Hello - I'm a new member and have been dealing with PCS since August after sustaining a concussion in a mountain biking crash. I have had a few setbacks during the intervening months, from bumping my head twice, to a violent head shaking episode due to insomnia and benzo drug withdrawal. Needless to say, it's been a challenging 4+ months.

I've been feeling better lately, and during a walk last week I decided to jump across a small stream - not once, but twice. Soon after I could tell that this had been a bad idea. In the days since, my PCS symptoms have returned to a point where they were two months ago. Headaches both behind the eye and in the back of the head, and anxiety and sleep issues.

Could I have sustained another concussion by jumping and landing, or have I simply exacerbated my PCS symptoms? I'm icing and trying to limit my screen time, hoping to get back to where I was a short week ago.

Thanks in advance for your thoughts.

I also wanted to add that one of the symptoms I have noticed most frequently when I reinjure or jar my head is sinus pressure and sinus sensitivity. Is this a common symptom of brain injury/re-injury?

NW Guy,

Welcome to NeuroTalk.

A common problem with concussions is upper neck injuries, specifically subtle upper neck injuries. Studies suggest up to 80% of symptoms can be due to these injuries. Imaging does not show these injuries in most cases.

Anxiety and sleep issues can also make symptoms much worse. Sleep issues can be due to neck issues or anxiety or any number of issues. Getting quality sleep should be a high priority.

Have you identified anything that may contribute to getting sleep ? Do you feel restless or uncomfortable ?

If you will, please tell us about your benzo experience. Why were you prescribed the benzo ? How soon after your concussion was it prescribed ?

What happened with the head shaking episode ? Was it voluntary or involuntary ? Have you experienced any shakes or twitches since quitting the benzo ?

My best to you.

Thanks for the reply, Mark.

I was prescribed Ativan for sleep issues directly after sustaining the concussion in August by a primary care doctor. I took 12 1 mg pills at bedtime over a three week period, and then quit cold turkey after talking with an ER doctor. Sadly I ended up back in the ER three days later with what I later realized were withdrawal symptoms.

Unfortunately i am still taking a dose of .8 mg/day as I've struggled to taper off the drug. Still taking the drug has contributed significantly to my continued sleep issues. I held off tapering during October/early November to get some rest and and let my brain heal, which I was successfully able to do to a large extent. This setback is discouraging, as I now have headaches again that had subsided back in late November.

I am now actively tapering the Ativan again and have been getting back to work on a part-time basis. With these headaches and the stress that comes with my work, I may need to pull back from work again for a bit and focus again on healing and tapering.

Thanks for the thoughts on neck injury. I saw a vestibular therapist earlier today and she referred me to a PT who specializes in neck/spine issues.

Regarding the head shaking event earlier in my recovery, this was an involuntary response to a combination of drug withdrawal and insomnia. I was not sleeping much at all, and also trying to taper the Ativan. Soon after I started taking Gabapentin to help with sleep and have spread out my doses of Ativan to reduce interdose withdrawal symptoms. I have not had the head shaking experiences again since spreading out the doses and getting better sleep.

Back to the jumping and resumption of symptoms issue, is jumping and landing something that could commonly rekindle some of my PCS symptoms?

In my opinion, sleeping pills are the devil. I struggled greatly from chronic insomnia and have successfully recovered, no thanks to the various pharmaceuticals I was prescribed.

I recently discovered, following a SPECT scan, that the lack of success from sleeping pills was because my problem was not primarily do to neurotransmitter activity which is what pharmaceuticals manipulate. Rather, my problems were caused by hyperactive regions in my brain, as measured by blood flow. Basically, certain structures in my brain would not turn off at night, my circadian rhythm was very weak, natural queues would not make me tired, and the pills I was taking were ineffective.

I'm not suggesting you try to get a SPECT scan, unless you live in a country with free health care. If you live in Canada, you can get this for free.

To recover my sleep patterns, I experimented with almost everything under the sun. Here's a list of affordable remedies that I found to be effective and easily accessible:

1) Cognitive Behaviour Therapy for Insomina (CBT-i) with Dr. Jacobs. This program costs USD$50. This is a 5 week interactive program that involves education, a sleep diary, and weekly correspondence with Dr. Jacobs. He provides scientifically backed research to educate you on the causes and effects of sleeplessness. The sleep diary is numerical only, he only wants to see things like bedtime, sleeptime, wake-up time, etc. Throughout the 5 weeks he tells you when to go to bed and when to wake up. This was the single most important resource I used to recover my sleep patterns. (http://www.cbtforinsomnia.com/)

2) Dr. Parsley's Sleep Remedy. This costs $60/month, there are some discount codes if you listen to his podcasts with Ben Greenfield and others. This is a powder supplement taken before bedtime. It is a vitamin and neurotransmitter micro supplement designed to give your body the exact ingredients necessary to initiate sleep. I found this product to be better than sleep pills, and effective 60% of the time. However, it includes the neurotransmitter GABA which makes you feel normal after a sleepless night. (Doc Parsley's Sleep Remedy | Sleep Remedy)

3) Magnesium Citrate powder. This costs $30/month and can be found in most grocery stores, and probably for cheaper than my quoted price. Magnesium deficiency is extremely common, especially for those who have experience concussions and TBIs. Magnesium is also quickly depleted during stress and anxiety. Taking this powder will calm the nervous system. I found this product quite effective taking before bedtime, or in the middle of the night if I woke up and couldn't fall back asleep. (Amazon.com: Natural Vitality Natural Calm Magnesium Anti Stress, Organic, Raspberry Lemon, 16 oz: Health & Personal Care)

