Headache and Migraine- Post concussion syndrome
Hello, This is another edition of concussion webinar for the brain and pain. We will talk about pain in the brain and the inner workings of concussion. Ultimately we’re going to run through this seminar or this module at a pretty good pace because if any of you are joining from last week we covered quite a few things and I’d like to kind of stray in. Our objective is to work together to try and understand concussion a little bit better.
My name is Dr. Russell Teames and I’m a board-certified chiropractic neurologist. I speak internationally with Dr. Berry and Dr. Brock, my business partners with BTB health systems. We lecture on various alternative therapies or really interdisciplinary practices that group together quite well. We present on the topics of functional neurology, functional medicine, laser therapy, nutrition, autoimmunity, and specifically a traumatic brain injury which is the concussion stuff we’re talking about tonight. In order to work with conditions like concussion, brain injury, stroke, rehab, autoimmunity, chronic pain, and chronic infection you have to know quite a few things and these particular conditions are really just a summary of a lot of the things that we’ve been dealing with in our clinical practice. So it’s not that we treat any of these individually but we work with them and we address them as we move through each case. In addition Dr. Berry and I each have got multiple seizure patients in the last two to three weeks. I don’t know if it’s because the temperature is going up here in Arizona but these seizure patients have been through a lot of different care tactics, a lot of different practitioners and they’re still dealing with their symptoms. They can’t drive anymore; they can’t do a lot of things with their families. If you guys learn to work with multiple conditions and evaluate and dive into different components of the nervous system and the metabolic system, you’re going to be able to work with us too. Now if you’re a patient you guys know exactly what you’re dealing with, you’ve been to all the different providers, you’ve been to the specialists that look at the big toe on the left foot but they won’t look at the big toe on the right foot. You’ve been to the endocrine specialist and neurology specialist and really your answers are not so much what you’re looking for and because you know that, you need an integrated approach and you hope that these specialists actually take care of you but unfortunately the way that mainstream medical is going, they just have the time even though they’re highly trained in a very specific direction. Whereas the neurologists are trained in on direction, the endocrinologist are trained in another direction, and to have cross talk between them and for them to think of multiple systems at the same time, unfortunately it just doesn’t happen. Here’s the most common concussions symptoms and tonight we’re going to be talking about headaches and migraines, so welcome to concussion education 101.
Why am I still dealing with these post concussion headache symptoms? and how long do I have to live like this? Are we going to have to live like this forever? Hopefully not, if you’re bouncing around the mainstream medical community with typically medications, more than likely they’re going to be managed for a short period of time until the physiology continues to worsen and you’re not addressing the underlying cause and that allows those headaches to kind of creep through those medications so you’re going to keep changing and keep changing your medications in order to live a normal life while in our office at ACNC we really try to promote a bottom line of health so that we address each individual system so that as those improve all your symptoms improve with it like we talked about the current solutions. I kind of got ahead of myself, a lot of it’s medication and these medications like I like to tell my patients they asked me about what they should take for this I say well which organ system do you want to destroy first and it’s kind of a joke but at the same time it’s the truth because it is the underlying physiology which is not operating properly. Most people go to medications because mainstream medical spends the most money getting in front of you so that’s one of the reasons why myself, Dr. Berry and Dr. Brock are trying to get in front of as many people as possible so that we can ultimately heal the world from the ground up instead of through bottle of pills or medication that simply is FDA-cleared at 60% of efficacy to manage headaches or migraines and we want you to know that there’s a comprehensive approach from nutrition to water consumption to acupuncture to love to learning more stuff, to having more friends, to having a good happy relationship, to having a good healthy gut. The ways to rehab the brain and the body is almost endless. I’m even learning things every day that can help you patients that I haven’t been able to help before that have fallen through the cracks and unfortunately at the time they didn’t have any other options and so now as we learn new things that we’re able to pass them on to our patients so today what are we going to learn what a concussion is and the 3 reasons (not all of the reasons) but 3 reasons why your head hurts after concussion. We will talk about the neck the eyes and the brain gut access and then how to heal with the brain and body and then again we’ll talk about a special offer at the end. So what is concussion is a type of traumatic brain injury or TBI caused by a bump, blow or jolt to the head or by a hit to the body that causes the head brain to move rapidly back and forth this is called a coup countercoup type of injury. This sudden movement can cause the brain to bounce around or twist