Headaches ... "They come out of nowhere"

One of the most prominent symptoms of concussion is headache. After a concussive injury headaches are often the main symptom that impacts one’s daily functioning. One moment you might be effectively managing your pain and then the next thing you know you have a significant headache that causes you to stop what you are doing. Patients often remark, “It just came out of nowhere!” . Usually, however, there is some kind of trigger that you are unaware of, causing the significant increase in head pain. 

While some triggers are more obvious, such as working for hours, others are less so.  Some triggers can be as simple as looking at a screen for too long, stepping outside without sunglasses, having the TV on in the background, overdoing it with physical exercise, etc.. The best way to understand your personal headache triggers is to monitor your symptoms, record your daily activities and any increase in symptoms you notice. Everyone is different, some symptoms may increase immediately at the onset or just after a trigger, but some symptoms may increase hours/days later. Keep an Activity & Symptom Log. 

For Example: 

• Gardening outside from 1:00 pm - 4:00 pm 

… difficulty sleeping and a massive headache the next morning 

• Went to the Costo 

… significant increase in headache beginning while at the store and continuing to increase on the way home

Once you have a log of your activities and symptoms, you can begin to find the patterns and identify your personal triggers. 

In the gardening example, the triggers may be sunlight, heat, and/or physical activity (e.g., bending down and standing up). Next time you garden, plan ahead and try to mitigate these triggers by wearing sunglasses and/or a hat, taking frequent breaks inside, and bringing a chair to sit down in instead of standing or kneeling. 

In the Costo example, the triggers may be background noise (e.g., people talking or music playing), fluorescent lighting, or trying to remember a long grocery list in your head. Next time you take a trip to Costo, plan ahead and try to mitigate these triggers by wearing a hat to shield your eyes from the fluorescent lights, wearing earplugs, and writing everything down in a grocery list organized by section in the store. 

The ultimate goal early in concussion recovery is to reduce significant symptoms such as headaches. When one is in a state of high pain and intense headache they are unable to complete daily activities (understandably so!). This is disruptive to one's life, and is also counterproductive to recovery. Once you understand your triggers, you will be able to hopefully reduce the frequency and intensity of your headaches, allowing the brain more time to heal your concussive injury.

Hannah Beach MS CCC-SLP

I’m not as young as I used to be...How do I know if my symptoms are due to concussion or early dementia?

As a speech-language pathologist who has focused on treating adults with neurological deficits, I hear this question ALL. THE. TIME. It’s understandable that people become very concerned whenever they have changes in their memory. And unfortunately, there is no easy answer. But hopefully the information in this blog post will provide you with the information you need to help answer this question.

Unfortunately, many of the signs of early stage dementia are also symptoms of concussion. These common signs include forgetfulness, trouble concentrating as long as you used to, difficulty finding the right words, changes in behavior/mood, and difficulty completing daily tasks. Therefore, it can be very difficult to determine if you have dementia based solely on those symptoms. One of the biggest ways to differentiate between the two is that you can typically make progress and recover after a concussion, but dementia typically gets progressively worse over time. If you did not notice any difficulties prior to sustaining your concussion, and then acute changes occurred, that would lead me to believe that the issues are concussion related. It is also possible that you are experiencing some normal cognitive decline (we call that getting older).

Once someone reaches us for treatment, we will typically perform a cognitive assessment.  After a period of time, we will re-assess the patient.  If the patient’s performance worsened, we would typically recommend a neuropsychological assessment, which can help determine the nature of the difficulties.  For most of the patients we see, the decline is related to factors other than dementia.  If there is some concern for a neurological process other than concussion, the neuropsychologist and/or neurologist will consider brain imaging, family history, and lab work to determine if a dementia (or other) diagnosis is applicable.  These tests will provide valuable information for treatment options, as well as comparison data for any future testing. 

If you are concerned, please schedule an appointment with your physician. Doctors are trained to differentiate between the two and to guide you on your path into aging. (Side note- you should consider seeing a physician who specializes in geriatric medicine.) Either way, early recognition is key. The sooner you know, the earlier you can do something about it! Cognitive therapy could be beneficial to learn some strategies to improve and/or maintain your functioning. 

If you think you’re having cognitive issues after sustaining a concussion and would like some help, call our office to schedule an appointment with one of our speech-language pathologists, who have spent countless hours specializing in cognitive rehabilitation.

Colorado Concussion Clinic 303.932.2030 

- Hilary Booco, MA CCC-SLP

“Jot That Down” - Thoughts about note-taking following a head injury

One of the things I hear frequently when I meet a new patient is, “All of a sudden I have to write everything down.  I used to just remember things and now I’m totally overwhelmed.  It’s SO frustrating!”

Let’s take a minute to analyze the situation and put things in perspective.  Normally, you have a routine which may involve work, typical household chores, family obligations, etc.  But now you’ve been hurt - maybe due to a fall, a sports injury, or a car crash.  You’re not feeling like yourself, you’re tired and scared, and all of a sudden tasks are piling up.  In addition to your usual responsibilities, you may be dealing with any or all of the following:

• Physical symptoms: headaches, dizziness, nausea, sleep disturbance, etc.

• Emotional symptoms: sadness, fear, anxiety, trauma, etc.

• Medical appointments happening at different times on different days

• Insurance companies

• Work issues

• Not having a car

• Being unable to perform household chores

When we think of it that way, it’s a lot!  You’ve had several things added to your plate, and it’s hard to juggle and remember everything that needs to be done.

It’s wonderful to be able to rely on your spontaneous memory - to not have to use a calendar, to not have to take notes every time you talk to someone, or to not have to check your notes 5 times a day to make sure you aren’t missing something.  Truthfully, though, this is what you have to do following a concussion.  My goal is to help you be at peace with this...to understand that writing things down is actually good.  It means that on some level you are recognizing that something isn’t working and you are problem solving that issue.  None of us need to be perfect.  What we need to be able to do is identify problems and solve them.  

Also, you need some free space in that precious brain to process the information that is coming at you throughout the day.  Putting appointments, reminders, and other information in your calendar is the perfect way to free up valuable brain space.  

Some of you may wonder, “Will I always have to do this?”  The answer is, probably not to the same degree.  Once you are feeling better, the appointments slow down, and you get back to your normal routine, your spontaneous memory will likely work much better.  Still, is it the worst thing in the world to use a calendar or to take notes during an appointment?  Life is busy, and as we get older we tend to have more on our minds.  For example, even though I pick my child up from school at the same time every day, I still set an alarm because I’m human and sometimes I can get caught up in what I’m doing...writing a blog post for instance.  Setting the alarm puts my mind at ease and allows me to focus on the task at hand without constantly checking the time.   

Writing information down allows us to focus, think better, and sometimes even process the information we are hearing.  At CCC, we encourage this sort of thing!

- Ramya Shyam, MS CCC-SLP