Hello everyone,

This is my first post here. First, I want to say how grateful I am to all the people who actively contribute to this forum. I am a PCS sufferer and I am having a very hard time explaining my situation to people, so a place like this one where I can find reliable information and where I know that people will not take my explanations with skepticism is a real blessing.

My name is Vania and I am 30 years old. I had a first concussion three years ago in a bike accident. All symptoms resolved within two weeks. I unfortunately had a second concussion five months ago after a heavy wooden door which was placed against a wall fell down on my head. The accident seemed relatively mild to me (no loss of consciousness, no symptoms during three days). But since then I am experiencing terrible and permanent headaches, as if my skull was full of pressure. This is basically the only symptom and I believe that the others that I am sometimes suffering from - fatigue, some difficulties to concentrate - are consequences of the headaches. I took three months out of work recently and avoided any intellectual or physical stimulation. It helped a bit but even after this period the headaches come back after any physical or cognitive effort (reading on computer, or even walking slowly).

I have done an MRI recently (everything is normal) and seen two neurologists. They gave me the impression that they did not take my situation very seriously. Both suggested that my headaches were caused by some psychosomatic condition and recommended that I take antidepressants. I must say that I am very skeptical regarding this theory - I am not feeling anxious or depressed, I am just in pain, therefore I did not take the treatment. I also had my eyes checked and everything is normal as well. I am not feeling any neck pain. From a cognitive perspective I haven't noticed any difference relative to my pre-concussion self. I tried taking some CBD but it did not help. I am following the dietary/vitamin recommendations from the sticky thread on it.

I recently went back to work and I have mixed feelings about it. On the one hand, it clearly improves my mood and I can sometimes spend one or two hours involved in an interesting discussion and forget about my symptoms, which is not the case when I stay home. On the other hand, the headaches are more intense since I went back to my office. Do you think that I should try to put myself off work for a longer period in the hope that the headaches will finally disappear, or is it a good approach to resume my activities and ignore the symptoms? I have seen some conflicting advice on that, so any thought would be welcome. Also, if anyone has any advice to share on how to reduce the headaches I would obviously be very interested.

Many thanks in advance, and all the best to all of you.
Vania

Vania,

Welcome to NeuroTalk.

You say you do not have any symptoms with your neck but have you probed to see if you have any tender spots, often behind the ear ? They would only be tender to touch. This can indicate muscle spams. The subtle neck injuries common to concussions are very difficult to positively diagnose. Sometimes, the only diagnostic is in reverse. If gentle traction and mobilization, followed by icing, reduces your head ache, that is a diagnosis.

Do you have to look at a computer screen screen at work ? For me, trying to focus on a screen meant I had to tilt my head back, even more once I needed trifocal glasses and needed to search for the right part of the lens.

The mental load of a 1 or 2 hour stimulating discussion can trigger symptoms. Do you experience any times when you have to work harder to listen to what others are saying ? This can be a sign of over-stimulation. Are there multiple voices trying to talk at the same time ? This is usually over-stimulating. The increase in symptoms often lags behind the task but can last long after the task is over.

btw, A common remedy is to prescribe amitriptyline in a small dose. It is a tricyclic antidepressant but the small dose does not provide an antidepressant effect. But, it can help with headaches and insomnia.

How is you sleep ? Poor sleep can be a big headache trigger. Quality sleep is more important than quantity. Tossing and turning to get to sleep usually means a night of poor quality sleep. A FitBit can tell you how much you toss when you are sleeping if you have access to one.

Have you tried any headache meds such as aspirin, acetaminophen, ibuprofen or a combination of aspirin and acetaminophen ?

Do you have a way to take your blood pressure when your headaches are at the worst ?

Relieving the pain can reduce the stress sensation and help with recovery.

When you are not working, it helps to stay busy with low stress activities. The idle mind will quickly focus on symptoms and cause them to magnify. Activities that use the hands, crafts, knitting, drawing, painting, gardening, playing solitaire with real cards are all low stress activities. The hands cannot work any faster than a PCS brain can tolerate (as long as you are not playing video games).

