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 headache trauma.. advice?  



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  #1

Hello,

8 months ago I received knocks to one area of my head. Since that time, I have
had a continuous dull pressure pain in that specific area, and I find my
memory significantly worse than before. In addition, on an almost daily basis
for 2 or fewer hours, the pain transforms into an "overwhelming" sensation
across my head, during which time I am unable to concentrate, and feel an
immense squeezing or tension, plus sensation of "not being really there",
which places me in confusion and sometimes agony.

On occasion this is accompanied by stabbing pains, a squeezing pain in the
left eye, dizziness, lhs face numbness, etc etc. On some days I also have
partial blackouts when standing up. I sometimes have slight tremor in my
hands, and certainly my writing is more scrawly and typing more error-prone
than "usual". The worst days (long periods of "overwhelming") and the best
(no such period) almost follow a cycle of about 3-4 weeks.

I have tried propranolol, amitriptyline (20-30mg), antihistamines (OTC), and
pizotifen (0.5mg): the first three make no significant difference to
symptoms, while the latter possible slight improvements with heavy adverse
affects (palpitations, aches/weakness, high morning BP). Analgesics
(strongest I've tried being ER-prescribed dihydrocodeine) are not much use
since the primary problem is not the pain per se but the debilitating
"overwhelming" above.

I have been on a careful nutritionist-discussed diet excluding all standard
migraine triggers and over periods of time excluding various food groups
(dairy this month!), but this has made no difference. The only food which
seems to bring on severe worsening (stabbing, etc.) is onion/garlic, although
I was perfectly tolerant to them prior. I've noticed a cold wind on that area
of my head occasionally triggers too. I monitor BP daily, which is normal. It
was much higher in mornings during use of pizotifen, although only slightly
now.

I am 22/male with no history of headache problems, but high fevers as a child
(of which, oddly, I had about 4 in the first 5 months after the injury).
Improvement since initial onset of symptoms has been minor. The
stabbing/numbness sensations are less frequent, but the "overwhelming"
episodes are not.

I have had blood tests five months ago and again just recently (FBC, thyroid,
liver, kidney); neuro appointment consisting of brief eye check, standard
reflex tests etc., cranial MRI scan; standard optician (inc. pupil dilation)
checkup; comprehensive dental check-up (X-rays etc.); hearing test (not full
ENT checkup). Everything has been clear bar (i) dentist's recommendation
that, because my teeth are worn down and occlusion slightly odd, I may have
temporalis issues, and am currently wearing a temp Lucia jig most of
day/night, but it is not helping (not surprising, as these were problems I
had before the injury); (ii) hearing test revealed affected side may have
slightly poorer hearing of lower tones.

I would greatly appreciate advice on what tests I should "push" for next. I
can throw my thoughts but this post is probably already too long! Thanks for
reading, and if this q is inappropriate for here, any pointers to elsewhere
would be appreciated.

:!:




  #2

I THINK YOU SHOULD HAVE FULL ENT CHECK UP AND IN THE MEAN TIME TRY CARBAMAZEPINE FOR A MONTH


  #3

Thank you for your advice, but isn't Carbamazepine an anticonvulsant? I know it to be a treatment for psychomotor epilepsy. It suppresses ventricular auto-maticity since it a membrane depressant.

Would you have any advice on what we should do next, that does not involve any medications. Any specific tests? We have seen an ENT and all is clear.

Thank you for your help!

Anai


  #4

Non-pharmacological treatment? Hmm... The only thing that comes to my mind is a ketone-diet. I cannot give you a full day schedule but it boils down to minimizing carbs to the very minimum with fats taking over and standing for about 90% of the daily caloric req. It's been proven that under such conditions the organism mobilizes the fat-utilizing metabolic pathways, producing reasonable amounts of HMB and other keton-like substances that not only become fuel for the brain but also become a substrate for other important reactions


  #5

drnut,

Thanks for your reply. I had stopped checking this board since I figured our post was long gone in the list.

While I agree with you on restricting carbohydrates for optimising health, I do not think it applies to this particular situation.

With normal blood sugar conditions, glucose actually *the* preferred fuel in the brain as well as in muscle and the heart. The body requires some carbs to sustain it.

Also Atkins didn't factor in those with compromised kidney function that cannot benefit whatsoever from the ketone diet.

I'm sure this is a debate that won't expire any time soon. I feel relating the ketone diet to brain trauma may not make a huge difference to the injury itself.

Granted, normally I would (possibly) suggest the ketone diet to someone who is able to eat normally and able to keep a steady diet. Its not so in this case. It is more of an injury that has lingering numbess and dull pain. Our main focus is to target the problem and resolve it at this point.

