Doctors Use Surgery to Relieve Lingering Concussion Pain

Headaches can linger long after the initial blow.

May 2, 2013, 4:46 PM

May 3, 2013— -- 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."

The Centers for Disease Control estimates that more than 170,000 children and teens end up in the emergency room every year with traumatic brain injuries, including concussions, caused by sports or a recreation activity. Those numbers have jumped 60 percent over the last decade.

Children are more likely to get concussions from a blow to the head than adults, and take longer to heal, according to the CDC.

A neurosurgeon who works in the brain injury program at Boston Children's Hospital believes only a small percentage of concussion patients suffer the long-term incapacitating pain that Marianna did. Dr. Mark Proctor said doing nerve surgery for headaches is well established, but he had not heard of anyone "doing this type of surgery for a post-concussive type of headache."

"If [Ducic is] right, it could be a real potential boon for these patients," said Proctor, who cautioned that he would like to see the evidence of its efficacy. "It's the sort of thing you want to approach carefully and be certain he is truly correct."

Crutchfield and Ducic are still working to publish their data, but say the procedure has now been done on more than 50 concussion patients, most ages 17 to 25. Ducic says the patients must meet strict criteria: three to six months of headaches, treatment by a headache specialist, tests to ensure nothing else is causing the headaches, and a nerve block to see if that helps, before he accepts them for surgery.

He's passionate about helping these concussion patients.

"Young people with post-concussion headaches shouldn't just be given drug after drug every three months," he said, "and they shouldn't be told your headache is due to the concussion; we can't do anything."

Excruciating headaches also brought 18-year old Christian Stephenson to Ducic. A soccer and lacrosse player, Stephenson had suffered three concussions over three years, but it was the last one in his senior year of high school that brought the throbbing, burning pain in his head. The headaches were so bad that he had to drop out of college just after starting his freshman year.

Stephenson had his surgery last October. For him, it took about four weeks for the headaches to clear completely. He was able to return to college this winter.

"Before, my entire day revolved around headaches," said Stephenson. "Now, they are one of the last concerns I have."

Concussion doctor Crutchfield is a true believer.

"We're getting kids back to school," he said. "I've gotten elite athletes back to competitions and regular folks back to work. It's a game changer."

Marianna couldn't agree more. Four months after her surgery she got to do something she never would have dreamed of. She got to attend her high school prom and was able to stay the whole evening, without a headache.

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