[Laupala]

Hi everyone,

I'm a 25 year old grad student who's had PCS for 4 months. I'll be upfront with the fact that I know things could be much worse and I'm lucky compared with many who frequent these boards. That being said, I'm not in a good place right now and need advice.

I slipped on some ice and banged my head 4 months ago, initial symptoms were just headache and feeling out of it. Rested for 5 days feeling better each day and then lightly hit my head on a car visor (still get headaches there now), sending me into a tailspin of 3 nights without sleep and anxiety, for which I was prescribed klonopin.

Headaches got worse on klonopin, was on that for 2 months while I mostly rested, then started easing back into activities. My concussion specialist told me that as long as headaches weren't getting to a debilitating point at the end of the day, I could still gradually increase activity. 2 months in I took the exercise exertion test and passed, headaches not being exacerbated (but still present) with exercise.

Over the next month I increased exercise and activity levels. The headahces weren't getting better, but they weren't getting worse, and I was able to concentrate on things for longer, look at screens, even watch TV without feeling overloaded or exacerbating headaches.

I was feeling so good that I decided to go on a backpacking trip with some friends in Utah (I live in NY). My doc OK'd it, and I thought it might be just the fun I needed to get out of this funk. The trip itself went fine, I was able to backpack 3 days, about 10 miles a day, without increasing headaches (or only slightly increasing headaches). I got back home, thinking that if I could handle that without getting worse, this bad dream might be behind me.

A few days after I got back I started feeling worse, getting new kinds of headaches and being less able to concentrate and more easily overloaded. This caused major depression (which I normally never feel), from which I've had trouble getting out. A doctor has recommended an SSRI, but I'm afraid it will hinder healing, although maybe being constantly down or anxious is doing worse to my healing.

Then a week ago (as alluded to on another thread) I bumped my head against the ceiling. I've been assured by people here and doctors that it wasn't another concussion, but I have even worse headaches now, and new ones where I bumped it.

I've also been going through a protracted distancing and probably break up with my girlfriend which has been really hard and caused a lot of emotional turmoil in addition to what I'm going through with PCS.

I'm seriously considering leaving my research, going home and starting from scratch, doing nothing all day for a week or two, and then slowly ramping back, hopefully returning to school in the fall. I think getting away from where I am now might distance me from some of the emotional turmoil I've been going through, and home is somewhere I could more easily rest. Is going back to total rest even helpful this late in the game, or am I in too far for healing to occur?

Typing this was too much, brought on a bad headache where I recently bumped it. Thanks for reading and any advice you might give.

[Mark in Idaho]

You are never too late for healing/improvement. It sounds like you never have taken enough time away from stress and activity to allow healing to take place. As has been said many times before, healing is a marathon, not a sprint or series of sprints. Recovery is measured over many weeks or even months, not a few days or a single week. A good day or two is not a justification to return to activity. It is just a sign that things are starting to head in the right direction.

You are still over-thinking every little detail.

I wish I had advice to help you stop over-thinking every little detail. It is something you will need to figure out.

My best to you.

[Laupala]

Thanks, it's just my personality, I am trying to change it (although I'm going to ask for a few details here!). Would it be best to return to doing absolutely nothing all day for a week or two? Or can I stick to quiet rest activities? If I get a headache while playing solitaire for instance, is that a sign I should stop? If I have a headache beforehand, should I not even play? I pretty much always have some headaches, so that would be tough to stick to. 4 months in and I'm still not really sure how to interpret headaches...

How many days can pass before I start to do more, a week at a certain activity level? Is it just something I need to figure out through trial and error?

[Mark in Idaho]

Do you take anything for your head aches ?

A week or two of rest is miniscule in the scheme of PCS recover. Besides, I doubt you could tolerate complete rest. You would still be mentally involved/anxious. Quiet activity is valuable to keep blood flowing through your head. Having some quiet activities to do when you have a head ache should be good. Take a break from the quiet activity from time to time. Close your eyes for a few minutes then resume the activity. Quiet activity is also a good distraction.

Do you spend your day with a smart phone in your hand ? texting, etc.

[Laupala]

I don't take anything for my headaches as I see them as a signal that I'm not well yet - I generally don't like taking medication, and think that if I took something I would be interrupting that signal and could make things worse by doing too much (although I've been pushing through headaches, so I guess I don't really stick to that rule). Should headaches be seen this way? As a signal that I'm doing too much? Or are they just a necessary part of my life right now that don't necessarily mean anything? Or somewhere inbetween?

I've been spending more and more time with the smartphone, but for about 3 weeks after the fall I used it sparingly if at all.

I have a friend who has taken amitryptiline for sleep and headache reduction. My sleep has improved since getting off klonopin, but it's still not great - I have nights where I wake up at 1:30 and have trouble getting back to sleep, despite keeping pretty good sleep hygeine. I think it's just because my body is used to being tired from strenuous exercise everyday, and I've cut that out.

My doctor has also suggestion amitryptiline - any thoughts on this? I know some medications disrupt deep sleep and rem sleep, both of which are crucial, so I'm hesitant to get on something like that.

[Laupala]

Was just riding in a car that braked suddenly and now I've got a new headache around my eyebrow. We were only going 20 or so, so I'm sure it didn't cause any actual damage, but man am I sick of feeling all these little bumps and brakes.