Hi everyone,

This is my first post on this forum, though I’ve been reading (and re-reading!) many of the threads over the past year. Just the simple realisation that others have been impacted similarly has aided me in my struggle with coming to terms with my post-concussion self.

In recent months I’ve met with several Neurologists and Psychiatrists, and I thought this community might have some valuable insight and suggestions on my current situation. Before getting to that, here’s a bit of background info:

- 43 y old male currently enjoying everything PCS has to offer

- Incurred a concussion (age 41) deriving from a multiple car pile up (I was the meat in this car sandwich)

- I have been diagnosed with PCS (now at 20 months), depression, and mood disorder

- Currently highly intolerant of any activity (e.g. simple 10 min conversations, public settings, watching my children play sports, etc) are triggering events for lengthy recovery periods (typically range from 3-14 days; my brain literally feels as if it’s ran a marathon and about to collapse)

- During the recovery periods, days 1-4 involve depression, rumination, issues with anger and frustration (gets vented at my family, unfortunately), and increasingly intense headaches. After day 4, the headaches either plateau and/or taper off to their “normal” level (unfortunately they never stop). Also, following day 4, issues with depression, anger, etc., are greatly diminished or absent.

-Headaches have persisted constantly since the concussion. Prior, however, I rarely had a headache

So, as I mentioned above, I have seen a number of specialists. The general consensus is that my current headaches are caused by depression, and not the mTBI. However, it is also acknowledged that it is possible that residual injury/effects of the mTBI may be the cause, but unlikely. Unfortunately these opinions on the etiology of my current state are always provided in a report, and thusly I’ve been unable to ask any questions.

For me personally, this conclusion of depression being the root of my headache issues seems qualitative in nature. There appears to be no data to substantiate this assertion for either mTBI or depression. For me, being someone who asks questions and looks for data to support conclusions, I am very uncomfortable with this.

Here’s my question for the community: is there any type of imaging analysis that can aid in determining if headaches are being caused by an mTBI or, alternately, can conclusively show a lack of defects (i.e. depression most likely cause)? Note, I have had a standard MRI performed with no abnormalities identified. However, this is normal for people with mTBIs. I was wondering if there are more advanced imaging methods, such as functional MRIs or other analyses with 3/7 T MRI, would be possess improved ability to detect mTBI damage?

Unfortunately I’m not able to endure the impact a lengthy review of the literature would have, but it occurs to me that other community members may have asked this question themselves or have relevant knowledge that would be useful.

Thanks to all for taking to time to read the post. Best wishes.

MicroMan,

Welcome to NeuroTalk. It sounds like you are suffering a classic case of post concussion syndrome with post trauma head aches. Has anybody suggested your neck, especially your upper neck as a cause of your head aches ? Injury at C-1 and C-2 can cause muscles spasms that can cause persistent head aches. Treatment can be difficult to find.

A simple experiment is to touch the bony spots behind the ears. If they are tender, this points to an upper neck injury. Absence of tenderness does not necessarily exclude an upper neck issue.

A DTI MRI may be helpful at identifying a organic injury. It does not identify the injury but it can show that an injury does exist.

It will help to learn to identify the specific triggers in your triggering activities. Over-stimulation is a common trigger. Multiple voices can be one. Too much visual clutter can be one. Along with identifying them, learning to recognize when you are about to hit your limit is also helpful.

Have you attempted to follow your blood pressure and see if it parallels your head aches ?

If you have not already, you should read the Vitamins sticky at the top.

Feel free to ask any question. We have heard them all. Lots of experience here.

btw, What kind of work do you do ? What is your living environment like ?

My best to you.

Thanks so much for providing such a thoughtful reply Mr. Mark : ) It appears you have a wealth of experience in the area. You’ve mentioned a number of things that are very helpful; I’ll try to respond in point form so as to minimise my written ramble

- I live with my wife (she has been tremendous) and our 2 children (6 and 10) in a detached home. Extraneous noise is not an issue for me, but interacting and tolerating the kids has been problematic. I tend to withdraw from family life via the basement… darker, cooler, and offers reprieve from in-home stimuli

- For employment I am in a very mentally challenging research-based position in which I direct a laboratory. However, I have not been capable of returning to work as of yet. My inability to tolerate basic daily interactions preclude this (see below)

- As you suggest, I’ve come to learn what my triggering activities are. I’m getting a feel for when I’m at risk for lengthy days of recovery. I’ve learned that any activity that increases bloodflow (possible pressure?) is intolerable. This includes simple exercises, such as walking (I was running >20 km a week at the time of the accident). Interestingly, even being declined in a dental hygienist’s chair for an appointment resulted in 2 weeks of recovery. Similarly, mental engagement (Xwords, sudokus, emails, reading) for more than 5-10 min are triggering events. Talking with someone other than my wife for more than 10 min is too much. Etc.

- I’ll take a look a the Vitamin post and also do some reading on DTI MRI… thank you very much

- Interesting on the C-1 and C-2. I have gone to 3 Chiropractors, all of who performed neck pressure point techniques, did an adjustment, and manipulated my skull. In every case, the impact on me was tremendously terrible… brought on some of the worst headaches and depression issues I’ve endured over the 20 months. Worst part of it was that the recovery from these lasted 4 weeks. With that said, I will look into this. Would massage therapy work?

- Interesting suggestion on the blood pressure. Since the accident, my blood pressure is higher and my heart beats approx. 25 time per minute more than prior to the accident. I was recently put on a diuretic bp medicine that has lowered my blood pressure, though no effect on my headaches has occurred.

