Approach to Understanding and Treating Chronic Post Traumatic Headache St. Michael s Head Injury Clinic. Session Two:

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Bethany Byrd
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1 Approach to Understanding and Treating Chronic Post Traumatic Headache St. Michael s Head Injury Clinic Session Two:

2 What will you learn in session two? Recap of session one: Are you using your medication appropriately? When to seek medical attention Are you participating in lifestyle modification? Explain importance of keeping the brain active Are you resting too much?

3 Great Source for concussion information basics/concussion_whatis.html

4 Are you using your medications the right way? Treat the headache as soon as you feel it coming Do NOT WAIT... If you do it may be too late Try and prevent headaches as best as you can Recognize triggers or situations that make your headaches worse KEEP A DIARY Mark down the days on a calendar that you have headache and what medications you took

5 REMEMBER: Too Many Pills Can Cause Headaches

6 Be Careful Avoid taking simple pain pills (Advil, Tylenol) more than 15 days/month Avoid Opioids (Tylenol with codeine, Oxycocet, Morphine). If prescribed, take no more than 10 days/month Triptans (for migraine) no more than 10 days/month Combination of the above pills no more than 10 days/month

7 When to seek medical attention A constant severe headache that gets worse Sudden severe vomiting or nausea Fainting or blacking out or if people can t wake you up Very drowsy Seizures or convulsions Increasing confusion, restlessness, or agitation Weakness, numbness or decreased coordination Slurred speech, trouble talking, or not making sense Fluid or bleeding from the ear or nose

8 Lifestyle Management Can help reduce the severity of the headaches that you have...

Things that help headaches Ask Family Doctor about taking Vitamin D3-4000 IU s per day with a high fat

9 Things that help headaches Ask Family Doctor about taking Vitamin D IU s per day with a high fat meal. Ask for a Vitamin D test to check level Can find at Pharmacies & Health Food Stores Burford-Mason,, 2017

10 Ask Family Doctor about Magnesium Helpful to take each day even when you don't have a headache to help with pain intensity Can take with your pain medications as soon as you feel a headache coming on Helps with sleep and stress (Burford-Mason, 2017) Be careful: may cause some diarrhea. Reduce dose if you start having diarrhea. Avoid if you have kidney problems

11 Magnesium Glycinate: Start with 100 mg at bedtime. Slowly increase by 50 mg every 3 days Alternate between mornings and evenings until you have 1 to 3 soft comfortable bowel movements per day You can divide the pills up throughout the day If you get diarrhea, you are taking too much and need to cut back. Burford-Mason, 2012, Fanchetti, 1991

12 Other things that help headaches Riboflavin (Vitamin B2): Take 400mg each day regardless of headache Co-enzyme Q10: 300mg per day These may help to reduce headache pain severity Sun-Edelstein et.al. 2011

13 Mindfulness techniques Practice mindfulness at least once a day Find a quiet place alone Download apps like.. Stop Breathe and Think

14 Mindfulness techniques Do Slow Relaxed Breathing- See for YouTube video Meditation-See Free guided Meditationshttp://marc.ucla.edu/mindful-meditations Progressive Muscular Relaxation-Relaxation audio Methodhttp://

15 Alcohol and other Substance Use Avoid after concussion Your brain is particularly vulnerable to the effects of alcohol and recreational drugs Increase your risk of re-injury (through falls), seizures, and slowed recovery May worsen post-concussive symptoms such as sleep, mood and thinking difficulties

16 Are you resting too much? Inactivity is not helpful Exercise increases blood flow to the brain An exercise program should be started as tolerated with gradually increasing duration and intensity. Walking around the house, the mall and stationary bike Stretch Not moving may make the headaches worse For some, exercise triggers a headache and in these individuals the intensity and/or duration of the exercise should be reduced or an alternative exercise should be trialed. Talk to your doctor about which exercises are best for you.

17 Keeping the brain active Challenge yourself intellectually Learn something new Online games (e.g., BrainHQ, Posit Science, Lumosity, Cambridge) Reading, puzzles, games Keep yourself mentally and physically active Cognitive, physical and social activities

Your New Normal There is a lot we do not know about concussion and therefore much uncertainty for those living with persistent symptoms How to cope?

18 Your New Normal There is a lot we do not know about concussion and therefore much uncertainty for those living with persistent symptoms How to cope? Mindfulness meditation, diet & exercise Manage your stress Track and log your achievements Set small and realistic goals for yourself Seek out support (e.g., groups, talk to others with concussion and share coping strategies)

19 Help Headaches By Healthy Eating Do not skip breakfast Our brains sense light before we wake up each morning and it wants protein right away! Drink water: 4-6 glasses each day Avoid Caffeine and Aspartame Eat breakfast, lunch & dinner at regular times Eat protein, vegetables & fruit at meals & snacks Limit sugar & processed food

20 When to go to the ER? You are having the worst headache EVER! You have a headache with one of the following: Unresolved loss of vision Loss of consciousness Uncontrolled vomiting New weakness in the face, arms or legs Your headache has new or unusual symptoms that scare you

21 Websites Go to these sites for further education on concussion and headaches: Ontario Neurotrauma Foundation: Concussions Ontario: Ministry of health: /concussions/

22 Feedback Don't like the colour of the slides? Too many slides? Is there too much writing? Should we include something else or make something clearer? LET US KNOW... We love the feedback so we can improve these slides for future patients. Please

23 Image Sources and References Image Sources: Slide3 and 21: Slide 8: Slide 9: : Slide 11: Slide 13: Slide 17: Slide 18: Slide 19: References: Slide 9, : Burford-Mason, The Healthy Brain. 2017, p 209 Slide 10: Burford-Mason, The Healthy Brain. 2017, p 193 and 109 Slide 11 : Daniel, O. & Mauskop, A. Curr Treat Options Neurol (2016) 18: 14. doi: /s Slide 11: Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991;31: and Burford-Mason, Eat Well Age Better, 2012, p. 269 Slides 12: Christina Sun-Edelstein, MD; Alexander Mauskop, MD. Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments. Headache Currents.2011.

Concussion or Mild Traumatic Brain Injury

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