Try to avoid tasks that require using your memory to juggle information. Make notes instead.

For some, the headaches just take time. I have had two concussions where the headaches were chronic for 6 months before they stopped. Not continuous headaches but part of every day. They get tiring. I did a lot of icing the back of my head.

I think you should just try to moderate your work activity level but not stop being active. The brain needs enough mental activity to cause good blood flow.

If you explain what a work day entails, we may have some suggestions to moderate it.

For some, walking has a pounding affect with each foot plant. Riding a bike, real or stationary may work better.

My best to you.

Hello Mark,

Thanks a million for your reply and advice. Regarding your questions,

• I do have a tender spot behind the ear, only on one side. I just noticed it thanks to your question - it never bothered me. I tried icing without much relief.
• I think that the quality of my sleep is bad (not the quantity), which I would attribute to the lack of exercise (I was running or biking 1h per day before my accident).
• I tried acetaminophen in the first weeks without any effect. I am allergic to aspirin and NSAIDs upset my stomach, so I did not try those.
• I do not have a way to take my blood pressure but I can certainly do it if you think this information would be useful.
• I can certainly relate to the "pounding" effect that you mentioned. To me this is the most dangerous trigger: whenever I inadvertently walk too "strongly" (sorry for the poor English, I hope you understand what I mean) I can feel the headaches immediately becoming more intense.

Regarding my occupation, I am a mathematician in academia. So a normal day of work would consist of a couple of hours doing research on my own (on computer or with pen and paper), a couple of hours talking to colleagues or students, and a couple of hours teaching. Perhaps surprisingly, I find that teaching is the most problematic activity even though it entails almost no physical effort (I am using slides, so I am basically just standing or sitting next to the whiteboard and talking) and the cognitive effort is much less intense than when I do research. I have none of the symptoms of brain over-stimulation you mentioned.

What makes me hesitant is the following: I really love teaching, to the point that I was almost crying of joy when I went to the university to give my first lecture after my accident. So if the only price that I have to pay to continue teaching is the temporary headache that I am experiencing afterwards, I am willing to pay it. But of course, if teaching compromises my recovery and puts me at risk of never seeing the headaches disappearing I would prefer going on sick leave again.

Finally, thank you very much for suggesting some activities. I think these are very good ideas and I will definitely try to develop one of these habits.

Best wishes,

Vania

Vania,

Welcome to the club!

I was able after some time to figure what at work:

1. What was bothering me the most.

2. What early signs my body was giving me of impending shtf.

When I discovered those two things I was able to let myself take some breaks...sometimes even just a couple of minutes before things got bad did the trick.

Bud

Vania,

The tenderness behind your ear suggests a spasming muscle, usually due to a neck strain or nerve radiculopathy. This is where gentle traction with neck mobilization can help. Then, it will be up to you to maintain good sleeping and resting posture so you do not strain that vertebral joint while it strengthens. That can take weeks to months. Avoid quick head turning. This can be a challenge if you give a lecture and turn to the white board frequently. Discipline is the key. Turning at the shoulders, not the neck can be helpful.

It will help if you can be disciplined to break up you talk time with colleges or students into 15 minute segments or so. Write down some notes after. It will help you 'put thoughts away.' Give your brain a chance to process and organize. Think of this like clearing and filing papers spread on your desk. It is easier if you do it frequently rather than let them pile up.

Carrying a stack of pocket note cards can help. Smart phones or tablets work for some as note taking apps.

Icing needs to be a routine activity. 15 on, 30 minutes off, repeat for as long as you can, usually 3 or 4 cycles is the minimum to help. An anti-inflammatory med or supplement can help. Omega 3 fish oil and high potency/concentrated curcumin extract with pepper extract are good for anti-inflammatory value.