In the end, it appears I’m going through what many of community already have. I need to find away to mentally feel better and increase my activity levels without sending me into lengthy recoveries… I guess this translates to “suck it up” : )

Again, thanks for the help Mark

If the chiros did the 'twist the head and pop the neck' adjustment, that is often too aggressive. A gentle traction and mobilization or gentle upper cervical technique may be helpful. But, no neck therapy will help if you do not get inflammation under control with ice and maintain good head and neck posture, especially when sleeping or resting. The dental chair can be problematic by how it holds your head and neck or by all of the stressful sounds. It takes months for a whiplashed neck and concussed head combination to settle down inflammation wise.

I dont know if this will be of any help, but I also was told the majority of my headaches were depression related stress related etc. As my mood improved certainly I did less focusing on my headaches but the fact was they were still ever present. Having soft tissue treatment and traction seems to have helped the consistent all day headache which is a big relief but my "concussion" head aches are still there. Sleep was a major help as well. If you feel like its not the cause, often its not. That's what I am finding, don't stop looking for answers

Your post was very helpful and appreciated. It appears we have similar headaches… the persistent, all-day headache (mine grows over the course of the day) and the much worse unilateral migraines that result from overstimulation, exercise, etc. After meeting with a Psychiatrist today, I’m having one of my A/Ds tweaked, so hopefully my mood improves. And hopefully that lessens some of the sleep disturbance. Good times.

Sticking with my prevailing feeling that the glass is always half empty, I was informed that if my depression and headaches do not clear up by the 24 month mark (i.e. 4 months away), any hope of substantial recovery dwindles. Sigh.

Anybody who tries to put a timeline to recovery is speaking without basis. Often, you have just not found the right angle of attack. There is always hope for ways to improve.

What A/D's are you taking ? Are you taking more than one ?

I really encourage you to look at the vitamin and supplement regimen. Plus, get some blood work done. Hormones, B-12, Folate, Mag, etc. If you can find a specialist in 'life extension' and 'maximizing potential' you may find some weakness in your metabolic systems and such.

My best to you.

I forgot to mention. You should get a Social Security Disability Income application started right away. If you improve, you can stop the application. But, the longer you wait, the lower any benefits will be because they are based on your pay over the final time period up to the date of your application. I lost a few hundred dollars a month by delaying my application.

Hey Micro Man, (like the name) just to reaffirm; what you are describing with your health since the injury all of us here have and are experiencing the same. Yes definitely its trail and error on the therapies (I have been to so many), the one therapy that I can say has helped my daily chronic headaches is Occipital nerve blocks or injections. The blocks basically block the pain nerve impulses because many head/neck injuries the major nerves have been irritated or inflamed. The blocks can come with a steroid that relaxes and eliminates muscle spasms, the steroid is added for extended relief. Side effects are very minimal. The procedure takes roughly an hour when all said and done with local anesthetic.

As mentioned I have tried MANY treatments, and reading your posts its like I wrote them myself because I have and been going through the exact same issues. Yes it was much worst in the beginning (March 2013), the symptoms have gotten better, but I can say the blocks really fight for you to relive the chronic daily pain. I have 2 children as well and understand totally what you are experience because I am experience the same things, it has gotten better from the early days, I'm 27 months post injury and I can truly say I never thought I'd make it this far, because the early day were really DARK.

Just to give an idea on treatments I'v done:
- message
- chiro
- hyperbaric
- cold laser therapy (helpful)
- PT
- Vitamins
- rest
- medications

Another intriguing treatment in neuro visual therapy, I have yet to try but I'm skeptical with this type of treatment.

It's been 2 weeks sine my injections and I can say pain has been reduced substantially, hope it lasts forever.

Yes triggers defiantly are the reasons for your pain and other symptoms if you can avoid those triggers.


Its important to sleep well also, as most of the healing takes place when body is a rest.

The key is nerve inflammation (cervical and cranial) get that under control.



ED

Mark and ED, thanks for the replies and info. I have to admit this forum has been more helpful and comforting than I thought it would : )

Mark, I’ve tried cipralex (SSRI) and was switched to Cymbalta (60 mg; SNRI). Later, amitryptiline (50 mg) was added, then removed and replaced with nortryptiline. I have to admit both TCA class A/Ds (am and nor) have side effects that I’m not keen on: dehydration, fogginess, urination issues, flat mood (at best) and I suspect they exacerbate my anger issues. Just yesterday the Psychiatrist upped my Cymbalta to 90 mg with the intent of going to 120 mg if I can tolerate it. If this works the plan is to get me off of the nortryptiline.

Also, thanks for mentioning disability payments. I’m in Canada and am fortunate to have good benefits for now, though the benefits provider has been a negative influence on me (i.e. they meddle).

ED, thanks so much for listing the various therapies. I plan on reviewing a couple things. On the nerve blocking, you reminded me of one intervention I didn’t list but might be useful: BotoxA injections. I’ve done three rounds of injections, and surprisingly I’m still ugly : ) Each round consists of 20-30 injections (painful as hell! Not sure why anyone would do this for cosmetics!), and lasts for 3 months. The first 2 months there is a significant reduction, and the effect wanes in the third month. However, I’m currently in the first month and still needing Tylenol 3s. How long does your treatment provide relief for?

I’m also sorry to hear you have kids. I feel like I’ve missed soooo much of their development, and have had a detrimental impact on both of them in different ways. Seeking counselling out for them this week. Hopefully things are going/getting better with your family.

This might be silly to ask, but my symptoms flare up I get seriously stupid… can’t figure things out, memory is useless, and I misinterpret stuff. Happen to you guys too??