in the skull creating physical and chemical changes and damaging the brain cells or what is called a diffuse axonal injury. This was just taken straight from the Center for Disease Control or the CDC and so ultimately what we’re looking at as it’s concussion is a brain injury, it’s not that I have to hit my head, it’s not I have to blackout, it’s not I have to lose consciousness, it’s not I have to have brain swelling, it’s not I have to have blood of my on the brain. It’s simply a an event that occurs that allows your brain to become injured to the point where the cells can burst they can basically create so much inflammation in the brain that your brain stops talking or your nerve cells stop talking to each other and there becomes like a fog between them and their connectivity becomes less and less to the point where those networks stop performing their job which is going to be things like pain and abyssion providing stability with your balance systems, your ability to sense things properly, to hear properly, to pay attention, to sleep well. Those are all the different things or systems that break down in concussion and our job is to basically rebuild them or to put Humpty Dumpty back together again. There’s a neuro-metabolic cascade of inflammation following a concussion so one of the first things I discuss with people with a concussion is this exact flowchart what I talk about is when you hit your head it doesn’t necessarily matter right where you hit it if you hit it on the front right side I talked about coup and countercoup so the front right side the back left side might be the two areas that are highly impacted based on the physical impact or the whiplash. As I transition from that I start talking about the midline system so your brainstem, your vestibular system things like that but then I also move into as though nerves break down and break apart and start spewing their inflammation this is exactly what happens so your mitochondria stop creating energy that allows breakdown of the cell energy systems in and out of the cell as that happens things become more positive in the cell and they start to fire off more than they should naturally as a result we get more firing and more calcium influx or sodium influx and then calcium influx and that calcium basically leads to more cellular degeneration as your cells start to degenerate more and more they start producing more free radical activity and inflammation inside the cell which then creates damages to the DNA and as that DNA that codes for structure proteins neurotransmitters and ultimately cellular life worsens then your mitochondrial function continues to degrade and then you start the entire process over again so really you can think about this as a down as a snowball rolling downhill unless you provide intervention whether from a neurological side, a structural side or a metabolic side to heal this brain. We talked about the midline structures getting hit which is really like doing a everybody out there and in digital amp tape makes a fist you wrapped your hand around your fist and then you pretend like you hit it and you get a coupon Turku. What you’re going to feel is in the areas that you’re squeezing that’s where you feel most of the stretch and that is actually your brain stem so we’ll talk about that coming up later here but I want you all to understand that if you don’t only get injured where you hit your head it’s the stock or the brain stem that holds the brain to the spinal cord that also becomes injured so today we’re going to talk about the three reasons why your head is hurting the neck the eyes and the brain get access or three of the reasons why your head might be hurting so the cervical spine is composed of seven vertebrae as long as well as multiple muscle groups we have very deep intrinsic muscles that actually move the spine very intricately and then we have larger muscles which actually do more of the large movements so say flexion extension whereas the deep little muscles think of them as like a little centipedes hands they move so quickly and acutely to be in the exact spot at the exact time those are the ones that actually stabilize your spine so they’re even for their even deeper to things like this so this is going to be some of your deepest musculature and this is going to be some of your trapezius muscle or SEM or sternocleidomastoid which can produce trigger points for head pain while the deep structures actually provides stability for the head on the neck so there’s multiple layers involved with head and neck pain following a concussion so you must be finding a practitioner that talks about head pain neck pain the deep muscles of superficial muscles as well as the eyes and the brain get access if you really want to heal from a concussion next we’ll talk about these sub occipital muscles so these sub occipital muscles are actually dictating the position of your head in space based on your vestibular system so no muscle to my knowledge really moves unless a nerve talks to it so that means we have to talk to the nerve or get understand what the nerve is telling the muscle and that nerve is only a trans do transmitter for what the brain is telling you so these sub occipital muscles are highly innovated with nerves they send a lot of information to your brain based on where your head and neck ISM is in space as well as it receives a lot of information from your brain and your brain stem to tell it what to do based on all the sensory systems that your brain is receiving the tone of the muscles is dictated by this distiller system up in the brain and that is one of the very immediate things that we start to look at when people tell us that they’ve got pain right along the back of their skull or they’ve got muscles that are tight that are impinging this nerve