When you give a lecture, try to avoid any memory straining. Use notes to stay on track rather than stress your memory. If you find you need to pause to collect your thoughts, you have pushed too hard. Try to think of it like juggling balls. You may be able to keep 5 balls in the air but you have to focus hard. If you reduce to only a couple balls at a time, then switch to a couple more, it will be easier on your mental work load. It may help you reduce your headaches.

Learning these skills will be important. With your struggles, even if you have a great recovery, chances are you will have a repeat in the future from a physical trauma, illness or even an emotional trauma. Having the skills will help you get past those times. PCS can become a very long roller coaster ride. With care, we can avoid the deep troughs most of the time.

As Bud said, pay attention and learn what your brain can do and make adjustments. There will be early warning signs if you pay attention to them.

btw, I was a math wiz at one time but lost my ability to do multi-step processing (too many balls juggling). I had to learn new ways to do multi-step tasks.

My best to you.

Hi my name is Matt from England. First time post


I am going through exactly the same thing. I've had concussion for a year now. Hit my head and got knocked unconscious playing rugby. Didn't have the correct advice and then went back into it. Felt alright but then hit my head not very hard at all but gave me horrible headaches and eye ache for about three months. I managed to get back into exercise again and at the start of the new season I clash head on head with someone. (Not knocked out) I tried to get on with it but didn't feel right at all. That was about 9 months ago. My life has been hell since. Considering I was on the road to a professional career in the sport. Any advice?

I've done all the amitrypitline stuff, Accupuncture, Chiropractor, and even had steroids injected into the back of my head.

This whole concussion is ruining my life

Exercise makes everything worse. Havnt been able to exercise properly for over a year...... very depressed. Every doctor I've been to hasn't seen anything like this before

Matt,

Welcome to NeuroTalk. Sorry to hear about your headaches.

I'm surprised you did not get better advice. I've read the UK rugby has been struggling with how to address concussion but they do recognize the need to take action. They have been resistant or slow to get with the program.

What diagnostics have you had ?

What kind of treatment did the chiro do ?

What are your days like ? What do you do ?

Have you had your eyes assessed by a behavioral optometrist ?
Go to BABO | British Association of Behavioural Optometrists to find one.

Convergence issues can cause headaches.

Matt,

It took me 1.5 years before he was able to return to the gym and another year before I was really up and running.

I still need to monitor my cardio levels, I can't get on the high aerobic end for extended periods without headaches. All in all I am quite happy with my fitness at this time.

There was a full 1.5 years that I couldn't walk 500 feet without a lot of symptoms knocking me down for hours...drove me nuts. I would try and if it was to much I waited for a couple of weeks and tried again.

I am 58 and been a runner since I was 15 but found I was able to swim several months before I could run..I still have to run on an inclined treadmill to avoid headaches but I can!!

Don't rush but don't quit experimenting.

Bud

Vania,

Mark has given some good advice. I think you should have your vestibular system checked and see a neuroophthamologist to see if there are any issues with your eyes. These can contribute to headaches. Also, seeing a pain specialist or neuro who specialises in headaches would be good. If your neck is not involved, and your eyes and vestibular system are functioning properly, it is very possible that you have post-traumatic headache (PTH).

PTH is not discussed in the concussion world, or even here, very often but many with chronic headaches who call it PCS likely have this. One of the hallmarks of PTH is aggravation of headaches with mental engagement.

As a fellow academic who used to oversee a largish research lab and program, I can empathise with your situation.

Anyway, starting by ruling the obvious out and determining whether your neck is involved is key. Too many assume the neck is an issue, and I've personally had experience in this. It leads to costly and unneeded overstimulation by chiropracters doing unnecessary "treatment".

Just my 2 cents

Many thanks to all of you (Mark, Bud, and Microman). Your advice makes perfect sense and I will follow it.

I am starting to think that my neck might be involved in the y headaches, since I realized that cognitive effort while lying in a good position is not aggravating the symptoms, so perhaps it is only the seated or standing position that triggers the headaches. I will report on any progress here in case it can help others.

Matt, I wish you all the best in your recovery.