migraines and concussions

I read this article in the New York Times a couple days ago, and have been mulling it over since then. Since I've had a few concussions myself, and as a result now have migraines, I found it particularly interesting. It describes the symptoms of concussion and post-concussion syndrome, then hints at the connection between concussions and migraines.

Show the NY Times Article

A Journey Through Concussion's Foggy Terrain
By DIANE ACKERMAN
Published: March 1, 2005

On a sparkling hot Florida day, I walked from an elevator into a small dark lobby and strode out the open door at speed. Except that the door wasn't open. It was an unmarked sheet of clean clear glass that clobbered me on the forehead two inches above my right eye.

I didn't pass out, see double, grow confused or feel nauseated. I did feel shaken, though, drove straight home, iced the area and rested.

For several days, I felt subdued, with low-level headaches. The world shone brighter than usual, which I attributed to the howling Florida sun. I tired easily and wasn't up to higher thought. My mind didn't feel it could do stairs.

It took three days before I admitted that I had a concussion. I went to the hospital for a CT scan, which showed no bleeding in the brain, thank heavens, and afterward I asked if I might have a look at the digital images of my brain and skull. How strange it was using my mobile, pink, three-dimensional brain to see itself frozen in time, starkly black and white, out of its box, on a two-dimensional screen that humans designed to provide the illusion of depth.

I knew that terrain intimately, but with more detail and hubbub. Where were the canyons of the mind? Where were all the curly haired selves? I scouted the images. At first glance, I was glad to find no spongy patches (some of Alzheimer's footprints) and no obvious shrinkage.

Mine was only a mild concussion, but low-level headaches persisted for a few days, and the lax mind for about a week, during which I stayed alert and in touch and reasonably able. I could drive short distances, do crossword puzzles, think and speak in the usual flux of imagery - though I felt too brain-weary for much conversation or activity. Mental work floated out of reach.

Gradually, I waded through the mind shallows and back into the churning oceans of thought. My brain checked its connections, made a few false starts, mumbled a bit and finally returned to its normal chatter and mischief. One day, I awoke feeling frisky and energetic, with a firm sense of being my self again. Home sweet home, I thought in profound relief.

A month later, back in Ithaca, N.Y., I was tending my roses, putting up birdhouses for returning wrens, cleaning out the hummingbird feeders and biking in the glorious sun. One morning I woke early, drowsily began dressing and wobbled a little, bumping my head against the wall. Not hard, just enough to say "ouch." I thought nothing of it, but later in the day severe headaches began, my mind clouded over, and I realized that I was reconcussed. I now know that, after a concussion, with balance slightly awry, it's very common to get a second one from the lightest knock.

Soon the fog lifted once more, and with exquisite care I made my first outing: a photo shoot at the local airport. All of the women of Ithaca with pilots' licenses were gathering to say hello and pose for a photograph. It was a lovely occasion, and when it was over I bundled up and jogged 10 steps or so through heavy rainfall to my car. Two hours later the symptoms of concussion returned with terrible headaches. A week or so later, I floated back into normal consciousness again.

Spring was everywhere and, with a snoot full of pollen, I sneezed hard through my nose. Two hours later my scalp hurt like the dickens, which no analgesics could curb, and my mind sank beneath the fog once more, this time for nearly two weeks. During that period, I could read and understand books, I could recognize what was important. I just couldn't think or write about what I read.

Once more, my senses were magnified. The sound of the windshield wipers was too loud to bear, the summer sun dazzled me, and I found action movies painful to watch. Worst of all was the fright, the absolute certainty that life was unlivable without the slender "I" we rely on to feel like ourselves. Anxiety makes postconcussion syndrome worse, and, unfortunately, one symptom concussion produces is anxiety.

Neurons are powerful and crafty, but they jar easily. I understand a little better now what happens during a concussion. Severe concussions can spark neurological havoc. But even a mild concussion, which is commonplace, especially among children, can be frightening if you don't know what's on the agenda, what symptoms are usual, and what comforts to seek.

For instance, it's typical for one's senses to be intensified, which can be scary at first, but pleasant if you use the opportunity to explore the rich textures of the natural world. When you're concussed, your stream of consciousness slows to a trickle. During that time, I found great pleasure in the garden, savoring colors and shapes, petals and insects.

Another salvation was to read and listen to books by Virginia Woolf, slip into her sensibility and senses, and allow her to do the mental heavy lifting for me. Wading knee-deep into her stream of consciousness, I felt it rise around me like water, and there I floated for whole days, sharing her voices and rich sensuality.

Woolf herself was often bedridden for weeks at a time with debilitating migraines. As it turns out, people who are vulnerable to migraine often have headaches as a sort of aftershock of a concussion. No one is sure why that's true, but one theory about migraine is that it isn't a pain disorder at all, but rather a sensory one.

I know now that a small injury can produce a gigantic array of symptoms, that bizarre sensory changes are usual and temporary for most people, and that reassurance (what you're going through is normal; you will get better) is an important first step to recovery.

It's reassuring to learn that almost all headaches stem from the scalp and neck, not brain damage, and are driven by tension and anxiety. I learned to ease them with guided visualization - a cross between biofeedback and controlled daydreaming.

Meanwhile, there are ways to cope, and even use the time richly, as a sensory adventure. That's how I remember it now, two years later and blessedly free from its spell. But, just to be safe, I wear a downhill ski helmet when I bike.

I don't remember any sensory enhancement after any of the concussions. I do remember feeling mentally dull, fuzzy around the edges of my mind. Not quite confusion, but not fully oriented, either. The best analogy I have is the "medicine head" feeling from cold/flu medications containing an antihistamine.

The sensativity to light and sounds that accompanies a migraine resembles what the author describes as the after-effects of a concussion, only magnified to such a degree that it is painful. What is the one thing that most migraine sufferers do to help alleviate the symptoms? Shut themselves in a dark, quiet room, basically induce as much sensory deprivation as possible. It's possible for a headache to get to the point where even physical contact is uncomfortable; I've experienced this personally and have had others describe the same phenomena to me.

What makes this similiarities between concussions and migraines so interesting is earlier today, on my way in to work, I noticed how beautiful the day was. The sun was shining brightly, the colors seemed vivid, after the past few days of dreary weather, even the music on my radio seemed more alive. About 7 hours later, sitting at my desk at work, I noticed the first hint of an auditory aura, a buzzing in my ears, which is the first signal that I'm about to have a migraine. I have both auditory and visual auras, with the auditory ones being the most common for me. They are my 20 minute warning, if I'm in a quiet enough environment to hear them. If it's noisy, I don't always notice the aura until the headache has already started.

So, I'm wondering if what I experienced this morning, the heightened senses, had anything to do with the migraine that occured several hours later, if it's an early warning of a migraine. Or was it simply coincidence - today the weather was nice after several days of cold and cloudiness, rain, and even some snow. I will have to be sure to pay attention to how sharp my senses are, and see if there is any correlation at all.