up into the back of the head one of the first things I actually look at is not the neck because they’ve already been treated at the level of the neck by another chiropractor, a PT, a massage therapist, and acupuncturist and if they’re still experiencing problems than the neck itself was not the problem so I have to look up into the area of the vestibular system in order to tell the neck what to do so most people are currently working on the spine itself that’s what most practitioners are trained to do and so with us we have a little different approach but just so you know the current medical approach is like this let’s say we get a concussion we get on medications for all the pain all the nausea you know concentration sleep so the next thing we know we’re on four or five six different medications to cover up the symptoms when there’s still an underlying foundational problem at the level of the neck to the eyes of the brain got access most individuals that come to see me are still on pain medications still or on or have taken muscle relaxers have gone through bouts of physical therapy whether it be vestibular therapy or physical manual therapy they’ve tried massage therapy they’ve gone to multiple different chiropractors they’ve had trigger point injections and then you start getting into branch blocks radiofrequency ablation and things to kill off the nerve from sending the signal of pain you know if you were to just if my hand hurt what I want you to cut my arm off or what I want you to treat my the problem that’s either in my hand or my brain that’s telling me my hand is hurting I’d try to either treat my brain or my hand to make sure that problem goes away before I have my arm so I had these conversations with my patients to say let’s try this before we try that I understand you’re in a lot of pain but if this doesn’t work in a certain amount of time and that’s dictate per case then I say go ahead and we try that most of the time we don’t have to do that a lot of times that’s actually happened before they get to me and then a lot of a lot of headaches and migraines deal with Botox is a is really a neurotoxin you know botulinum toxin so Botox is really a neurotoxin for the nerve cell what it does if this is a muscle that contracts here the nerve that talks to that muscle is poison so that it now can’t talk to that muscle anymore so this muscle goes flaccid so the same signal is being sent through the nerve more than likely from the vestibular system it’s just not making connection and then usually after about 90 days that reconnects and so you start getting the same problem so most of these people who get Botox will see them going in every three months to get an injection for the same exact problem while the underlying issue is still there and that’s what leads us to the underlying cause now in some cases the alternative therapies are really no different depends on their level of training but most chiropractors most physical therapists most acupuncturist and most massage therapists that are going to see somebody after concussion are strictly working on the injured area or the area of complaint so physical therapy does often a lot of strengthening and stretching chiropractors adjust acupuncturist poke massage therapists really get in and dig into the muscles so as you’re going through your journey of post concussion rehab ask yourself is there a problem with my neck probably is there a problem with my eyes in my vestibular system most likely and then am I starting to experience any GI complaints or did I have any complaints prior to this injury that are maybe impacting the reasons for me not recovering so we just so next up we’re going to talk about the eyes so we just covered the neck now we’re talking about the eyes the eyes are the window to the nervous system and we say that because there’s so many connections here this is simply the vestibular system that we’re looking at just based on this we’ve got multiple connections to the entire brain and body so your vestibular system gets damaged in a concussion remember we’ve talked about how tight it is here on the brainstem as it moves it stretches this area and this is the area that gets damaged when that vestibular system gets damaged you lose the ability to fixate on the target track a target locate new objects and your head neck interplay or that way that your head moves on your neck or your body moves in relation to your head becomes disoriented and so if you’re the stimulus system is not being addressed during your rehab from concussion I would highly suggest seeking somebody to at least Co manage that that rehab if not finding somebody that’s been trained in concussion rehab in addition to the vestibular system that controls the eyes and the cervical spinal cord for adjustment of head position we’re going to be looking at autonomic centers cortical projections as in pain and the brain get access or the vagas nerve so here’s an example of a test that we perform after a concussion so we perform a video miss Dagmar fee which is infrared goggles that go over the eyes that actually these little crosshairs here they find the dark part of the pupil and they center themselves on the pupil there’s a target on a screen that jumps back and forth at random and the patient is supposed to track it this blue or green line here is the actual target and then you’re going to see this grey line as the patient’s eyes so it just as you’re watching this this square here or rectangle or a 90-degree curves are not being followed very well by this patient down here it shows how fast their eyes are moving anything in the gray area is not what we want so this person seems quite a bit slower to the left and the right then this shows us the accuracy which it’s more accurate to the right than the left here and