Brain Plasticity by Brain Researcher Dr. Lara Boyd

I discovered a good TEDx talk from a brain researcher in Vancouver, Dr. Lara Boyd. In it she describes the chemical and structural changes that occur in your brain during neuroplasticity (brain changes). The key points I took away were:

  • Her work with people recovering from stroke shows a lot of variability in results from person to person.
  • The primary driver of brain change is your behaviour. “There is no neuroplasticity drug you can take. Nothing is more effective than practice at helping you learn. The bottom line is you have to do the work.”
  • Increased difficulty/increased struggle in what you are practicing results in not only more learning but also greater structural change in the brain.
  • Neuroplasticity can be either positive (e.g. learn something new) or negative (e.g. become addicted to drugs, have chronic pain).
  • Neuroplasticity is shaped by everything you do and everything you don’t do.
  • There is no one size fits all approach to learning. There is no one intervention that will work for all of us. This has forced the researchers to look further into “personalized medicine” (unique interventions).
  • Biomarkers in the brain are helping them to match therapies with individual patients recovering from stroke.
  • Not only do we need personalized medicine, we need personalized learning.
  • Even for people without a brain injury/stroke, behaviours in your everyday life and things you encounter are important because each of them is changing your brain for better or for worse.
  • Break bad habits. Do the positive learning that your brain requires. Build the brain you want.

Concussion Information Booklet for Patients and Families

The Ontario Neurotrauma Foundation (ONF) has recently released a new Concussion Information Booklet for Patients and Families. It is excellent and I hope multiple copies are delivered to every hospital emergency room and general physician’s office for distribution to people with a concussion. Here is a link to download a copy of it:

http://concussionsontario.org/wp-content/uploads/2018/04/ONF-Concussion-Booklet-Web-Feedback-link.pdf

Representatives of the ONF were at the recent Concussion Public Forum in Toronto to distribute copies of it. They indicated they would like to receive feedback on it from patients and families at info@onf.org or through Twitter @ontneurotrauma.

The representatives indicated the purpose of this guide is to help you navigate through the industry after potentially receiving a concussion. The ONF has developed concussion standards by working with 100 stakeholders including people with lived experience and their family members. They found that concussion was becoming a business and people were calling themselves “concussion experts” without proper training. The ONF’s concussion standards and this guide are intended to help deal with this issue.

 

Concussion Public Forum in Toronto, ON

There will be a free public information night with the dual themes of “The Consequences of Concussions” and “Concussions Through the Eyes of Concussion Sufferers and Their Families” to be held on the evening of Friday May 11th at Toronto Western Hospital in Toronto.

Here is a link to the agenda:

https://ers.snapuptickets.com/ers/event-files/2495/Public_Forum_Program_Apr_4.pdf

Here is a link to the registration form:

https://ers.snapuptickets.com/ers/online-registration-conference-form.cfm?event=2495&lan=eng&RegType=2

If you decide to register, once you enter your information on this form and click “Continue” then review your information and if it is correct, make sure you click the “Complete Registration” button which is in grey at the bottom of the screen (it’s not that obvious).

New Study Indicates Number & Severity of Brain Injuries Raises Dementia Risk

A large study offers more evidence of a link between traumatic brain injuries and dementia later in life, with repeated injuries and severe ones posing the greatest danger.

According to the study’s results, a single severe brain injury increased the risk of later developing dementia by 35 per cent compared with a person who never had brain trauma. A mild brain injury increased the risk by 17 per cent.

But, also note the line “Overall, the risk was small. About 95 per cent of people who suffered a brain injury never developed dementia.”

To read the full article in The Star, click the link below, or if you would prefer to have the article read aloud to you, simply click the play button below.

https://www.thestar.com/life/2018/04/11/new-study-says-number-severity-of-brain-injuries-raises-dementia-risk.html

Dr. Charles Tator’s 2017 Presentation on Photosensitivity in Women with Post Concussion Syndrome

Here is a link to video presentation which Dr. Charles Tator, a neurosurgeon at Toronto Western Hospital, gave at a 2017 “Concussion in Women and Girls Conference” in Toronto. His presentation is currently available online. In this presentation, Dr. Tator provides some information about women with Post Concussion Syndrome (PCS) who experience photosensitivity (a.k.a. photophobia). He also describes a study that he was involved with where they had 29 people with PCS use a “non LCD” device instead of a traditional computer monitor. The device had a slower refresh rate (so less flicker) than a typical computer monitor and did not have a backlit screen.

http://www.uhn.ca/KNC/Research/Projects/Canadian_Concussion_Centre/Pages/symposia.aspx

Court Ruling in Favour of Cognitively Disabled

Here’s an interesting article regarding a court case involving a man who was married by a woman (apparently for his money) shortly after he received a serious brain injury. Ontario’s marriage laws are loose, leaving little to stop vulnerable people from being pressured to marry. The decision in this case to void the marriage shows that courts are recognizing the rights of the vulnerable person.

If you would prefer to have the article read aloud to you, simply click the play button below. Use the comments box at the bottom to post your views on this ruling.

