Prolonged Post Traumatic Headache after Repetitive Sports Related Concussions

Abstract

Background: Human and animal studies have shown evidence of pathological brain changes as well as increased cognitive dysfunction with repetitive injury. Case Presentation: We present a case of prolonged persistent post concussive symptoms after a mild concussion, in the setting of multiple prior concussions. In this case a 29-year-old man presented for a moderate persistent daily headache for one month after a minor injury due to a branch hitting his helmet while mountain biking. He had previously sustained one non-sports related concussion with loss of consciousness as well as at least two other sports related concussions in the past five years which caused one-to-two-week intervals of headaches and dizziness. At initial evaluation he reported persistent photosensitivity, difficulty working on screens, as well as intermittent lightheadedness, insomnia, irritability, anxiety, and anhedonia. Symptoms of headache completely resolved over the course of three months with serotonin norepinephrine reuptake inhibitors (SSRI) management, but he reported some persistent anxiety and depressive symptoms. Conclusion: This case report highlights the long-term impact as well as the need for more specific return to activity guidelines for patients with multiple prior concussions.