then we look at what’s called a latency or their reaction time this reaction time has been shown with cicadas or fast eye movements to slow down during a concussion so what we should see here or what we typically see here and anybody from the age of about 15 through maybe the 50 60 year old age range is 200 or 100 90 milliseconds up to about 230 milliseconds so if I see anything slower than that and this year I believe says 313 that’s going to be much too long of a reaction time and that’s indicating that my frontal lobe is not reacting to that visual target being moved so my eyes try to re-fix eight to it here we have saccadic eye movements and traumatic brain injury we talk about TBI patients saccadic eye movements remain delayed within three weeks post injury these patients also showed persistent symptoms or no improvement on their neuro psych evaluation testing so if you’ve got prolonged symptoms or headaches or concussion headaches or vestibular issues or dizziness or sleep issues these symptoms are showing to be persistent when the eye movements are not normalizing after concussion here’s more research to show we’re going back to 2009 2016 2015 there’s a lot of research out there that’s showing that if you’re not looking at the eyes the brain and vestibular system are are really a lot of that underlying problem of dealing with headaches and things like that this is our video nystagmus via equipment this is the VNG or infrared cameras here they project down onto these little glasses which pull up the eyes here and then we track the system here’s our balance testing which we’ll talk about probably in different modules or webinars but we do eyes open eyes closed and we can do different head and neck positions to determine or cervical a challenge someone in order to determine if their how much their neck is playing a role in their issues so it’s actually very cool to see the outcomes after you do head neck therapies and Oculomotor therapies to stabilize the head on the neck and then you recheck those and they’re balanced completely improves and that shows along with all of their symptoms too why do we measure the eye movements many patients with brain health issues have issues with eye track it’s plain and simple by assessing these eye movements we are able to get a much better insight into the function of their brain or to say in a different way to why their brain is dysfunctional so here is a quick little video of a VNG test so what we’re seeing is abnormal eye movements the eyes are drifting slowly to the right and they’re quickly moving to the left side so this is telling me that that patient has this tubular dysfunction so if I just treat their neck they’re probably most likely not going to get better so what we’re looking at here is the same patient don’t worry about the crisscross ties here but what we’re seeing is an absence of those quick re-fix actions here’s another patient that I asked to turn their head to the left and then I asked them to turn their head to the right anytime I have them move their head with their neck they get a massive convergent spasm and that gives this patient a feeling of dizziness as if they’re spinning as well as neck pain right in the back of their head now while we’re doing this I want you to just stare at your nose cross your eyes and stare at your nose and you tell me how long it takes for the back of your neck to tighten up it’s not very long especially patients that are symptomatic if you have a patient that’s got headaches, dizziness, nausea, anything like that if you have them cross their eyes to look at their nose they’re going to have exacerbations and their symptoms like that so be careful do but if you need to prove a point to that patient how their eyes are involved in with their head or their neck pain then you’re going to maybe want to try that just to show them how much the eyes are involved now for the patient or the person that’s dealing with these things these headaches and dizziness and knowledge of dealing with post concussion symptoms what you’re going to want to do is just simply take a look at your nose and if that creates problems for you, you’re going to need the stimuli rehab that’s very specific for you now most patients in my experience and just saw a new patient today that’s got unilateral vestibular loss that has positive findings on our initial testing sequence on the B and G and they just gave her the exact same exercises they give everybody else I could line up ten patients that came from a PT’s office and they’re all going to have the same treatment so it doesn’t make sense to me to give everybody the same treatment if every one of those patients has a different problem so we’re going to have to go through that evaluation process identify that problem maybe tweak that exercise a little bit but make it specific for them maybe give them a right head movement followed by the same gaze stabilization pattern that they did to try to ramp up their vestibular system to create stability in their eyes so that their head and neck can relax just an example but we’ll walk through a case study here in a little bit just to show you the outcomes that we can have so next up okay so we talked about the neck we talked about the eyes and next up we’re going to talk about the brain gut access so the brain got access or brain got HP axis is a complex being what’s funny about this is if you think about the brain and the gut there’s really only one main nerve that connects the brain to the gut but that one nerve is called the vagas nerve it connects to the GI system to the liver to the lungs to the spleen to the kidney to the adrenal glands it connects to everything it controls our blood flow as you can see here it controls different aspects of endocrine system or endocrine function and