She was just a 12-year-old athlete when it happened: A blow to the head from a lacrosse ball left Marianna Consiglio with a severe concussion. Recovering from the brain injury took more than a year and a half, but it turned out that was the easier part.
Marianna and her family hadn't figured on debilitating headaches that often left her unable to function. The headaches lasted four years through every imaginable medical treatment. Nothing worked.
Then Marianna's mother, desperate for an answer, ended up on the Internet and came across a doctor she hoped could help. Last December, the Connecticut family traveled to Washington, D.C., to MedStar Georgetown University Hospital, where Marianna underwent outpatient surgery.
Marianna, now 16, was understandably skittish.
"I was almost at the point where I wanted to give up," she said. "I was really nervous about having surgery, but there was no way I couldn't try it."
On Dec. 15, Georgetown plastic and peripheral nerve surgeon Dr. Ivica Ducic operated on Marianna's occipital nerves, which he found were inflamed. The occipital nerves begin in the spine in the upper neck and run through muscles in the back of the head and into the scalp.
Ducic performed decompression surgery, shaving a tiny section of the muscle around the nerve to help free it.
"It's like unbuttoning your shirt and tie", Ducic told ABC News. "It's freeing up that area, enlarging the space around the nerve."
That night, Marianna spent the night in a hotel near the hospital. Her mother still remembers her daughter's first words the morning after the procedure.
"I don't have a headache," Marianna told her mom. "Zero. Zilch."
It was the first time she had been pain free in years.
"This has been a life-changer," said Dr. Kevin Crutchfield, a concussion specialist who began referring patients with severe headache pain to Ducic just over a year ago.
Crutchfield, who runs a concussion program at Sinai Hospital in Baltimore, said this type of surgery has been used successfully in whiplash cases, but is not common practice with concussion.
"I've come to appreciate that a head injury does not live in isolation from neck strain," said Crutchfield.
Headaches are common following a concussion, but they are usually blamed on the brain injury itself. Crutchfield and Ducic believe the blow that causes the concussion can also leave some patients with severe neck strain, almost like a whiplash injury.
Some patients get relief from steroid injections in the occipital nerve. Patients are also often put on pain killers.
"Patients are snowed on medicine," said Crutchfield, "or worse, told they are psychogenic headaches and they need to see a psychiatrist."
That's what doctors suggested to the Consiglio family -- that Marianna either was suffering from migraines or stress.
Ducic thought otherwise.
"He went in there," said Marianna, "and he saw something physical inside my head that he could fix. That was really reassuring because all the doctors had said nothing was wrong and it was all in my head."
Her mother, Laura Consiglio, agreed.
"I am 100 percent convinced," she said, "that the [concussion] injury was a catalyst for this nerve damage."