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My Child was hit in the head – What should my doctor do?

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After a blow to the head, it’s certainly wise to see the doctor. The blow could be from falling, from a sporting event, from a fight, from an accident – but whatever it was, it can result in brain damage and needs to be taken seriously.

Many organizations have a specific process that they want doctors to go through when seeing a patient who may have a concussion. An excellent example of this is the Concussion Algorithm from Hamilton Public Health Services in Hamilton, Canada.

You can download the one-page document for yourself using the link at the bottom of this article. But here are some highlights.

Concussion Algorithm

If there are certain red flags after or even before an examination, the patient is advised to go to the emergency department immediately. Red flags include loss of consciousness, slurred speech, or ongoing vomiting.

If the red flags aren’t present, but there are other symptoms (such as headache, dizziness, irritability, or sleeplessness), doctors need to check for factors which may predetermine the patient to more serious problems. These issues will help doctors decide how much rest/recovery time the patient needs.

If no symptoms are present, patient may return to normal activities (with caution, I would add. Symptoms may show up later, or another blow to the head may make matters worse.).

It’s worth your time to have a document like this handy, particularly if your child is heavily involved in sports, so that you and your child will know what to expect.

Concussions can be very serious, and can lead to lifelong problems. Taking them seriously right from the start is vital to your child’s health.

To pick up the document, see Concussion Algorithm [Important: Original link no longer available. This is an archives link.]. If you’re actually in the Hamilton area, you’ll notice that there is a second page with emergency numbers and addresses.

Sleep Master Sleep Mask

Sleep Master: A New Kind of Face Mask to Help You Finally Sleep

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We’ve talked a lot about face masks (“eye pillows”) here in the past. Having a way to block out light is quite often a life-saver for someone having a migraine attack.

Sleep Master in actionThere is one face mask that we haven’t talked about, and it has become very popular. I wanted to find out why, so I did a little investigation.

Out of almost 2000 customer reviews on amazon, the Sleep Master has a solid 4.1 stars out of 5. That’s very high for that number of reviews, considering that a face mask really is a very personal thing – there is no face mask which is perfect for everyone.

Now I haven’t yet tried the Sleep Master, but after reading reviews and watching some videos (I’ll include a couple below), I can tell you what customers are saying about it.

The Advantages of Sleep Master

Here are some of the advantages that this face mask seems to have over the competition:

  • Lightweight, and yet covers well. For a migraine patient, blocking out light is key – every BIT OF LIGHT. The design of Sleep Master is unique – it fits well over your nose (no matter how big or small it is!) and covers a lot more area than a typical eye pillow.
  • The wrap-around design keeps the mask over your eyes. I’ve tried quite a few face masks, and let me tell you – they slip and slide all over the place, especially if you’re tossing and turning in bed. Sleep Master velcros to itself, and so is not as likely to slip.
  • “Sound muffling”. Although I ear plugs are included with your purchase, this sleep mask muffles sound without them, because it goes over your ears. If you don’t like the feel of ear plugs, or you want to be able to hear some sound if necessary (for safety reasons), but muffle it, this is a great option.
  • Washable and durable. Unlike some of the more or less disposable sleep masks I’ve used in the past, Sleep Master can be washed and is high quality. A customer survey indicated that even with daily use it will last for many years.
  • Adjustable pressure. This is key for migraine patients. Some of us like a bit of pressure during an attack, others want to keep it at a bare minimum. Because of the way the velcro attaches, Sleep Master is adjustable. Nice!
  • Can even be used with CPAP.

Because Sleep Master wraps around your head, those with long hair actually claim that it keeps their hair style in place while they sleep. That’s something I won’t be able to test – but that’s the word on the street. 🙂

Sleep Master Sleep MaskNow, you may be wondering if this will actually work well for migraine patients – I was curious too. So I checked out the reviews again. The answer – almost every migraine sufferer who reviewed Sleep Master gave it 5 stars – even better than the overall reviews!

Impressive.

Where can I get Sleep Master?

I’ll leave you with a typical review, and the two videos I mentioned (for a good idea of what the mask is like, check out the first video).

Sleep Master is available in the USA at amazon.com, and in the UK and some international locations at amazon.co.uk

Love this sleep mask. It is really comfortable and blocks out all light. Between my work shift and getting migraines, I have a lot of trouble sleeping and this has helped me immensely since I started using it. I have tried a few others with the elastic strap on the back that would pull my hair or slide off my eyes whenever I would move which would wake me up after I had actually fell asleep. The adjustable velcro strap allows me to loosen or tighten it depending on how I am laying and whether I have a headache or not. I have tried to use every style of earplugs but they would not stay in my ears and the ones that came with this mask do, even if I am not wearing the mask. The mask just gives a little extra holding power to keep the earplugs in. It is silky and slightly padded so when I roll around it is still comfortable and doesn’t stick to the pillowcase. I was concerned about the cost because others that I have tried were so much cheaper but that is just what they were, cheaper. This works and is comfortable so I have to admit that the cost of this would have been cheaper had I bought it before trying all the cheap ones that didn’t work or I wouldn’t use because they were so uncomfortable. My only regret about this mask is that I didn’t purchase it a long time ago. (Dawn on amazon.com)

Yep, this one is going on my wishlist!

