue in between vestibular and vision therapies. I can get my heart rate up to 165 now on the elliptical machine without bringing on excessive symptoms, although I went to an NBA playoff game last week and felt on overload of stimulation. I also felt like I was going to pass out on a walk the following evening after a long day of doing stuff, so I guess it depends on the day and circumstances.

A couple interesting developments have been revealed by my blood work recently. My vitamin B, vitamin D, and cholesterol are all extraordinarily low (Total Cholesterol is 101; Triglycerides: 30; HDL (good): 74; LDL (bad): 21). Do you know if having too low cholesterol can affect brain health? I forget the exact vitamin B and vitamin D numbers, but they are well below the typical range. One doctor thinks my bloodwork in conjunction with my PCS symptoms could actually be an indication of Lyme disease, so I got tested for Lyme disease but I am still awaiting the results.

Regarding alternative treatments, I am considering trying hyperbaric oxygen. I am reading Dr. Harch's book, "The Oxygen Revolution," about using hyperbaric oxygen to treat PCS. It reviews some fascinating studies on the effectiveness of HBOT (hyperbaric oxygen treatment). HBOT appeals to me because I have always said that my PCS symptoms make my brain feel like it's not getting enough oxygen. I know that traditional, old-school neurologists belittle HBOT treatment as a snake oil solution with no evidence behind it, but I think recent studies that implement SPECT brain imaging can objectively show an improvement in oxygenating the brain and seem to have a real effect in helping the symptoms for combat veterans. Do you have any thoughts or experience with HBOT?

HBOT is an expensive process with usually little gain. Some see no gain, others see a small gain. Either way, it usually requires 40 to 80 sessions (dives) to see a difference. One could easily spend $10,000 on HBOT. It can be shown to improve capillary growth and function but daily living functions are harder to measure.

You can effect your B-12 and D3 levels with supplements. 5000 units of D3 and 2500 mcgs or more of B-12 methycobalamin would be a good start. I read a study years ago that connected low cholesterol to poor brain function. Larges doses of Omega 3 DHA fish oil may be worthwhile.

Before I answer this question, I'm going to do a little research. There is plenty of information available on the internet these days. The problem is the quality of the info. In order to justify a recommendation, people sometimes quote studies that were either improperly powered to make specific conclusions because of sample size, were not randomized, had selection bias, etc...... Sometimes there aren't any properly constructed studies to answer a specific medical question and one has to rely on the best available evidence. I know little about HBOT and PCS recovery but will venture to see what quality evidence there is to justify such a cost. Stay tuned.

Canadoc

Further to my recent reply,

I did a pub med on-line search and came up with a few studies of interest. Unfortunately, in most of the abstracts, the sample size of study subjects is small. The other issue that is not well described in the abstracts is the profile of the participants with regards to their disabilities. As you know, PCS comprises a multitude of symptoms that likely reflect injury to different parts of the brain. Grouping all those afflicted with PCS under a single diagnosis would make the study outcome more difficult to extrapolate to an individual. When extrapolating study outcomes involving vitamins, one must distinguish between individuals who are supplementing because of a state of deficiency versus those (which includes most of us) who supplement even though we are vitamin sufficient. I'll let you make your own conclusions.

HOBT
http://www.ncbi.nlm.nih.gov/pubmed/24260334
http://www.ncbi.nlm.nih.gov/pubmed/24255008
http://www.ncbi.nlm.nih.gov/pubmed/24004322
http://www.ncbi.nlm.nih.gov/pubmed/23031217

Vitamin D

(Not much I could find on specifically mTBI and benefits of Vitamin D supplementation in human study subjects other than case reports or very small studies. Plenty of research on vit D and its potential role in neurocognitive health. Whether this can be extrapolated to those suffering from PCS is less clear from an evidence point of view. Remember though absence of proof doesn't mean proof of absences. Not much data on optimal daily dose from a purely neurocognitive perspective and any recommendation I would make would be purely anecdotal. Personally I follow the current recommended daily dose of 1000-2000 units considering the other proven benefits of this supplement (especially in colder Canada). If there indeed is a role for vit D in PCS healing, that's icing on the cake).

http://www.ncbi.nlm.nih.gov/pubmed/24604440

Vitamin C

Many of the studies I came across involve ACUTE head injuries and involve animal models. There is great interest in the role of vit C and its reduction of oxidative stresses in the acutely injured neural cell. Extrapolating this data to the improvement of outcomes in chronic PCS patients may not be accurate but not necessarily unreasonable considering the low risk of toxicity at recommended doses. I realize this may be contrary to what others have stated in this blog but I'm basing my statement on purely evidence-based data that I've been able to find. If others have come across data to support recommendations, I would invite them to respond.