"Cutting" out chronic headaches after concussions

As many as 3.8 million athletes suffer concussions each year in the U.S. These injuries can cause serious brain damage, but for many there's also another painful problem.

"It was awful,” said Anita Byer Hollie’s Mom. “It's a parent's worst nightmare."

Hollie Byer has suffered four concussions from playing soccer. The last one caused painful headaches that just wouldn't go away.

"It would go from the back of my neck all the way up to the front of my head," describes Hollie Byer.

The concussion not only injured Hollie's brain, but it also flattened nerves in the back of her head. When medications didn't relieve the pain Georgetown Plastic Surgeon Ivica Ducic suggested surgery to decompress the nerve, essentially "unbuttoning" it.

"The equivalent of unbuttoning a shirt and tie because it's just too tight, and you can't breathe or speak normally," explains Dr. Ivica Ducic, MD, PhD, Professor, Plastic Surgery & Neurosurgery Director, Peripheral Nerve Surgery Institute MedStar Georgetown University Hospital.

The doctor cuts the muscle and tissues that surround the damaged nerve, giving it room to expand. This relieves pressure and pain. One study found nearly 85-percent of patients who underwent this procedure had at least a 50-percent reduction in symptoms.

"Changing somebody's quality of life is really, really rewarding," says Dr. Ducic.

Hollie's headaches were gone the day after her surgery.

"No more pain,” says Hollie. “It's been great."

Now she's thrilled to be back in the game, an athlete who doesn't have to play through the pain any longer.

Now the doctor says there's no sure way to know how many concussion patients report to having headaches. He feels the problem is under-reported and under-recognized though.

He also believes there are less than 100 surgeons in the entire country performing the nerve procedure that helps get rid of these headaches.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: "Cutting" out chronic headaches after concussions
REPORT: MB # 3538

BACKGROUND: A concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary, but can include problems with headache, concentration, memory, judgment, balance and coordination. Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don't realize it. Concussions are common, particularly if you play a contact sport, such as football. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Luckily, most concussive traumatic brain injuries are mild, and people usually recover fully. (Source: MayoClinic)

TYPES/SIGNS: Signs and symptoms of a concussion may include: Headache or a feeling of pressure in the head, temporary loss of consciousness, confusion or feeling as if in a fog, amnesia surrounding the traumatic event, dizziness or "seeing stars", ringing in the ears, nausea or vomiting, slurred speech, and fatigue. (Source: MayoClinic)

TREATMENT: Rest is the best way to allow your brain to recover from a concussion. The American Academy of Pediatrics recommends both physical and mental rest for children. This means avoiding general physical exertion as well as activities that require mental concentration, such as playing video games, watching TV, texting or using a computer. School workloads should also be temporarily reduced. For headaches, use acetaminophen (Tylenol, others). Avoid other pain relievers such as ibuprofen (Advil, Motrin, others) and aspirin, as there's a possibility these medications may increase the risk of bleeding. If you or your child sustained a concussion while playing competitive sports, ask your doctor or your child's doctor when it is safe to return to play. Resuming sports too soon increases the risk of a second concussion and of lasting, potentially fatal brain injury. No one should return to play or vigorous activity while signs or symptoms of a concussion are present. Experts recommend that children and adolescents not return to play on the same day as the injury. (Source: MayoClinic)

NEW SURGERY FROM THE DOCTOR'S PERSPERCTIVE: "What we do is make an incision after the opening which is accessing just plain sub continuous tissues, and then you are approaching the areas were nerves actually live," Ivica Ducic, M.D., Ph.D., Professor of Plastic Surgery and Neurosurgery, Director of Peripheral Neurosurgery in Georgetown, told Ivanhoe. " You free the fasual layer, which is just a coat over the muscles, but due to trauma it gets to be stiffer. Instead of just being a nice envelope around the nerve, it starts pinching the nerve and pressing it, and the nerve protests and gives you the headache or migraine. If the oson atomically intra-operatively defines variations or pressure by any other structure of vessels or a portion of the muscle, we would free up that as well."

FOR MORE INFORMATION, PLEASE CONTACT:

Marianne Worley
Director of Media Relations
(703) 558-1287
WorleyM@gunet.georgetown.edu


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