here’s your vagas nerve we’ve got one big nerve it’s not like a far-reaching nerve it’s like a it’s almost like a line that grows up the side of the house or a wall it just keeps going it innervates almost everything so here you can see that vagas nerve just working its way down touching the heart touching the stomach the liver the colon the kidney the spleen the lungs it really connects with everything and so if you think about it one of the really the consequence of events or process of events here you injure your brain the vagas nerve goes from the lower brainstem down towards the gut as it goes down you’re basically going to potentially start having changes in blood flow because it innervates your vascular system or cardiovascular system you may have changes in heart rate or rhythm right like you may stand up and start to get dizzy and you never got dizzy before because that natal system or really the NTS is not regulating that fat system so well this is both for doctors and patients out there by the way I know we’ve got a lot of doctors and a lot of patients watching this so I’m trying to speak to both of you at the same time now as we get towards the stomach we have what’s called HCl or hydrochloric acid that’s in our stomach at a very low pH to help destroy bacteria break down foods anything so that we can basically save ourselves from pathogens and start that breakdown of food process so now if our Vegas system is not working we’re not going to produce as much hydrochloric acid so we’re going to be now exposed to the opportunity of developing a gut pathogen that may not supposed to be there may-maybe isn’t supposed to be there excuse me it’s been a long day and so right out of the gate we become open to the opportunity of becoming a detective at the level of our gut even if we’re not exposed to pathogens in our food or in our environment so things that live in our mouth and our nose can make its way down the throat through the stomach if it’s not peeled off by the hydrochloric acid we can have changes in our phases 1 & 2 of liver detoxification one of the ways to measure this is on a stool test where it has beta glucuronidase that’s more of a phase 2 liver detoxification so you can detoxify things toxins and things in phase 1 but it doesn’t get prepped for being removed from the body in phase 2 so what happens is it basically just circulates all those toxins continue to circulate you can lose motility in your gut you can become constipated you can actually get increased firing rate so you can develop diarrhea you can have issues with kidneys water retention spilling glucose that’s more of a different condition and then you can have immune system dis-regulation with splenic activity so here in 2017 just late late last year around Christmas to us use me Thanksgiving time there’s a bidirectional gut brain macrobiotic access as a potential nexus between traumatic brain injury inflammation at disease long story short this gentleman here who works down at the University of Arizona is really diving into how the brain and the gut talked to each other and the effects it has on the gun itself so now we’ve got researchers really jumping on board with some of the things we know as clinicians to be true and they’re really just proving a lot of this stuff and the research that is that we’ve been doing for quite a while so we hope that it continues to evolve and more practitioners become interdisciplinary in their applications so that they can help more people so that for instance in Arizona Dr. Berry and I are not one of the few practitioners that receive these post-concussion patients that are really at their wit’s end and other practitioners seem to not be able to work through it and check off all these components on the list and I’m not saying that we do but we’ve got a pretty good handle on it right now there’s we can’t help everybody and I will ever claimed to help everybody but with the cases that we do get you know the worst case scenario to be honest is I get to a certain point with a case and I’m able to refer to Dr. Berry which I’m actually going to share with you what this is exactly what we did with one of our case studies so no practitioner knows at all and I think if you find the right practitioners to have on your team as the patient that’s the best thing for you so here’s a just a quick run-through of the brain gut access as you get injured that’s considered a stressful situation it’s going to light up certain areas of the of the brain which are going to change your ability to produce blood flow to the brain and the gut and at the same time your inflammation is going to rise when certain things are when really when you remove those stressors or you heal the brain and you improve the function of the neurological connectivity as well as the gut your brain starts to work like it should the prefrontal system works we have great behavior we have great relationships our stress is reduced we’re able to meditate we’re able to sleep we don’t have headaches we don’t have I ate we don’t have dizziness and then we have proper blood flow to our brain and gut as well too as well as to all of our other organs so again I maybe run it through this kind of quick but I want it to be a general overview because if I dive in too deep I may lose some people and it may not apply to you if you’re the patient watching this or a potential patient watching this I want to make sure that we cover enough things that makes sense to you so that we can actually have a conversation in the future about how we might be able to help you so today we’ve covered the neck the eyes and the brain got access so far and really what I want to talk about next is how do we begin the process of healing your brain if you are looking for someone to try and help you through this post