When I slipped in my driveway and fell on my backside following a snowstorm in December 2019, I didn’t even realize I had a concussion until the following day. Yes, I got a severe headache and felt nauseous within minutes, but since I didn’t hit my head, the idea of a concussion didn’t cross my mind. When I awoke the next morning, my head felt like it was locked in a vice. A Google search suggested I had a whiplash concussion, but because I’d supervised my son’s treatment and recovery from five concussions, I knew the drill. No screens. No reading until the headaches subsided.
I read that it wasn’t safe to drive with a concussion, and my husband had left for work, so I texted my primary care provider just in case. I hadn’t hit my head, lost consciousness or experienced amnesia, so I didn’t need a CT scan, she said. But the Centers for Disease Control guidelines suggest someone with a suspected concussion be seen by their doctor or an emergency department physician for a neurological exam to determine if they need a CT scan to check for trauma to the brain.
The problem was, the headaches didn’t subside. After a few days’ rest, I tried working, but had to stop because the headaches and nausea sent me to the bathroom. I couldn’t work, volunteer or fulfill my caretaker roles. Not only could I not drive to Massachusetts to see my mom in assisted living or my sister with metastatic breast cancer, I couldn’t even drive close to home to shop for Christmas presents. (Driving brought on headaches, and headaches were my body’s signal to rest.) I have ADHD, and, normally, the only time I’m not moving is when I’m working or reading. I couldn’t engage in my normal stress-reducing exercise routine — not even yoga — because everything brought on symptoms.
As I’m writing this, it’s been almost 18 months since my concussion, and life still hasn’t returned to normal. After 14 months of only listening to audiobooks, I can finally return to my lifelong habit of reading books before going to sleep. But if I have deadlines and work more than two hours without taking a “headache break,” I pay for it with a relapse. When I missed a relative’s funeral because I couldn’t drive or be in the car for more than short distances, I worried my family would think I was making excuses. When I forgot to respond to emails or typed the wrong words, I started disclosing I was recovering from a concussion. These lapses embarrassed me, as someone who makes their living as a writer and editor.
That’s how I learned my cousin has been dealing with post-concussion syndrome for years and others in my circle had a sibling, child or friend who also suffered from symptoms for months and years. Two months after my concussion, I saw a neuro-APRN and she told me it was perfectly normal to still be having symptoms. No, I did not have to stop all work, she said. But I had to take frequent breaks and step away from the laptop until headaches waned.
While I’m certainly not alone, I am in the minority among those who suffer a concussion, which is a mild type of traumatic brain injury. Most people recover within seven to 10 days, says Dr. Stephanie Alessi-LaRosa, associate director of the Sports Neurology Program at Hartford HealthCare’s Ayer Neuroscience Institute. However, about 10–15 percent of concussion sufferers have persistent symptoms after a concussion. “That could be months. That could be years,” she says.
I thought my only mood change was frustration, but my husband tells me my anxiety level rose for more than a year — for as long as it took to get to the point where I could read for pleasure without headaches. Mood issues, including depression and anxiety, are a common symptom of post-concussive symptoms, says neurologist Dr. Deena Kurvilla, director of the Westport Headache Institute. People with post-concussive symptoms sometimes face stigma from spouses, bosses or others in their lives who think they’re being lazy or exaggerating their symptoms, she says.
Physicians used to prescribe cocoon therapy, advising patients to do nothing for two weeks, Alessi-LaRosa says. “That can be a real problem. If you rest an athlete for two weeks, you’re going to get a different person.” The standard of care now is to rest for two days and slowly resume normal activities, stopping when headaches strike. She recommends “starting with a stationary bike at low intensity, which shows the brain what it feels like to have the heart rate elevated,” Alessi-LaRosa says. Every brain is unique and every concussion is different. There is no one-size-fits-all protocol.
She advises patients to take breaks if symptoms return, which can be a challenge for someone like me who needs to move and likes being busy. “It’s very difficult for someone with a Type A personality to have a concussion,” Alessi-LaRosa says. “They sort of want to just push through because that’s how they fix most things.”
Who is more likely to have post-concussive symptoms, or what is now called “persistent symptoms after concussion”? Anyone with a personal or family history of headache disorders such as migraines or a history of head injuries, Kurvilla says. People with a history of anxiety and depression are at higher risk for developing vertigo, balance issues and chronic headaches after a concussion. In addition, she says, those with bipolar disorder, post-traumatic stress disorder or those with poor social support can be at risk for post-concussive symptoms. Also, Alessi-Rosa adds, people with a personal or family history of anxiety, depression or ADHD are at higher risk for prolonged recovery.
Women report more post-concussion symptoms than men, but researchers don’t know why. Women have a higher propensity to get migraines than men, so “maybe that’s a component,” Alessi-LaRosa says. There’s speculation that estrogen could play a role, but “we don’t fully know,” she adds. Are women more likely to report delayed recovery than men because women are more proactive about their health or more likely to heal more slowly from concussions? Researchers don’t know, she says.
How is post-concussion syndrome diagnosed? Those with headaches, migraines, mood issues, cognitive complaints such as memory recall, forgetfulness, concentration and speech issues — anything involving executive functioning skills — three months after the concussion are considered to have post-concussion symptoms, Alessi-LaRosa says.
She wasn’t surprised that driving caused me to relapse a few months after the concussion. Drivers need to watch the road, other cars and pedestrians, and the concentration required is symptom-provoking, she says. While recovering from a concussion, people should continue to hydrate, eat regularly, get enough sleep and do whatever level of physical activity they can endure without symptoms.
I had to start with 10-minute walks a few times a week and work my way up to 30 minutes daily. Through very gradual increments, I’m able to walk or hike for more than an hour and able to drive straight for three hours without headaches or nausea. Even though writing this story gave me a headache, I look forward to being able to return to my normal 10-hour workday.
Concussion treatment options
Immediately after sustaining a concussion, people should be seen by their primary care provider or the emergency department, says neurologist Dr. Deena Kurvilla, director of the Westport Headache Institute. The “cardinal signs of concussion,” are loss of consciousness, memory loss, mental fog, headaches, dizziness, lightheadedness, vertigo, unsteadiness or mood changes, Kurvilla says.
If headaches persist for more than four days a month, a preventative medication treatment may be prescribed, including anti-seizure medications, antidepressants, blood-pressure medications, Botox and anti-inflammatory meds.
Doctors diagnose someone with persistent symptoms after concussion if they have some of the following symptoms three months following a head injury: headache, migraine, mood changes and cognitive complaints such as difficulty concentrating, forgetfulness, memory issues, speech issues and any deterioration in executive function skills.
Treatment options for persistent symptoms are limited and little understood.
Despite the fact that Connecticut residents can obtain a prescription for a cannabis derivative, such as cannabidiol (CBD), if they’ve been diagnosed with migraines, Kurvilla says, “there is no scientific evidence that CBD is a useful treatment for migraines,” let alone concussions.
Craniosacral therapy, in which a therapist applies gentle pressure to the head and neck, has been shown to help headache sufferers, says Kurvilla, adding that there’s evidence it relieves headaches for 85 percent of those with post-concussive symptoms.
Dr. Stephanie Alessi-LaRosa, associate director of the Sports Neurology Program at Hartford HealthCare’s Ayer Neuroscience Institute, cautioned that there’s a lot of pseudoscience around craniosacral therapy. If performed by a trained physical therapist, she says, “It won’t do harm. It may be helpful.”