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What Causes Severe Headaches, Weight Loss And Problems Of Post Concussion Syndrome?
Question: I wanted to follow up with you Dr. Saghafi. I consulted with you a few months ago after I was hit in the head with a XXXXXXX by a child while doing my job through Child Protective Services. I was suffering from awful headaches that my neurologist was struggling to get under control. I also ended up with a GI bleed as a result of the Fioricet I was placed on. That's when I consulted you. As your suggestion indicated, my Topamax needed to be increased and is now at 75mg a day. I still appreciated our conversations. Your thoroughness in our internet exchanges were way better than I have ever had with my neurologist. That was making a difference in the headaches some. Still, I had daily headaches, but I was losing a lot of weight. My neurologist then added Nortyptiline at 10mg. This seemed to finally make a difference in the headaches, but also stabilized my weight. My Nortryptiline was increased to 20mg. I was experiencing significant cognitive issues as I had due to the Post Concussion Syndrome. My neuropsychological functioning had not significantly improved since my injury and additionally, I had a significant speech issue in word finding and work pronunciation. My symptoms were so severe that they were apparent to everyone around me. My symptoms would worsen as the day would wear on and as the week would wear on. My speech was so impaired that many people described it as a "stutter, stammer, slur," etc. My condition was so deteriorated that it led to my husband, a colleague and a friend who did not know each other being so concerned for my condition to write my providers letters of concern describing my symptoms. My scores on Lumosity.com made some initial improvements early on, but have not changed much since August through November. I was referred to a speech therapist and cognitive rehab. My appointment is scheduled January 6th.
At the same time as the Nortryptiline was increased, my pain management doctor put me on Gabapentin at 300mg for what she believes is biliary colic (if you recall my GI bleed was in part due to a complicated gastric bypass that I had and my gallbladder is diseased as a result). Suddenly, within days of the increase of the Nortryptiline and the addition of the Gabapentin, my cognitive function has dramatically improved. My speech impairment that was so apparent a month ago that led to my referral to speech therapy is nearly gone almost in an instant. Is this possible from the medication? These conditions were consistently present from about week 3 of my injury until about 3 days after starting these medications which was about 6 months and 2 weeks post injury. They did not gradually disappear. They were gone nearly overnight. Please let me know your thoughts.
At the same time as the Nortryptiline was increased, my pain management doctor put me on Gabapentin at 300mg for what she believes is biliary colic (if you recall my GI bleed was in part due to a complicated gastric bypass that I had and my gallbladder is diseased as a result). Suddenly, within days of the increase of the Nortryptiline and the addition of the Gabapentin, my cognitive function has dramatically improved. My speech impairment that was so apparent a month ago that led to my referral to speech therapy is nearly gone almost in an instant. Is this possible from the medication? These conditions were consistently present from about week 3 of my injury until about 3 days after starting these medications which was about 6 months and 2 weeks post injury. They did not gradually disappear. They were gone nearly overnight. Please let me know your thoughts.
Brief Answer:
Now for a hard question?
Detailed Answer:
Thank you for thinking about me once again. I've been reading your presentation various times since this afternoon and thinking about how to answer your question because now.....you've given me something that turns out to be rather challenging for me to answer.
And so to recap- you had been dealing with the PCS after being struck on the head with the XXXXXXX and your Topamax was raised to 75mg. per day at which point headaches seemed to improve somewhat. Nortriptyline was started subsequently at 10mg. and then, soon thereafter raised to 20 mg. by your neurologist. You state that your cognitive status was still problematic and not much better since being struck by the XXXXXXX You did not specify elements of the cognitive domain which were primarily affected but did mention that speech was significantly affected with respect to word finding and pronunciation issues.
That problem seemed to be getting worse until you were placed on gabapentin 300mg. for management of biliary colic. However, within days of being on this triple therapy of Topamax, Nortriptyline, and Gabapentin your cognitive function began turning around and the speech impairment itself virtually disappeared overnight....literally....according to your statement.
So your question very simply put is, could the combination of these 3 medications done something to the cognitive and most dramatically the speech impairment situation or not?
I checked the interactions between the 3 medications and actually found that between Topamax and Nortriptyline there is an increase in sedating effect. That would be the possible explanation of why your speech began to become affected after you had been started on and then, raised on the Nortriptyline. And in fact, that particular reaction is seen in our clinic on a regular basis. However, when adding gabapentin to have everything literally CLEAR and not only that, nearly reverse itself to the point where your cognitive and mental statuses became perfectly normalized and without any sign of previous impairment....well, that does not make pharmacological or neurological sense at all. Recall that gabapentin is a drug that tends to reduce mental and physical functioning and so I have no explanation for why its addition for biliary colic would suddenly elevate mood and speech function like nobody's business.
