Post-Concussion Symptoms: When to See a Neurologist

Approximately five years ago, I sustained a significant blow to the back of my head?

At around 14 years old, I experienced a significant blow to the back of my head while playing.
Recently, I've noticed that I sometimes forget what I wanted to say or the names of my high school classmates (I am currently a freshman).
Occasionally, my speech seems unusual, and I experience severe headaches when riding amusement park rides.
During these headaches, I also feel slight dizziness and pulsating pain when walking, bending down, or climbing stairs, along with a sense of pressure in the back of my neck.
In general, I sometimes experience headaches that can be pulsating or pressure-like, with the pain located deep in the back of my head.
Over the past two to three years, I have had multiple episodes of headaches.
Should I consult a neurologist or a neurosurgeon? Are there any specific things I should be aware of? If I need to undergo a CT or MRI, is there anything I should pay attention to? Thank you, doctor.

Bora, 10~19 year old female. Ask Date: 2021/01/19

Dr. Jiang Junyi reply Neurology

Hello, based on your description, generally speaking, head trauma without loss of consciousness, the use of anticoagulants, or significant local hematomas is usually mild.
If your symptoms have persisted for more than six months, they may be less related to the incident that occurred when you were 14 years old.
Your symptoms may need to be considered as vascular headaches, particularly migraines.
Common aura symptoms associated with migraines include visual disturbances such as seeing stars and lightning-like flashes, as well as blurred or distorted vision.
These are all precursors to a migraine.
A few minutes after the aura appears, you may experience tingling, weakness, or numbness in the face, hands, or legs.
During the attack, symptoms may include nausea, vomiting, photophobia, phonophobia, and pallor.
Once the aura subsides, you may experience severe, unilateral throbbing pain in your head.
These migraine symptoms typically last for several hours, and can even extend up to 2-3 days.

Q: I have experienced multiple headaches over the past two to three years.
Should I consult a neurologist or a neurosurgeon? Are there any specific considerations I should be aware of?
A: If there is no acute head injury or surgical need, it is usually advisable to first consult a neurologist for diagnosis.
Q: If I need to undergo a CT or MRI, what should I be aware of?
A: It is recommended to have a diagnosis from a neurologist first, and then proceed with imaging studies as needed.
I suggest you consult with a neurologist for discussion, examination, and treatment.
Wishing you good health and peace.
Dr.
Jiang Junyi, Neurology Department, is concerned for you.

Reply Date: 2021/01/19

More Info

Understanding post-concussion symptoms is crucial, especially for someone who has experienced a significant head injury, such as a blow to the back of the head at a young age. Your symptoms, including memory lapses, unusual word choices, severe headaches, and feelings of pressure in the neck, warrant careful evaluation by a medical professional.
Post-concussion syndrome (PCS) can manifest in various ways, including cognitive difficulties, headaches, dizziness, and emotional changes. The symptoms you describe—forgetting names, odd speech patterns, and recurrent headaches—are not uncommon in individuals who have suffered a concussion. The headaches you experience, characterized as pulsating or pressure-like, could be tension-type headaches or migraines, which are often exacerbated by stress or physical activity.

Given your history of a head injury and the persistence of your symptoms, it is advisable to consult a neurologist. Neurologists specialize in disorders of the nervous system, including the brain, and can provide a comprehensive evaluation of your symptoms. They may conduct a detailed neurological examination and review your medical history to determine if your symptoms are related to the previous concussion or if there are other underlying issues.

In some cases, imaging studies such as a CT scan or MRI may be recommended to rule out any structural abnormalities in the brain or to assess for any potential complications from the concussion. When undergoing these imaging tests, it's essential to inform the technician or physician about your symptoms and history of head trauma. This information can help them interpret the results more accurately.

Here are some specific considerations when seeing a neurologist:
1. Symptom Diary: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your doctor.

2. Medical History: Be prepared to discuss your medical history, including the details of your head injury, any previous concussions, and any other medical conditions you may have.

3. Medication List: Provide a list of any medications or supplements you are currently taking, as these can impact your symptoms and treatment options.

4. Lifestyle Factors: Discuss any lifestyle factors that may contribute to your symptoms, such as sleep patterns, stress levels, and physical activity.

5. Follow-Up: Be open to follow-up appointments, as managing post-concussion symptoms can be an ongoing process. Your neurologist may suggest cognitive therapy, physical therapy, or medication to help alleviate your symptoms.

In summary, your symptoms following a concussion are significant and should be evaluated by a neurologist. They can help determine the best course of action, whether it involves imaging studies, therapy, or other interventions. Early intervention can often lead to better outcomes, so seeking medical advice is a prudent step.

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