If you have any other suggestions, please feel free to share them with us. We appreciate your ideas. You suggesting has provoked thought and further research from our side.

Thank you,

Anai Rhoads


  #6

hi,
can you give more details about the lab tests that were done?
get well soon.


  #7

Thanks Ritu,

Blood: rbc, wbc, liver, kidney, thyroid

Optician: standard eye checkup, tropicamide in left eye to dilate

Hearing: perhaps slightly impaired on lhs for low freq, otherwise excellent hearing

Neuro: preliminary tests noted slight subjective numbness over area of pain [this as recently as a few weeks ago]

Cranial: MRI showed unremarkable results.

Dental: general checkup with xrays of jaw. Occlusion was off, but lucia jig didnt make a difference.


Thank you for any advice you have on this.

Best,

Anai Rhoads


  #8

hi Anai,
can u tell in little more detail about blood test and the results eg, ESR?


  #9

ALL THAT HAVE BEEN SAID TO YOU WAS VERY FAR FROM THE TRUTH
CHECK THE SITE FOR TREAT. BELOW AND SOME INFOS FOR YOUR CONDITION. HOPE YOU'LL BENEFIT FROM THIS :wink:


http://www.upstate.edu/neurology/haas/hpptrx.htm


Acute and chronic post-traumatic headaches
Overview
Roughly 50% of patients who are stunned or knocked out by a blow to the head experience headache soon afterwards. The International Headache Society (IHS) calls this headache an "acute post-traumatic headache." However, as acute suggests "severe" and "brief," which are inaccurate adjectives for many of these headaches, I prefer "early post-traumatic headache." Most of these headaches are not severe and require only simple analgesics for relief. These early headaches occur just as commonly in people whose heads have been jerked during automobile accidents. (The inappropriate metaphorical term "whiplash" is commonly used to refer to these movements of the head and the neck.) These headaches disappear within a few weeks in about 70% of the sufferers, but the other 30% (or 15% of persons subjected to head trauma or "whiplash") continue to have headaches for years. The IHS calls these chronic post-traumatic headaches .

No correlation exists between the severity of the trauma and the chance of developing a chronic post-traumatic headache (Haas, 1993). This well-established fact suggests that this headache is not caused by brain damage. Instead, as other evidence suggests, the headache is most likely related to a person's reaction to the traumatic event. Some cultural determinants of these reactions are discussed in the section on "whiplash".

My recent study (Haas, 1996) found that about 75% of chronic post-traumatic headaches had the features of the naturally occurring (non-traumatic) chronic tension-type headache and about 25% had the features of naturally occurring migraine without aura. Among the former, roughly 25% were probably adversely affected by analgesic abuse.

Patients with chronic post-traumatic headaches after head trauma or "whiplash") often have other symptoms, such as dizziness, insomnia, and impaired memory and concentration, which together with the headache are commonly referred to as the post-traumatic (or post-concussion) syndrome. To believe that these symptoms are from traumatic brain injury, in the usual case, is a mistake in my opinion. Instead, the symptoms are most likely related to altered psychological states, as are the headaches. However, patients who have suffered brain damage may be mentally impaired. Sometimes, neuropsychologic examinations are needed to distinguish between these two types of altered mentation. Exactly what changes in a person's psychological state account for the post-traumatic symptoms has not yet been adequately explained.



Chronic post-traumatic headache
Diagnostic criteria
The 1988 International Headache Society criteria are in need of revision, in my opinion (Haas, 1994). They were based on the assumption that the headaches were related to intracranial disturbances. I suggest the following criteria for the category of chronic post-traumatic headache.

Headache should begin within 3 months of a traumatic event.
Headache should be present for more than 3 months after its onset.
Subdural hematoma or traumatic hydrocephalus should be absent.
Headaches meeting these criteria are ostensibly related to the traumatic event, but not by means of a subdural hematoma or traumatic hydrocephalus. At our current level of understanding, coding a headache as "chronic post-traumatic" should not imply that it is related to brain injury or other structural intracranial or cervical abnormalities.

Chronic post-traumatic headaches can be subdivided into the following classes.

Chronic headache after head trauma.
Chronic headache after head movement without a blow to the head ("whiplash movement").
Chronic headache after accidents without head trauma or notable head movement
Although the headaches in these three categories are identical both symptomatically and etiologically in my opinion, I favor coding them by antecedent events, since the prevalent view is that these headaches are distinct entities.

After coding a chronic post-traumatic headache as one of the three above types, I advocate coding it for the class of natural (non-traumatic) headache in which it fits--in other words as chronic tension-type, or as migraine without aura, or as whatever other headache class it resembles.


  #10

a placebo may ...... ........oops shouldnt say that





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