 

My Story – Headache Medications I Have Tried Over the Years

Previous posts provide general information on post-traumatic headache and Ontario Neurotrauma Foundation’s recommended approach to medication for post-traumatic headaches. This post describes my personal experience with headache medications and my views on the use of medication for post-traumatic headache pain. I have tried numerous different headache medications over the years since my accident. This post describes them in detail.

For the first month after my headaches first set in, I tried Tylenol, Advil/Ibuprophen, and prescription-strength Naproxen (my doctor indicated it would also help with any brain swelling) but these didn’t help with the pain. Frustrated, I went back to my family doctor who switched me to Gabapentin, which is supposed to work “prophylactically” (i.e. prevent the headaches before they start) but you must work up to the desired dosage slowly. Her recommended daily dosage of 600mg Gabapentin took away the constant headache as long as I lay perfectly still, but I still had extreme light and noise sensitivity and many common, everyday things such as reading, TV, computer screens, car rides, two people talking at the same time, any type of music and many more things would trigger an instant headache.

Eventually another doctor diagnosed me with two types of headaches – migraines and tension headaches. To try to prevent both headache types, he recommended I slowly increase the Gabapentin all the way up to 2,100mg/day (spread over four daily doses). For the migraine headaches, I was to take 5-10mg of Rizatriptan  as soon as I was sensing the start of a migraine. I was someone who at that point rarely took any medication so I was extremely hesitant to follow this advice. I worried about negative side-effects like liver damage and I felt the headaches were a form of information from my brain, giving me signals about what I shouldn’t be doing. I felt the additional medication could mask this information and allow me to do things I shouldn’t be doing. When I went for my next appointment and hadn’t increased my medication as the doctor had asked, it was explained to me that the body heals better when it is not in pain and that allowing the pain to continue on an ongoing basis could create a chronic pain syndrome. With that additional information I then followed the recommendations. An additional daily prescription was also added for 30mg of Amitriptyline, which although usually prescribed as an anti-depressant, in a much lower dose can also be used to prevent migraine headaches and help with nerve pain and sleep issues. This combination of pain medication, when combined with lifestyle changes and the use of pacing and planning including stopping an activity before or as soon as the headache started, took away the constant headache but still did not prevent the headache from starting with even very mild cognitive effort.

Months later, after triggering a brutal migraine that lasted for five days and nights straight and wouldn’t respond to medication, I went to the hospital and they gave me Metoclopramide intravenously and it quickly got rid of the migraine, but the effect was only temporary. I was then prescribed a 10 mg pill form of Metoclopramide that I took twice daily (with no changes to the other medications I was on). For me, this drug did wonders. It allowed me to tolerate much more cognitively before the headache was triggered. However, having read about the potential side effects, I was worried about being on it for a long time so eventually I weaned myself off of it.

A year later  since I was still very limited in what I could handle cognitively and was not living anything close to a normal or desired quality of life, it was recommended I try switching the Gabapentin to 300mg of Lyrica (aka Pregabalin). He explained that these two drugs are very similar, but Lyrica has been known to provide better relief for nerve pain. To make the switch I had to slowly wean off of the Gabapentin and slowly wean onto the Lyrica. The increase in symptoms in between showed me how much the medication was actually doing for me. This amount of pain medication allows me to keep practicing doing the things that trigger headaches and I am slowly increasing the number of minutes I can do them before the headache is triggered.

My Thoughts on the Use of Medication For Post-Traumatic Headache

To this day (several years later) I have not been able to reduce the dosage of Lyrica. I don’t like that I am dependant on it, but it allows me to function at a certain level of cognitive effort before the headaches are triggered and I wouldn’t want my capabilities to be any less than they currently are. I have been able to wean off of the Amitriptyline though and I save the Rizatriptan for those times when I have overdone it and triggered a migraine. By implementing proper pacing and planning of my activities, using Mindfulness techniques and by immediately stopping whatever activity has triggered the headache, I am able to reduce the number of migraines, their severity and my need for additional Rizatriptan medication.

There is no one medication that will work for everyone’s post-traumatic headache. My suggestion is to be persistent and willing to work with your doctor to try different options, to maintain a headache journal so you can provide him/her with accurate information about your headaches, their severity and triggers, how often you have had to take extra medication and whether it worked. It is unfortunate that you may have to take medication for a longer period than you would like but it can increase your quality of life.

 

 Disclaimer: The information contained in this post and others like it is intended for information purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion I strongly recommend that you contact a qualified health professional for appropriate diagnosis and treatment. The collaborators have made responsible efforts to include accurate and timely information; however, the individuals and organizations listed on this website make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

What Medication is Best for Post-Traumatic Headache After The First 48 Hours?

In order to best treat or prescribe the most appropriate medication for a headache, doctors need to know what types of headaches you’re having and the root cause. A previous post provides general information on the types of post-traumatic headache and recommended medication for the first 24-48 hours. This post provides Ontario Neurotrauma Foundation’s recommended approach to medication for post-traumatic headaches after that initial 48 hours, the risks of using too much medication and the importance of maintaining a headache journal.