The “other” ingredients in your pills…

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Could it be that all those “extra” ingredients in your pills – or even skill creams or injections or …. whatever it may be – are causing headaches?

Recently I received an email from Jonathan in Turkey, who explained how he has seen a significant reduction in migraine attacks since going on a gluten free diet. The attacks that he did have he feels were brought on by an extra ingredient in a medical drug – a drug for migraine, no less.

Those extra ingredients...Many people don’t realize that there are a lot of ingredients in medications beyond the “main” “active” ingredient. The same goes for supplements and vitamins.

Now most people who are allergic or sensitive to something in particular are going to watch out for those ingredients – looking for labels that say, for example, “gluten free”.

Of course, recently even those labels have been questions in the USA, where allegations were made that some “gluten free” supplements contained – gluten!

All these medications have these extra ingredients – known as excipients. In the industry, the myth was discarded long ago that these ingredients are “inactive”. The reality is that these ingredients can indeed affect your health.

Avoiding “Excipient Reactions”

An article (Pharmaceutical excipients – where do we begin?) in the Australian Prescriber, an independent journal of drugs and therapeutics, offered some suggestions for health professionals who are trying to help patients avoid excipient reactions.

First, watch for those at high risk – ask about allergies, and about other medications and supplements that the patient may be taking.

With this information, you can check the excipients that the patient is already exposed to. Anything they’re allergic to? Are they taking multiple medications/supplements with the same excipients? Are there known side effects to these?

You can also find possible problems by experience – does a different brand of the same medicine work better or alleviate symptoms?

How do I find out which excipients are in my pills?

First, check the packaging. Look on the bottle, or on the paper that came with your medication or vitamin. Take note of what ingredients are there.

If you can’t find the information that way, you can look for the manufacturer’s website, or find national registries (for example, this one in Australia. A site in the USA that may help is RXList).

To find out more about the excipients you’re consuming, look up the name here. Each link will give you basic information. Then you can search online to find more information.

Remember – if you can eat it, someone can complain about it. Just because someone in a forum says that they think that sodium stoerate copolymer 2 is making them sick, doesn’t mean you should throw out all your supplements. Take your time to do your research, talk to your doctor, and if you’re concerned try changing to a different brand or even stopping the supplements for a couple of months (I did say “talk to your doctor”, right? Don’t just stop taking what your doctor has prescribed without talking to her!).

(Side note: online forums are very useful – I’m just saying don’t take one person’s story as a universal truth)

Again, although excipients seem to be generally safe, people in the industry and health fields recognize that these ingredients can cause problems, especially due to mislabelling but also because of sensitivities and allergies that some people have. Just be aware of what you’re putting in your body.

Also see: Q&A: How can I find out which ingredients are in a medication? (USA)

Do I need an MRI to diagnose my Headache?

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Over the past few years, the number of CT and MRI scans for headache symptoms have been increasing. The increase has concerned experts, and has led to campaigns to stop scans that aren’t needed.

Unneccessary scans can lead to direct health risks (particularly in the case of CT scans), they can lead to more unnecessary tests, wasted money and time, and in almost every case they will not lead to any new treatment.

MRI for Headache?But there are times when MRIs (magnetic resonance imaging) should be requested. Along with concerns that too many MRIs are being done is the concern that doctors aren’t asking for them at the right time. A recent study in the USA indicated that many doctors may not recognize the “red flags” that warn doctor and patient that more investigation is needed.

So – the big question – should I as a patient be asking for an MRI? Or, as a doctor, should I refer a patient to have an MRI?

The answer is complicated. And the decision needs to be made with a lot of knowledge of the context of each patient.

Before a decision is made…

What needs to be done before a final decision is made? First, a proper and complete neurological examination. This means a lot of questions from the doctor to the patient. When did the pain start? What other symptoms are you experiencing? Are the symptoms temporary, or permanent? Are they getting worse?

This will also include medical history questions, and possibly (ideally) family history questions. Do you have family members who suffer from migraine? What other conditions have you been diagnosed with? Any childhood diseases?