And so the bottom line to answer your question directly and HONESTLY is that I have no reasonable neurological nor pharamcological explanation that delineates what you've described on the basis of medication activity. However, it certainly is compelling to consider that this Trio of medications were on-board at the very instant that neurological issues suddenly reverted to near normal.
In order to prove that the combination really does work the way it may appear to work in this case I would recommend considering stopping the gabapentin over the course of a few days to a week and document what is going on with the speech over the next few days. To me, that would more clearly define at least that there is a contribution by the gabapentin though we won't be able to ascertain exactly why right now.
In the mean time I will continue to ponder the question and search for references and bibliographies that may be able to shed some light on this phenomenon but quite honestly, it goes against all logic and pharmacological principles of these medications and how they act on the brain, let alone how they interact with each other.
Have a very happy and SAFE NEW YEAR and I hope to hear more improvement and good news and if I can possibly further an explanation on how you've been able to overdose your condition I will let you know by hook or by crook.
If this information has been helpful and I've answered your questions would you do me the favor of some written feedback and a STAR RATING of the answer as you've so generously done in the past even though I really don't have an answer to your question?
And if you have no further questions or comments to place- CLOSING THE QUERY would be greatly appreciated as well.
In the future I'm happy to answer more concerns personally if you'd allow me this privilege by going to the following website and sending me your questions:
bit.ly/drdariushsaghafi
This query required 45 minutes of physician specific review, research, and final draft documentation for envoy.
Now for a hard question?
Detailed Answer:
Thank you for thinking about me once again. I've been reading your presentation various times since this afternoon and thinking about how to answer your question because now.....you've given me something that turns out to be rather challenging for me to answer.
And so to recap- you had been dealing with the PCS after being struck on the head with the XXXXXXX and your Topamax was raised to 75mg. per day at which point headaches seemed to improve somewhat. Nortriptyline was started subsequently at 10mg. and then, soon thereafter raised to 20 mg. by your neurologist. You state that your cognitive status was still problematic and not much better since being struck by the XXXXXXX You did not specify elements of the cognitive domain which were primarily affected but did mention that speech was significantly affected with respect to word finding and pronunciation issues.
That problem seemed to be getting worse until you were placed on gabapentin 300mg. for management of biliary colic. However, within days of being on this triple therapy of Topamax, Nortriptyline, and Gabapentin your cognitive function began turning around and the speech impairment itself virtually disappeared overnight....literally....according to your statement.
So your question very simply put is, could the combination of these 3 medications done something to the cognitive and most dramatically the speech impairment situation or not?
I checked the interactions between the 3 medications and actually found that between Topamax and Nortriptyline there is an increase in sedating effect. That would be the possible explanation of why your speech began to become affected after you had been started on and then, raised on the Nortriptyline. And in fact, that particular reaction is seen in our clinic on a regular basis. However, when adding gabapentin to have everything literally CLEAR and not only that, nearly reverse itself to the point where your cognitive and mental statuses became perfectly normalized and without any sign of previous impairment....well, that does not make pharmacological or neurological sense at all. Recall that gabapentin is a drug that tends to reduce mental and physical functioning and so I have no explanation for why its addition for biliary colic would suddenly elevate mood and speech function like nobody's business.
And so the bottom line to answer your question directly and HONESTLY is that I have no reasonable neurological nor pharamcological explanation that delineates what you've described on the basis of medication activity. However, it certainly is compelling to consider that this Trio of medications were on-board at the very instant that neurological issues suddenly reverted to near normal.
In order to prove that the combination really does work the way it may appear to work in this case I would recommend considering stopping the gabapentin over the course of a few days to a week and document what is going on with the speech over the next few days. To me, that would more clearly define at least that there is a contribution by the gabapentin though we won't be able to ascertain exactly why right now.
In the mean time I will continue to ponder the question and search for references and bibliographies that may be able to shed some light on this phenomenon but quite honestly, it goes against all logic and pharmacological principles of these medications and how they act on the brain, let alone how they interact with each other.
Have a very happy and SAFE NEW YEAR and I hope to hear more improvement and good news and if I can possibly further an explanation on how you've been able to overdose your condition I will let you know by hook or by crook.
If this information has been helpful and I've answered your questions would you do me the favor of some written feedback and a STAR RATING of the answer as you've so generously done in the past even though I really don't have an answer to your question?
And if you have no further questions or comments to place- CLOSING THE QUERY would be greatly appreciated as well.
In the future I'm happy to answer more concerns personally if you'd allow me this privilege by going to the following website and sending me your questions:
bit.ly/drdariushsaghafi
This query required 45 minutes of physician specific review, research, and final draft documentation for envoy.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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