Q. Can vestibular problems and C5-C6 bulge cause headaches?

Hi doctor,

I have had persistent, recurrent headaches and shooting head pains due to a concussion from a traumatic brain injury, that I acquired five years back. The doctor has described my headaches as tension-type headaches, I have pain behind the eyes mainly, but it can be on the top of the head and upper neck, the base of the skull. I also had vertigo for two months after the injury. Does vertigo or dizziness give an indication of the severity of the concussion that I suffered?

I still require vestibular correction, as the Unterberger test was positive. Can vestibular problems cause headaches? Is there any way of telling if I suffered more than one concussion during the accident? Could that be the reason for my prolonged symptoms? To my knowledge, I did not suffer a loss of consciousness, but I am not entirely sure. Does concussion cause damage to the structures of the head and neck and to the blood vessels supplying the brain, that could be causing the recurrent headaches? Can a C5-C6 bulge cause headaches, because this was revealed in the MRI? The brain CT scan was normal at the time of the injury. What can I do to repair the muscles of the neck if they are causing my headaches? Would physiotherapy help?

The brain MRI, four years after the injury, revealed a few scattered foci of high signal intensity in the frontal lobe deep in the white matter. The doctors that I have consulted so far will not definitively say whether or not they are attributable to the injury. One doctor said that these white matter hyperintensities could be caused by the hardening of the arteries. Would this not be unusual for a man, who is 40 years old? The radiologist has described the hyperintensities as a small established lesions. As part of the MRI, I had a gradient echocardiogram which was normal for the investigation of microbleeds.

I used to smoke for about two or three years only, and I gave up smoking about fourteen years ago. The severity of this injury and the persistent, debilitating symptoms caused by it, continue to ruin my life and as well as the persistent headaches. Every day I feel the damage done to my brain, and it just feels distinctly different, the effects of the trauma and just a reduced mental capacity which is unquantifiable and a lack of motivation and depression, especially with the persistent pain. It is tough to lift myself up and put this behind me. I take Amitriptyline occasionally. I would be grateful for your response to my questions and your expert opinion.

Hi doctor,

Thanks for your response to my query. The head injury has made me very susceptible to headaches. I initially had a constant headache for five months after the accident. The headaches were mainly in the forehead, behind the eyes, and the upper neck area. I also had significant pain behind the ears. In the last year, there has been some abatement. The headaches I have are episodic. A headache can last for days at a time, and I never know when an episode is going to attack. I did not have this vulnerability to headaches before the accident. This headache can be triggered by exposure to heat or hot environment, this is debilitating as I like the sun, but heat and the brightness of the sun can trigger a headache. I have also noticed that I have to be careful with my diet. If I eat out and the food disagrees with my stomach, it can trigger a migraine headache which lasts for days. The pain is sometimes throbbing in nature and mimics a migraine headache. It can be accompanied by nausea if I have eaten something which disagrees with me. I do not know whether a headache itself is the trigger for nausea or whether heat or food are the triggers.

My vision is fine, I suffer from myopia, but I also had this before the accident. The doctor has said that I have saccadic eye movements which are probably caused by the vestibular disturbance caused by the trauma. I have made an appointment to see the vestibular retraining physiotherapist. I have taken Amitriptyline, and it does help with the pain, but it has side effects mainly drowsiness and feeling woozy. So, I do not like to take it, but I guess I could try it again even for when I am having these episodes. I would be relieved if these spots were caused by normal or ischemic changes and not by the injury because the thought of it being caused by that depresses me and freaks me out. I will try and see if I can send you a copy of the MRI images. I would be very grateful if you could have a look at them and give me your opinion.

Hello doctor,

Please find attached CT brain, which was done one week after the accident, and the MRI scan which was done three and a half years after the accident. I would be very grateful if you could confirm if the findings are due to the concussive injury or if you think they could be attributable to ischemic changes or hardening of the arteries. Are there distinguishing features of these hyperintensities which can help to identify their cause? I also wanted to clarify that the headaches are usually located behind the eyes and in the forehead, sometimes the top of the head and behind the ears and occipital region. It was the back of my head which was subjected to repeated trauma, and the headaches vary in intensity from a predominant dull aching pain most of the time when they occur, to sometimes throbbing particularly in the forehead and behind the eyes or top of the head.

Thankfully, I have felt some signs of abatement in the last year, where there have been times where the headache pain appeared to be subsiding for a period. Stress also exacerbates this headache, but life is full of stress, so it is difficult if not impossible to completely avoid it. My sleep was significantly disturbed by the injury initially, and I had a lot of insomnia at the time of the concussion. My sleep patterns have improved, but I have not returned completely to the sleep pattern. I will keep a headache diary as advised. I think I have pinpointed some of the triggers, like hot and stuffy environments, diet, stress, and staying up late at night. The concussive injury itself has affected my motivation. I do not have the same level of motivation nor sense of well being that I had before the injury. I want to return to work this year, but I need to get on top of this headache problem or be able to manage it when I do so. Amitriptyline 10 mg does help. Will the side effects subside or will they continue while I take this medication? What are the implications of taking this medication on a long-term basis and for the rest of my life? Is it good or bad for me to be taking this medicine long-term?

Hi doctor,

Thanks for reading my scans and for your helpful advice. Your assessment of these scans has helped to further reassure me. I will try the jogging, and see if this helps to reduce my headaches. I will also try the Amitriptyline when required. I will need to discuss the Propranolol with my doctor. I will revert to you and let you know how this treatment plan is working. One further point I just wanted to ask you was, the radiologist said that the brain MRI showed minimal tonsillar herniation, which he has described as not significant. In your opinion, could this have been caused by the head trauma or is this a congenital variation? Would this have a role in causing headaches as well?