One great example is visiting the doctor with a new headache. A new headache is often a good reason for an MRI. However, with a family history of migraine, and a history with related disorders, and symptoms consistent with migraine, an MRI won’t be necessary. But if there is reason to suspect another cause for the headache, or certain symptoms are present – an MRI will be called for.

Other important factors are gender and age. For example, getting headaches for the first time when you’re over 50 is a good reason to consider an MRI.

So even before we look at the warning signs, we have to assume you have a qualified doctor who is asking the right questions.”Red Flags”So what are some of the danger signs that may mean you should be getting an MRI? Here are a few examples.

  • As mentioned above, a new headache (a new type of headache in someone who doesn’t generally get headaches), especially if symptoms have appeared suddenly, is a good reason to call for an MRI.
  • A progressive headache. When symptoms get continually worse, an MRI may be required.
  • Exertion headache. Any headache that seems to come with exertion, such as straining to use the toilet, a sex headache, a headache you get when exercising. This is specifically a headache that appears directly because of exertion – most “exercise headaches” that come from moderate to intense exercise are not the same thing, and will probably not need an MRI for diagnosis.
  • Headaches that change with head position, or that show signs of raised or lowered intracranial pressure. This can be tricky, because a feeling of “pressure” or “fullness” is common in migraine. But hearing sounds, a change with head position, a worsening feeling of pressure – these things may indicate another problem, and an MRI may help with diagnosis.
  • Certain other symptoms, such as neuralgic pain. There are too many other possibilities to list, but one example is shooting, sudden pain along certain paths, certain vision or hearing problems, changes in behaviour and weakness.

And then what?

Even if an MRI is called for at the right time, it’s very likely that it will not show anything and simply confirm that you have a headache condition such as migraine. However, more tests may be called for if something shows up.

Many symptoms that look like something else are actually migraine. Migraine can look like stroke, or brain tumour, or sinusitis. But in certain cases it is worth it to investigate further.

If you are a doctor, this is worth taking at least a few minutes to study further. An excellent place to start is the MedScape article MRI in Headache by Dr. Michael Eller and Dr. Peter J Goadsby.

For more information, check out the links above, and also Most headache-related brain scans aren’t needed from Harvard Medical School and Imaging: Do I need an imaging study for my headache? from the American Headache Society Committee on Headache Education (ACHE).

Dysautonomia and Migraine

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Yesterday we took a quick look at dysautonomia symptoms and the relationship between dysautonomia and migraine. Today we’re going to talk a little about what you can expect, and what you can do, if you have both migraine and a dysautonomia disorder.

Migraine and DysautonomiaYour prognosis will vary drastically depending on what type of dysautonomia you have been diagnosed with. As we mentioned yesterday, some types of dysautonomia are progressive, and can shorten your life. Other types are chronic, and never go away completely. Some resolve on their own. Some are severely disabling (limiting your ability to get out of bed), while others are mild.

So it is very important to get a specific diagnosis, and to talk to a specialist who can guide you. There is help available, but you will need patience to find what works and to improve your quality of life.

Lifestyle Changes

In general, you will fight dysautonomia symptoms with changes in lifestyle. Diet changes can be key – drinking plenty of water, increasing your salt intake, avoiding sugar, artificial sweeteners, alcohol, and caffeine, and eating several small meals during the day, for example.

Exercise is important, but can be very challenging for patients with dysautonomia. A gradual increase in moderate exercise is usually planned.

As with migraine, an overall healthy lifestyle will go a long way. But there are some specific changes you may need to make depending on your specific diagnosis.

Other (non-drug) Treatments

Other treatments may include wearing compression stockings and elevating the head of your bed. Sometimes supplements are recommended.

Drugs: A Balancing Act

Sometimes drugs are used for dysautonomia as well, but this can be a very challenging balancing act.

For one thing, some drugs that you may be familiar with can actually lead to dysautonomia, such as some drugs taken for high blood pressure or depression – and yes, drugs for migraine. You may need to take a medication which will contribute to your symptoms, but hopefully you can find something that will have only a small impact (I’m talking about changing to a different but similar medication). Your doctor will need to monitor you carefully. Watch your symptoms, but don’t expect them to go away completely.

If you have a dysautonomia from another disorder, such as diabetes, your treatment will likely focus on the “primary” condition. In some cases, you may take medications for both, but again, it’s a difficult balancing act.

Some medications that may be used in some cases include fludrocortisone, midodrine, and ephedrine. Medications will require monitoring and adjustment over time.

You may need to adjust your migraine medication, because it could be making your symptoms worse. This is another reason why it is helpful to speak to a specialist.

Selected Sources and Resources

Here are some of the key sources I’ve used in these two articles, as well as resources you can use to learn more:

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The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.