Fatigue, migraine, memory loss: How a bump on the head can affect your brain for years
Concussion is caused by nerve cells being shaken - but there is effective treatment for it, writes Julie Cook
MICHELLE PARKER remembers little of what happened the day her horse, Flash, headbutted her four years ago - but she is still living with the after-effects.
Michelle (55) doesn't think she was even knocked out after the incident, but went to see her GP, who diagnosed concussion and told her to go home and rest - assuring her that she should feel better in a day or so.
Yet four years on, Michelle, a council administration worker, lives with daily migraines, fatigue, 'brain fog', forgetfulness and struggles to find words, as a result of that head injury - a condition known as post-concussion syndrome.
Yet she has found, even though it is a recognised medical condition, it can be difficult to get some doctors to take it seriously.
Concussion is defined as a "minor traumatic brain injury" causing symptoms such as headache, dizziness, vomiting, nausea, slurred speech, confusion and visual disturbances, says Dr Mike Loosemore, a professor in sport and exercise medicine at University College London and an expert in concussion in sports.
"Concussion is where you get an energy transfer to the brain either by a direct blow to the head or transferred energy - for example, falling on your behind and transferring the momentum to the brain," he says.
"Ninety-five per cent of people who suffer concussion get over it in a week and 99 per cent within a month."
Yet for some, including Michelle, the symptoms endure and are referred to as post-concussion syndrome (PCS).
"Unlike other injuries, PCS cannot be picked up on a scan," says Professor Loosemore.
"This can cause problems with diagnosis, prolong symptoms and delay them getting the right treatment such as physiotherapy."
Michelle knew none of this back in 2017. On the day of her injury, she had gone into the field to feed Flash when something spooked the horse. She remembers little of what happened next.
"I saw Flash coming towards me - I felt a huge pain - and then nothing." Michelle's next memory is of having a searing pain across her eye and head.
She recalls walking back to her friend who insisted on phoning an ambulance. Michelle, a self-confessed "hard, horsey woman", refused.
"I went to my GP later that day instead. She checked my pupils with a light for severe head injury and said I would 'have a shiner'. Then she sent me home, telling me I had some symptoms of concussion and to rest and come back if I vomited or felt worse."
The next morning, Michelle woke to a swollen-shut black eye, as well as typical symptoms of a concussion - an aching head and nausea.
Michelle, who has two grown-up daughters, rested at home. But within two days, she felt worse.
"It wasn't just my eye, my forehead and up to my hairline hurt," she says. "I got pounding headaches which no paracetamol or ibuprofen would touch. I felt sick, ill, spaced out. I also realised I couldn't find words for things."
Two weeks later, she went back to her GP who told her this was normal following a head injury.
For the next few months, Michelle was back and forth to the GP. The symptoms were so severe that she had to be signed off work.
Six months after the incident and still suffering migraines and forgetfulness, she was finally sent for a CT scan. It showed there was nothing wrong with her brain.
Still wanting answers, Michelle was finally referred to a neurologist. "He told me that I had chronic benign daily migraines triggered by my injury, but he never elaborated that it might be post-concussion syndrome," she says.
Michelle was prescribed strong migraine medication called carbamazepine which alleviated the headache a little. "But it wasn't just the migraines," she says.
"It was the fatigue. I had to sleep all the time, couldn't work and now couldn't even go in public places because fluorescent lights in shops would trigger migraines."
It was from descriptions of symptoms on online forums that Michelle realised she had post-concussion syndrome.
Professor Loosemore is adamant that "doctors are becoming more aware of PCS and the symptoms following a head injury".
However, Michelle's doctors refused even to agree her symptoms were caused by her injury.
"On one visit to my GP three months after my injury, he mentioned PCS but said: 'It's been a long time since your head injury. It can't be that now, can it?' I felt so patronised and upset that I left in tears." Michelle has been offered no further treatment or support.
Yet Professor Loosemore says that migraines following a knock to the head are often a symptom of PCS.
"So if you're suffering from migraines, headaches, dizziness or fatigue following a head injury, you should demand help," he says.
Dr Elizabeth Griffett, a specialist clinical psychologist in neuropsychology at Hobbs Rehabilitation Clinic in Hampshire, says for many post-concussion syndrome patients, just being told what they are feeling is not just "in their heads" is a relief.
"We see people who have experienced chronic symptoms following a concussion, which all impact on each other," she says.
"Someone who's experiencing dizziness might be anxious or frustrated. Many people we see have symptoms related to depression or find that they can't control anger."
Emma Harris, a specialist neurological physiotherapist who also works at the Hobbs Rehabilitation Clinic, adds: "In PCS you typically won't see anything on scans. It is more a problem with the functioning of nerve cells after being shaken and stretched.
"There are three main aspects of physiotherapy in treating PCS. One is looking at exertion, as those with concussion experience extreme fatigue, the second is balance, which can become uncalibrated causing dizziness; and the third is the neck, which can also contribute to headaches and dizziness. Rehab following a concussion is about a gradual return to activities, both physical and cognitive."
Despite such treatments being available on the NHS, Michelle was not offered help. She carried on, struggling with basic tasks such as remembering words or coping with the supermarket shop.
A year ago, Michelle was finally given an MRI scan. This showed she had suffered multiple mini-strokes and had lesions on her brain - which must have come on since her CT scan.
A mini stroke (also known as a transient ischaemic attack or TIA) can involve the same symptoms as those of a full stroke, such as slurred speech, but the symptoms last no more than 24 hours and as with Michelle, a patient may not even be aware of it.
Professor Loosemore says that during a head injury, blood vessels can be damaged in the neck which can create clots, causing strokes.
Michelle continues to experience headaches, forgetfulness and fatigue. She now hopes to raise awareness that PCS can cause problems years after a head injury.
"I end up in tears most days because I am so frustrated about my condition," she says. "I hope one day I might be cured."
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