Hello everyone,

I am 10 months into PCS (I introduced myself here in a previous thread), and the main symptom I am suffering from are headaches. Although I have been making good progress during the past months, to the point that I am now working full time without any impairment, I still have trouble with any type of physical exercise (even walking) and I am experiencing relapses quite frequently, but the overall trend is positive and I am not complaining; I now even have some moments when I am not feeling any headache at all, which is a blessing.

I wanted to share one piece of information and ask a couple of questions to the community. First, although I do not really have any neck pain, I now have a strong suspicion that some neck-related issues play a major role in my headaches. The reasons why I am convinced of this are the following:

• First, Mark mentioned this possibility to me as an answer to my first thread. This reason should be sufficient in itself, but let me give you two other arguments
  
• Second, there seems to be good evidence that the neck is often involved in post-concussion headaches, even among subjects who do not feel any neck pain. I am not allowed to post any link given my current post count, but I have found some convincing articles that show that neck injuries often have similar symptoms as brain injuries, and can last much longer. There is also some causal evidence that treating the neck alleviates concussion-like symptoms.
  
• Lastly, and more importantly, I have been seeing a chiropractor a couple of times recently. She focuses on the upper neck (C0-C1, in particular), and she is absolutely convinced that my headaches come from a dysfunction in that area. I am less confident than her, but each session leaves me completely symptom-free for at least a couple of days, which I find quite miraculous given the basline intensity of my headaches.

As a consequence, I would really like to second Mark's recommendation to pay a particular attention to the upper neck and perhaps try to find a good chiropractor, even if you do not experience any neck pain.

Now, I would like to ask two related questions to the community.

• First, do you have any advice on how to heal neck-related issues in the long term? The therapy with the chiropractor is the only thing that has helped me so far, but the improvement is only short-lived, and I am wondering what to do to help the long-run recovery.
  
• Second, I noticed that my relapses often trigger a feeling of inflammation in the body (flu-like feeling: higher body temperature, hot hands), even if these relapses follow a purely mechanic event (e.g., walking too fast). Does anyone else experience the same thing? Do you have any theory of what his happening in these moments?

Many thanks in advance for your answers.

Vania

Vania,

It appears you have discovered the reality of what I call subtle neck injuries. Those are neck injuries that do not cause pain or specific stiffness but appear to cause other symptoms if properly assessed.

The biggest challenge with these is the recovery. As you noted, treatment creates a short time improvement. We need to find the postural behaviors that allow this improvement to last longer. C-0 to C-1 (occiput to C-1) does not have a self centering facet structure like the lower vertebra. The treatments do not have that 'pop' when they settle into place. As such, they can slip out of place until we have allowed ligament healing/tightening. This takes discipline and time.

It often take 6 weeks or more for ligaments to strengthen. Every time we stress those ligaments, we lengthen that healing time. Good posture, especially during sleep and resting is important. Anti-inflammatory efforts are also helpful. Icing, NSAIDs, and such help.

For me, nothing helped until I developed good sleep posture discipline. My head and neck need to remain straight throughout the night. This often means finding a sleep position and bed that allows you to wake up in the same position. Adjustable beds with proper pillows can help. I bunch up the sides of my pillow so my head does not roll to the side while on my back.

You did not say what treatment your chiro is using. NUCCA.org and atlas orthogonal GlobalAO: About Atlas Orthogonal and similarly trained chiros have helped some.

Relapses that cause other bodily issues can be related to upper neck inflammation such that the brain stem has reduced blood flow disrupting proper autonomic nervous system function. I used to get temperature changes, both up and down but usually I felt cold. My BP and pulse would slow.

It has been known that up to 85% of concussions include an upper neck component and that the symptoms are overlapping. For some, the symptoms may be just the upper neck issue without brain involvement.

I suggest you look at sleep posture issues as a lifetime investment. I resolved my more serious neck related symptoms a decade ago but can easily cause a relapse if I do not maintain sleep posture discipline.

Thank you very much, Mark, for the very helpful advice. I really appreciate it. I will try to develop the good habits that you suggest for the sleeping posture.

I am not sure how to describe the treatment that the chiro is using; I am lying on my back, and she "presses" several points in the upper neck, in particular one sore point near the spine. She does that during half an hour, and as I wrote earlier it completely eliminates the headaches.