"Concussion is one of the most underdiagnosed and misdiagnosed conditions. When we talk about concussion, it's important to note that this doesn't have to involve a hit to the head. Concussion can occur from a whiplash-type injury, such as in a car accident, a hit to the body or simply falling down the stairs. So when I speak with patients, there is a high probability that prior to the onset of migraine, there was a concussion, or car accident, or some type of head trauma about 18-24 months prior. If it was a significant trauma, that time frame could be reduced a bit. I usually get a stunned "how did you know?" response that makes me look like a mind reader.
Think of it as if you were to throw a rock into a pond. The biggest impact is where the rock lands, but there is a ripple effect all around it. The areas directly adjacent to the rock will be most affected, and that effect will degrade as you get further away from where the rock landed. This is how concussion impacts migraine.
The areas of the brainstem that are damaged from the concussion make the areas that are already 'weaker' and associated with migraine become even more damaged. Therefore, it will take less and less stress in order for that person to have migraines. There is a concept known as diaschisis that helps to explain why it takes time for a head injury to really impact migraine. Diaschisis is defined as "the changes of structural and functional connectivity between brain areas distant to the lesion". Any area that is connected to the damaged area will begin to show damage over time due to the lack of activation. So if neuron A supplies neuron B & C, and neuron A dies off, neurons B & C are now getting less activation, and over time will begin to show signs of damage as well.
The good news is, you have billions and billions of neurons, so if you lose a few, or even a few hundred, you may never notice. However, if this continues over time without proper treatment, you can see how 1 or 2 years down the road you would start to notice the effects of diaschisis. This is why we specialize in post-concussion syndrome as well as migraine, they go hand-in-hand. Even if you haven't had a concussion, many of the treatment modalities that would help rehab a concussion are extremely effective in treating migraine.
I can't tell you how many people I've talked to that have been diagnosed with migraine, who actually had post-concussion headaches. This leads to improper treatment and long-term effects that should have been addressed right away. One of the main reasons that this happens is due to migraine and post-concussion syndrome sharing many of the same symptoms. Another reason is due to the lack of objective testing to properly diagnosis migraine or post-concussion.
If you suspect that you've been diagnosed incorrectly or are having symptoms similar to what I've described, I'd be happy to spend 5-10 minutes over the phone with you to get you the best info. Simply contact my office 805-962-1988 and mention this newsletter. We would be happy to get you the information you have probably been searching for."
- Dr. Adam Harcourt