Managing Persistent Head Pulsations and Sleep Disruptions After Trauma

Continuous pulsating sensation in the head for 24 hours affecting sleep?

Hello, doctor: Several years ago, I had bipolar disorder.
Four years ago, I stopped seeing a psychiatrist and my condition improved significantly.
However, two years ago, I was involved in a car accident caused by a drunk driver.
At that time, I experienced fractures and felt extremely sleepy.
After a few hours of sleep in the hospital, I began to experience severe headaches.
After being discharged, the headaches became more painful than the fractures, and my head felt like it was pulsating.
Two months later, unable to endure the pain, headaches, and palpitations, I visited a family medicine doctor.
He asked if the pulsating was painful, and I said no.
After reviewing my medical history, he informed me that I was experiencing post-traumatic stress disorder (PTSD) from the accident, which led to depression, anxiety, and autonomic nervous system dysregulation, causing my palpitations, headaches, and body pain.
He suggested I return to see a psychiatrist.
When I did, the psychiatrist echoed the same sentiments.
I was prescribed medication for two to three months, but my headaches did not improve, and I became increasingly irritable, feeling suicidal, and crying daily.
Even after taking painkillers and sleeping pills, I would wake up with headaches after about two hours of sleep, only to repeat this cycle.
Each time I returned for a follow-up, the doctor mentioned that my psychological trauma had not healed and that I needed medication for treatment.
My family could no longer tolerate my condition, so I stopped taking the medication.
Gradually, over the course of a year, my headaches became less severe, and I recognized that my bodily pain was due to internal injuries from the accident.
However, I still experience persistent pulsating sensations in my head.
When my leg injury improved, I found that I could only sleep on my left side, as lying flat or on my right side would wake me from sleep.
However, after sleeping for a long time, my face often becomes numb and painful, and my left side is more relaxed than my right.
I have been trying to return to a normal sleeping position.
What should I do about my current situation?

choya, 30~39 year old female. Ask Date: 2007/10/20

Dr. Zheng Jingming reply Psychiatry

Hello, I'm not sure if you had a CT scan or other examinations of your head two years ago.
The physician may be able to assess the extent of any brain injury based on those results, your medical history, and a neurological examination.
I cannot determine whether the reason for "the head pulsating continuously for 24 hours affecting sleep" is related to the brain.
I recommend seeing a neurologist or neurosurgeon for further evaluation to identify the cause.
If their examination concludes that there are no significant brain issues, then you should consult a psychiatrist to address your concerns.
Of course, since you mentioned having bipolar disorder, you should already be regularly receiving treatment from a psychiatrist.
Psychiatrist Zheng Jingming.

Reply Date: 2007/10/20

More Info

Managing persistent head pulsations and sleep disruptions after trauma can be quite challenging, especially when there is a history of mental health issues and physical injuries. Based on your description, it seems that you are experiencing a combination of post-traumatic symptoms, which may include headaches, sleep disturbances, and emotional distress. Here’s a comprehensive approach to understanding and managing your situation.

Understanding Your Symptoms
1. Post-Traumatic Headaches: After a traumatic event such as a car accident, it is common to experience headaches that can be tension-type or migraine-like. These headaches may be exacerbated by stress, anxiety, and changes in sleep patterns. The pulsating sensation you describe could be a form of migraine or a tension headache, which can be triggered by stress or physical strain.

2. Sleep Disturbances: Your difficulty in maintaining sleep and the need to sleep in a specific position to avoid pain suggests that your body is responding to discomfort. This can lead to a cycle where poor sleep exacerbates pain and vice versa. The fact that you wake up with pain after a couple of hours indicates that your sleep architecture is disrupted, possibly due to pain or anxiety.

3. Emotional and Psychological Factors: The history of bipolar disorder and the trauma from the accident can contribute to feelings of anxiety, depression, and irritability. It’s important to recognize that psychological distress can manifest physically, leading to symptoms like heart palpitations and increased pain perception.

Recommendations for Management
1. Consult a Specialist: Given the complexity of your symptoms, it may be beneficial to consult a neurologist or a pain specialist who can provide a thorough evaluation of your headaches and recommend appropriate treatments. They may suggest imaging studies to rule out any structural issues related to your head injury.

2. Cognitive Behavioral Therapy (CBT): Engaging in therapy, particularly CBT, can help address the psychological aspects of your pain and anxiety. A therapist can work with you to develop coping strategies, improve sleep hygiene, and manage stress.

3. Medication Management: Since you have a history of medication use, it may be worth revisiting this with your psychiatrist. There are various medications for chronic pain management, including antidepressants and anticonvulsants, which can also help with headaches. It’s crucial to find a balance that minimizes side effects while effectively managing your symptoms.

4. Physical Therapy: A physical therapist can help you with exercises that may alleviate tension in your neck and shoulders, which can contribute to headaches. They can also guide you on proper sleeping positions and ergonomics to reduce discomfort.

5. Sleep Hygiene: Establishing a regular sleep routine can help improve your sleep quality. This includes going to bed and waking up at the same time each day, creating a restful environment, and avoiding stimulants before bedtime. If lying flat causes discomfort, consider using pillows to elevate your head or support your neck.

6. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, yoga, or deep-breathing exercises can help reduce anxiety and improve your overall sense of well-being. These techniques can also be beneficial in managing pain perception.

7. Gradual Return to Normal Activities: As your physical condition improves, gradually reintroducing normal activities can help restore your sense of routine and normalcy. However, it’s essential to listen to your body and avoid overexertion.

Conclusion
Your situation is multifaceted, involving physical, emotional, and psychological components. A comprehensive approach that includes medical evaluation, psychological support, lifestyle modifications, and possibly medication can help you manage your symptoms more effectively. It’s essential to communicate openly with your healthcare providers about your experiences and any changes in your condition. With time and appropriate interventions, you can work towards regaining a sense of normalcy in your life.

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