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Post Concussion Syndrome & Whiplash

Just over 5 months ago I was in an auto accident. A driver made a left turn in front of me, causing me to hit the side of his car. My air bag deployed and knocked me out, yet my car kept moving, jumping the curb and hitting a telephone pole head on.

I was later told by a witness that I was out for just under a minute. I felt fine for a couple days but headaches and neck pain progressed.

I've seen both an orthopedist and a neurologist, have had x-rays and CT scans (no MRI). Both were normal, according to my physicians. I was given anti-inflammatory medications, muscle relaxants and medicine for migraines. None seemed to really help.

I had physical therapy for about 2 months and then, at my neurologist's suggestion, continued therapy with a sports medicine/chiropractic therapist. Both had minimal lasting affects. I have gone 2 weeks since the last therapy visit and my neck and head aches are back to where they were soon after the crash.

In addition, I have noticed balance issues. Finally, I have a more difficult time staying focused, have trouble remembering recent events and at work find myself confusing topics and not using strategies that I created and have taught to other employees.

Is there a time frame I can expect to reach at which point all of these issues will fade or is this something I will have to deal with for life?

Your response is greatly appreciated.

Answer

Hi,
I suspect like many whiplash injury patients, you have been under treated. As mentioned elsewhere on my site, the drug of choice is amitryptiline and start at 10mg, work it up slowly to about 50mg. (or until headaches disappear!)

Memory loss, confusion, mild vertigo, are all symptoms of post concussive head injury.

At 5 months out, if you have not improved, I would recommend you see a headache specialist, not just a neurologist. You are moving into a chronic pain syndrome and the longer you go, the worse it might be to get it under control.

Best of luck!
Mary Kay Betz MS RPA-C

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Post Concussion Headache with Neck and Back Pain

by Shannon
(Staten Island, NY USA)

4 weeks ago I was assaulted and had a pretty serious concussion and possible forehead fracture. I don't remember anything about the incident, I don't remember even interacting with the person prior to the assault. I was hit with an object as indicated by the dent on my forehead (still present with some swelling) and the black eye (which has since gone away). I was unconscious for an unknown amount of time. I was swimming in a pool and the next thing I remember was 'comming to' in a friends car approximately 2 hours later, bloody and disoriented. My friend pulled up to their home, got out of the car and apparently I got out of the car and walked off. I walked the streets for hours, barefoot, not knowing where I was (I only remember bits and pieces) I ended up miles away from where I began walking. I must have made a phone call (I don't remember) because another friend of mine picked me up (later said they were looking for me for hours). I was bloody, barefoot and wearing a bathing suit with a tee-shirt and I was not in a safe neighborhood. My friend said my pupils were unevenly dilated. Anyway....I refused to seek medical attention and have been experiencing terrible aura headaches, tension headaches and pain where the mark on my head is. I get sharp pains on the right side of my head, and visual disturbances (floaters, flashes, blurriness). I know that I should have seeked medical attention, but I was not right in the head (literally). I'm tired all the time (I slept for hours and took naps for hours every day for 2 weeks) and have I these headaches everyday. It's been 4 weeks,is this just part of post concussion syndrome? Should I be worried about internal bleeding?

Shannon

Answer

Hi Shannon,

At this point I think you already kind of know what I might say..yes you need to get to a doctor soon! You sound like you had a very serious head injury that could have involved a bleed on the brain.

This bleed is also known as a sub-dural hematoma and can take weeks to resolve. Only a doctor can assess you to determine what happened. If you do not have a doctor, I would strongly advise you go to an emergency room.

Good luck
Mary Kay Betz MS RPA-C

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post concussion syndrome

My 16 year old daughter suffered a concussion 12 weeks ago, and is still struggling to recover. Important details.(dx with post concussion syndrome, inner ear concussion and awaiting imaging results for possible neck injury)

She was not immediately treated as we and coaches did not know she was injured. She was hit in back of head with lacrosse ball during a warmup, was not attended to, and was although told us after she was hit seemed fine.

Fast forward 72 hours it became apparent she was injured but during this time she attended school, practice, game.....She has been seen by sports medicine dr/2neurologist/acupuncture and chiropractor. She currently is improved in terms of the fog, but still has daily symptoms, is very limited as a result, needed to finish school with tutors, daily symptoms remain headaches, noise and light sensitivity and lack of focus.

All Dr tell us it "takes time" two dr. have recommended meds but there is not continuity of opinion and we are concerned about side effects. (brain MRI negative, pending cervical X-ray and mri ) Chropractor feels there is a soft tissue injury)

We are increasingly worried as time goes on, as to if she will have full recovery and are we making mistake not putting her on medication. Her life has been turned upside down, and we feel the medical community does not have a team approach to this leaving us in the position of making clinical decisions on her behalf without a consensus form the Dr's. Medications that have been recommended are Propranol, amitriptyline, and topamax

Any feedback appreciated.

Ann

Answer:

Hi Ann,

I know you might not want to hear this..but it does indeed take time for the brain to heal after a concussion. Since she was hit in the back of the head, she has probably a whiplash injury. Remember when suddenly yanked around, the brain has nowhere to go but hit the skull.

Please read this information about post concussive headaches and see if any of this sounds familiar.

I have not used propranolol in this type of headache as that is a migraine medicine and there are better choices. The drug of choice is amitriptyline, low dose of 10mg 2 hours before bed. Usually it is worked up slowly until headaches are relieved. In my experience for concussion that is anywhere from 40mg to 100mg depending on the patient. Remember, your daughter is in pain, why withhold something that might actually help and speed healing? Topamax might also be a good choice if she is having migraine which is common in post concussive headaches.

The good news is that she is young. At age 16 her brain is still growing, and therefore has a better chance of healing faster than an adult in the same situation.

Unless she can't take tripans for some reason, if having migraine we use Zomig or Maxalt for the teens as both come in a melt wafer. Many kids don't like to swallow pills.

Regular sleep is important. She should go to bed and get up the same time every day for about 6 months to "settle" the brain. No skipping meals either.

Good luck..
Hope she feels better soon.
Mary Kay Betz MS RPA-C

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