I am hoping some of you can provide some insight to help me.

My 13-year-old son hit his head falling backwards playing hockey back in January. He did not lose consciousness, but suffered from severe headaches, dizziness, fatigue, and nausea. He had symptoms for almost 3 months, during which we at first eliminated all activity then slowly eased him back to school. After the 3 months all symptoms were gone, so resumed all normal activity other than hockey, which was to resume this winter.

In July/August, he started having some headaches again, but only when playing French horn, and the headaches would go away 15 minutes after he stopped playing. We did not think it was connected to the concussion, thinking instead it was related to trying to play his instrument for more difficult songs and more frequently while wearing braces. Some days he had them but some days he did not, and they pretty much went away end of August.

Two weeks ago, he came down with a cough and had headaches too, which we attributed to being sick. The cough went away a week later, but now he has headaches more frequently. They are triggered by things such as watching certain videos (I think it was some videos with bright colors and patterns in science class), singing, playing piano, playing horn, even walking through the hallway in school or sitting in a noisy classroom. In all cases the headaches seem to go away 15 minutes later, but they are pretty strong.

MRIs were done both at the time of the injury and just now, with nothing showing up.

My questions:

1) Is it normal or unusual for headaches to return months after being symptom free? Can he expect to have such headaches return throughout his life, or do some grow out of them?

2) Is it dangerous to have these headaches, so that the activities that bring the headaches on should be avoided, or does he have to learn to deal with them?

3) After the initial injury, we made sure he would not play hockey until all symptoms were gone, as our understanding was that during that time he would be in a dangerous state and getting another injury before being recovered from the first could be very bad. We had thought that after being symptom-free for a few months it would be OK to resume playing hockey now. Since some headaches have returned, does that mean he would again be in this "dangerous state" as if he had never recovered from the initial injury in the first place, and avoid playing (even if playing does not trigger headaches now)? Or has he passed that state and is it OK to play (knowing of course there is always the danger of another concussion, but the danger is no greater than if the headaches had not returned)?

4) Any advice on how to deal with the headaches?

We are talking with doctors as well, but unfortunately our experience has been that they don't seem to be very knowledgeable and may even contradict one another! So any advice would be appreciated.

jplm,

Welcome to NeuroTalk.

1) Head aches are quite common and can be chronic for months after a concussion. Nobody can say how long he can expect to have them. For some of us, head aches are just a part of life, even years later.

2) These head aches are not dangerous unless there are other symptoms with them, like slurred speech, loss or struggle with motor control, nausea, and any stroke like symptoms.

3) He is very likely long past the time where a second impact (Second Impact Syndrome) is a severe risk. Second Impact Syndrome is where the brain has not regained control over intracranial pressure and a second impact can cause an increase in intracranial pressure that can be life threatening. This risk period is usually within the first month or so of the original injury. He is at risk of Multiple Impact Syndrome where each consecutive impact causes far more injury and symptoms and takes longer to heal with a greater likelihood of long term persistent symptoms.

There are no tried and true ways to treat headaches. Pain meds can help, ibuprofen, acetaminophen, etc. Icing the back of the head and neck can help.

If he has any tenderness at the bony parts behind his ears, he may need to seek treatment for a subtle upper neck injury. Upper neck injuries are often the cause of head aches. Gentle chiro, PT, etc combined with good head and neck posture discipline, especially when sleeping or resting, can help. These injuries can take months to heal.

Returning to hockey is a big question. If he is having such a struggle with head aches, a second concussion can magnify he chronic head aches. Though not likely life threatening, another concussion can be lifestyle threatening. He is at an age where his brain is in the middle of serious maturing. Disrupting this maturing can have lifelong consequences. Personality changes, problems with impulse control,and such can be the result of concussions at this age.

There is a growing number of professionals that are suggesting avoiding head injury sports until after 14 years old. For an already injured child, this age should likely be a few years older.

It sounds like he has a busy and accomplished life. This puts a strain on his brain and makes him less tolerant/slower to heal from impacts. It also means he has more activities that can be negatively effected by another concussion. So, returning to the ice is a serious question. If he was my child, I would be keeping him off the ice for a year or so minimum, until his brain was older.

I know this is a tough issue. Hockey players are usually very passionate about their continued play.

My best to you.

Thanks for the reply.

We will probably hold off on playing hockey for a while. But unsure about other activities.

For example, playing musical instruments. If I knew the headaches were something that he simply has to deal with going forward, we would treat the headaches as we can but try to resume most normal activities. So I would encourage him to play his instruments, even to try to play a bit past once the headaches start, to try to work through them. If the pain is so much that it is not bearable, stop, but if the pain is little more than a nuisance, play through it, and maybe by doing this would be able to deal with better over time.

On the other hand, if I knew that abstaining entirely from musical instruments (or video games, or TV, or whatever) for a period of x days would make the headaches go away for good, we would obviously do that! But hate to restrict all activity in hopes of it curing the headaches if the reality is the headaches will come and go regardless of whether activities are done or not.

For a case like this, is there any evidence that would support restricting activity for some period of time (a week? a month?) would improve our chances of the headaches going away for good (or for a long period of time)? Or any evidence to the contrary - that resuming normal activity would help one deal with the headaches better than restricting activity?

As I said, there is no tried and true ways to treat head aches. There is no rhyme or reason as to when and why they come and go for many people.

I would suggest not pushing until they become uncomfortable. If they are just annoying, he is probably OK.

The Buffalo protocol suggests to stop pushing at the first sign of a head ache and reducing effort the next time around to avoid causing a head ache/return of symptoms. But, this is regarding exercise.

You need to understand one simple concept.

If you have seen one head injury, you have seen ONE head injury.

Every concussion is different. They may have the same or similar symptoms but it is very difficult to compare treatments, timelines and outcomes between concussions. The statistics are just that. Numbers crunched after observing hundreds of concussions.

If he pushes through his head aches, chances are it will take longer to recover from them. But, he may also develop a tolerance for the discomfort.

So, Mom, you needs to sit back and be supportive knowing you can not fix this. I know moms want to fix what ails their children. The best you can do is consider how to reduce his risks in the future. Please keep in mind that his next concussion may cause cognitive deficits. I dropped a full grade point as a high school sophomore from a very minor concussion heading the ball playing soccer. I had 3 prior concussions. One serious, 2 mild. A mild concussion my second semester in college caused me to drop out. Negative personality changes are also common. I'm not trying to scare you. I'm just trying to give you a dose of the reality of concussions. He is young and has lots of life ahead.

You can help with good brain nutrition. There is a sticky at the top called Vitamins. Check post number 101 on Nov 8th. I have updated the information. I'll make it easy. here is a link to it. http://neurotalk.psychcentral.com/thread181974-11.html

My best to you both.