4) Binaural Beats. This ranges from free to $5. You can download various apps onto your phone or tablet. Basically, our brains emit wavelengths at all times. Certain wavelength patterns have been well researched relating to sleep. What has been found and reported in scientific literature is that our brains are good at mimicking frequencies, so plugging headphones in to binaural beats can be an effective sleep remedy. There are many free apps available, but this $5 app I found to be the best.(SleepStream 2 - Premium Sound Therapy)

5) Max Richter Sleep music. This acclaimed musician has created an 8 hour album specifically for sleep. It was labeled as the most relaxing music ever. Here is a free 1 hour sampler (Max Richter : From Sleep (Full Album) 215 - YouTube).

6) Daily meditation routine. I was a hard charging adrenaline junkie before my world crashed down on me from PCS. A daily meditation routine was a difficult thing for me to accept. I now believe that it has been the most instrumental tool for overall recovery of all of my symptoms. There are many types and many instructors of meditation. Any type will work, the key is to pick up a habit that you will stick with. So I won't recommend any particular type. I think everyone on this form should try at the least an 8 week program to advance their recovery.

Good Luck.

Hains

Personally, I would not touch Doc Parsley's Sleep Remedy until he lists the dosage of the ingredients in it. L-Tryptophan is just a precursor to 5-HTP which is a precursor to melatonin and serotonin. Why does he include L-Tryp, 5-HTP and melatonin ? Just seems odd. He includes a GABA like compound called phenibut that has some contraindications and its use is controversial and can have withdrawal problems. What form of magnesium is in it ? It appears to be mag oxide because he warns of diarrhea from taking too much. Mag oxide is not absorbed well and is the form used in laxatives.
Each packet is 5.8 grams with 1.1 gram of proprietary sleep blend. That is a large dose to take without knowing what is in it.
From his web site.
Serving Size: Approximately 5.8 Grams (1 Packet)

Servings per Container: 30
Calories 5
Total Fat 0g
Trans Fat 0g
Sodium 0mg 0%
Total Carbohydrate <1g 0%
Sugars 0g 0%
Protein 0g
Vitamin D as Cholecalciferol 1000%
Magnesium as Citrate 100%

Proprietary Sleep Blend 1100mg

L-Trytophan, GABA (as phGABA), 5-Hydroxytrytophan, Melatonin.

Other Ingredients
Xylitol, Citric Acid, Natural Flavors, Stevia 80% Glycosides, Natural Colors.

Not a significant source of calories from Cholesterol, Dietary Fiber, Vitamin A, C, or Iron.

The numbers just don't add up and look scary to me.

I experimented with the product for a few months. As mentioned above, I found it more effective than pharmaceuticals, but it wasn't always effective. I didn't experience side effects or withdrawals.

You raise a good point regarding phenibut. The research suggests it can cause withdrawal symptoms from varying doses. The products intention is to provide a GABA type product that crosses the blood brain barrier, as most forms of GABA are poorly absorbed, whereas phenibut satisfies this objective.

The product maker claims the concentrations are all microdoses, thus safe. However to your point, without providing these details how is one to know.

My intention was to provide some non-pharmeceutical alternatives for remediating sleep. Turns out this product blends pharmaceuticals with vitamins, minerals and neurotransmitters. As such, I apologise for misleading anyone and recommend to do your research and experiment cautiously.

Thanks for the catch Mark.

Hains

I have a hard time understanding what a microdose is in a substance that has 1100 mgs of proprietary blend or 5.8 grams per serving. Parsley does not use the term microdose. He uses vague terms to describe the amounts. They are all relative terms but we are never told what they relate to.

Doing the research is important but people like Parsley do not provide the answers we need.

Thanks for the recommendations, guys. Sleep is my top priority on a daily basis, and I welcome the recommendations around sleep sounds, magnesium supplements, etc.

Mark, based on answers I've seen you post to other users, I gather that the resumption of symptoms that I'm experiencing (headaches, nausea and fatigue) after jumping is something that has slowed my recovery, but is no cause for panic. I now know that my brain remains very sensitive to jolts, and that I need to take extra care for the foreseeable future. It's discouraging, of course, since I had made a lot of healing progress during the past two months.

Thanks in advance for any additional wisdom you'd like to share.

NW Guy

NW,

I will try a very brief synopsis of my return to exercise.

I was active before my accident so it was VERY important for me to get back to running.

Basically I attempted way to early and tried to man my way through it, the jarring of running proved to be way to much as well as the bumpy farm roads I drive on, even walking was traumatic for almost 2 years.

I stupidly swung a sledge hammer to break up some concrete 3 months after having the left side of my skull rebuilt, I didn't seem to understand the severity of what happened to me and that really set me back for months.


I continued to test my recovery and if it proved to much I waited awhile for more healing.

It has been 2.75 years now... I cannot run on the street still but I can run on a treadmill while inclined, it doesn't jar my head and I swim.

I cannot get my heart rate up on the high end for sustained periods as I could pre accident without causing headaches but I am active again with cardio and weights and back to enjoying skiing again this summer and soon in the snow again.

I have been most fortunate and thrilled to be active again even if there are some limitations but maybe at 57 it is time to accept a little slowing down.

Listen to your body, it will give you clues as to what you should and shouldn't be doing...it took me awhile to learn what my body was telling me but I did catch on.