Ontario Neurotrauma’s Concussion Guidelines’ Recommended Approach to Medications

The Guidelines provide the following medication suggestions for post-traumatic headaches:

  1. For certain headaches consideration may be given to using acute headache medications, limited to <15 days per month:-Over-the-counter or prescription NSAIDs (e.g., Tylenol);
    -Acetylsalicylic acid;
    -Acetaminophen; and
    Combination analgesics (with codeine or caffeine).
  2. For migraine headaches, migraine-specific triptan class medications may be effective to abort the headaches but should be limited to <10 days per month.
  3. Narcotics should be avoided or restricted to “rescue therapy” for acute attacks when other first- and second-line therapies fail or are contraindicated.
  4. Medications that work prophylactically (i.e. prevent headaches) should be considered if headaches are occurring too frequently or are too disabling, or if acute headache medications are contraindicated, poorly tolerated, or being used too frequently.

These Guidelines also indicate “post-traumatic headaches may be unresponsive to conventional treatments. If headaches remain inadequately controlled, referral to a neurologist, pain management specialist, or traumatic brain injury clinic is recommended”.

The Problem with Overuse of Pain Medication

Patients suffering from post-traumatic headache may over-use pain medication (known as analgesics). Doctors are aware that this over-use can perpetuate the problem and become the cause of the headaches. Even an over-the-counter medication like Tylenol if over-used can start to cause headaches when it wears off. This is known as “The Rebound Effect”. Doctors need to provide their patients with clear guidance as to the maximum number of days in a month they can take any medication that falls into this category. The Ontario Neurotrauma’s Concussion Guidelines indicate the medications that fall into this category should be used no more than 10 days per month to avoid rebound headaches.

The Importance of a Headache Journal

It is important to maintain a daily headache journal in order to accurately know how many days you are using headache medication. This will help you provide your doctor with all the necessary information for him/her to accurately diagnose and treat the headaches. See the Concussion Guidelines mentioned above for details to include in this journal and suggested places to keep it in order to remember to complete it daily.

 

In Conclusion

It’s clear that medication for post traumatic headache is a complicated subject. It will take considerable effort by you and your doctor to develop a treatment plan that works best for you. A later post describes the many medications I have personally tried.

 

 Disclaimer: The information contained in this post and others like it is intended for information purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion I strongly recommend that you contact a qualified health professional for appropriate diagnosis and treatment. The collaborators have made responsible efforts to include accurate and timely information; however, the individuals and organizations listed on this website make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

Post-Traumatic Headache Information

Background

According to the Ontario Neurotrauma Foundation’s Concussion Guidelines, headache is the most common symptom following a mild traumatic brain injury (mTBI).  They say “Studies to date have documented that anywhere from 30-90% of individuals who sustain a mTBI develop post-traumatic headache. Several researchers have reported that post-traumatic headache is more common after mild TBI than after severe TBI.”

Guidelines

Ontario Neurotrauma’s Concussion Guidelines suggest during the first 24-48hrs giving acetaminophen or acetaminophen/codeine for headaches (e.g., Tylenol).  It’s important to note the vast majority of people with post-traumatic headache improve within days or weeks; however, for some individuals, headaches continue for months or years. Unfortunately there aren’t clear guidelines doctors can use to help guide their post traumatic patients who continue to experience this symptom.

Assessment

According to these same Concussion Guidelines there is a lack of research in this area so doctors are left to use their own experience and expertise. Their approach should include:

  1. Determining which type of headache the patient is experiencing (migraine, tension-type, neck referral or occipital nerve) and trying to identify possible root causes.
  2. Making suggestions for lifestyle changes and non-pharmaceutical approaches to reducing the severity and frequency of headaches (such as pacing and planning of activities and alternative strategies to relaxation – all subjects to be discussed in subsequent posts).
  3. Making suggestions/giving prescriptions for medication (a topic discussed in my next post).

Additional Sources of Information

In addition to reading the Ontario Neurotrauma Foundation’s Guidelines for Concussion/Mild Traumatic Brain Injury Modules Two (“Management of Concussion/mTBI”) and Six (“Post Traumatic Headache”) I also recommend:

  • Podcast by the Director of Brain Injury Programs, Northeast Center for Special Care titled “A Pain in the Brain – The Problem of Headache After Traumatic Brain Injury”
  • Webcast with Dr. Keith Sequira, Parkwoods Hospital titled “Dealing with Headaches and Pain Following ABI”.
  • I also found it helpful to meet with Michael Zitney, a Toronto doctor specializing in chronic headaches and chronic pain.

I will provide additional information about medications for post-traumatic headache in a subsequent post.

 Disclaimer: The information contained in this post and others like it is intended for information purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion I strongly recommend that you contact a qualified health professional for appropriate diagnosis and treatment. The collaborators have made responsible efforts to include accurate and timely information; however, the individuals and organizations listed on this website make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.