Michelle Parker remembers little of what happened the day her horse, Flash, headbutted her four years ago — but she is still living with the after-effects.

Michelle, 55, doesn’t think she was even knocked out after the incident, but went to see her GP, who diagnosed concussion and told her to go home and rest — assuring her that she should feel better in a day or so.

Yet four years on, Michelle, a council administration worker from Eastbourne, East Sussex, lives with daily migraines, fatigue, ‘brain fog’, forgetfulness and struggles to find words, as a result of that head injury — a condition known as post-concussion syndrome.

However, she discovered that, even though it’s a medical condition, it can be difficult to get doctors to treat it.

Concussion can be described as a minor traumatic brain injury causing symptoms like headache, dizziness and vomiting, nausea, slurred speaking, confusion, and visual disturbances. Dr Mike Loosemore is a Professor in Sport and Exercise Medicine at University College London and an expert on concussion in sports.

Michelle, 55, doesn¿t think she was even knocked out after the incident, but went to see her GP, who diagnosed concussion and told her to go home and rest ¿ assuring her that she should feel better in a day or so

Michelle, 55, doesn’t think she was even knocked out after the incident, but went to see her GP, who diagnosed concussion and told her to go home and rest — assuring her that she should feel better in a day or so

‘Concussion is where you get an energy transfer to the brain either by a direct blow to the head or transferred energy — for example, falling on your behind and transferring the momentum to the brain. According to him, 95% of concussion victims recover in one week and 99% within a month. Michelle is one of those people who still experience the symptoms, which are known as post-concussion syndrome (PCS).

Professor Loosemore says that unlike other injuries, PCS can’t be detected on a scan. This can lead to problems in diagnosis, prolong symptoms, and delay patients receiving the right treatment like physiotherapy.

Michelle didn’t know any of this back then in 2017. She had been in the field feeding Flash on the day of her accident when Flash was spooked. She doesn’t recall much of what happened next. ‘I saw Flash coming towards me — I felt a huge pain — and then nothing.’ Michelle’s next memory was of feeling a burning pain in her eyes and head.

She recalls walking back with her friend, who insisted that she call an ambulance. Michelle, a self-confessed hard, horsey woman’, refused. 

“I went to my GP that day instead. She examined my pupils and diagnosed severe head injuries. She advised me to ‘have a shiner’. She sent me home and told me that I had concussion symptoms and that I should rest until I feel better.

The next morning, Michelle woke to a swollen-shut black eye, as well as typical symptoms of a concussion — an aching head and nausea.

Michelle, who has two grown-up children, rested at her home. She felt worse within two days.

She said, “It wasn’t my eye. It was my forehead and right up to my hairline.” I suffered from pounding headaches that no paracetamol nor ibuprofen could treat. I felt sick, ill, and out of control. I also realized I couldn’t find the words for certain things.

Two weeks later she went to her GP, who said that it was normal for a head trauma.

Concussion is defined as a 'minor traumatic brain injury' causing symptoms such as headache, dizziness, vomiting, nausea, slurred speech, confusion and visual disturbances, says Dr Mike Loosemore, a professor in sport and exercise medicine at University College London and an expert in concussion in sports [File photo]

Concussion refers to a’minor trauma brain injury’ that can cause symptoms such as headaches, dizziness or vomiting, nausea and slurred speech, confusion, and visual disturbances. Dr Mike Loosemore, a University College London professor and expert in concussion, defines it as “minor traumatic head injury”. [File photo]

Michelle returned to the GP every other day for the next few weeks. Michelle was unable to work because of her severe symptoms. Six months later, she still suffered from migraines. It revealed that there was nothing wrong in her brain.

Michelle was still looking for answers when she was finally referred by a neurologist. “He said that I had chronic benign migraines that were triggered after my injury, but he never explained that it could be post-concussion syndrome,” she says.

Michelle was given strong migraine medication called carbamazepine, which helped a bit. She says that it wasn’t just migraines.

“It was the fatigue. I was unable to work, had to sleep all day and could not go into public because of migraines. Michelle was able to identify post-concussion syndrome from the descriptions she saw on online forums.

Professor Loosemore insists doctors are becoming more aware about PCS and symptoms after a head trauma. Michelle’s doctors denied that her injuries were the cause of her symptoms. “On a single visit to my GP three month after my injury, he mentioned that I had PCS. However, he said that it’s been a while since your head injury. It can’t be this now, can it? I felt so humiliated and upset that I left the room in tears.

Michelle was not offered any further treatment or support.

Professor Loosemore explains that migraines caused by a head injury can often be a sign of PCS. He says, “So if you are suffering from headaches, migraines, dizziness, fatigue, or other symptoms due to a head injury, it is important that you seek medical attention.”

Dr Elizabeth Griffett is a specialist in neuropsychology at Hobbs Rehabilitation Clinic, Hampshire. She says that for many patients with post-concussion syndrome, it is a relief to be told what they feel, and not just in their heads.

She says, “We see people who have suffered chronic symptoms after a concussion. These all impact on one another.” 

“Someone who feels dizzy might be anxious or frustrated. Many people we meet have symptoms of depression or find it difficult to control their anger.

Emma Harris, a specialist in neurological physiotherapy, works at the Hobbs Rehabilitation Clinic. It is more about the function of nerve cells after being stretched and shaken.

There are three main components to physiotherapy when treating PCS. The first is to look at exertion as people with concussion can experience extreme fatigue. The second is balance, which can cause dizziness and uncalibrated balance. The third is the neck, which can also lead to dizziness and headaches. Rehabilitation after a concussion involves a gradual return of activities, both cognitive and physical.

Michelle was not offered assistance despite such treatments being available on NHS. Michelle continued to struggle with basic tasks like remembering words and coping with the supermarket checkout.

Michelle finally had an MRI scan a year ago. This showed she had suffered multiple mini-strokes and had lesions on her brain — which must have come on since her CT scan.

A mini stroke, also known as a transient Ichaemic attack (TIA), can present the same symptoms of a full-blown stroke. The symptoms last for 24 hours and, as Michelle said, the patient may not even notice it.

Professor Loosemore explains that when there is a head injury, blood vessels in the neck may be damaged, which can cause clots, leading to strokes.

Michelle still experiences fatigue, forgetfulness, headaches and forgetfulness. She hopes to raise awareness of the fact that PCS can cause serious problems many years after a head accident. 

She says, “I find myself in tears most days because of my condition.” “I hope that one day I will be cured.”

Gut instinct 

Your gut bacteria may be more important than you think

According to a study published by PLoS One in 2019, the more diverse your gut bacteria is, the better your chances of sleeping. 

Professor Jaime Tartar, who is a specialist in neurobiology of sleep at Nova Southeastern University, Florida, believes that disturbed sleep may be caused by bacteria in the Lachnospiraceae famiy. Firmicutes and Bacteroidetes are linked to sleeping well.

Other studies have shown that Firmicutes and Bacteriodetes produce GABA, a chemical messenger that calms the body and stimulates sleeping. However, other bacteria have been linked with a rise of interleukin-6, an inflammatory cytokine that has been shown reduces sleep quality.

What does this mean for insomniacs, you ask? ‘I don’t think the answer will be to simply supplement with one particular probiotic or probiotic mixture to significantly sleep better — but it would be wonderful if that turns out to be the case,’ says Professor Tartar.

The gut is home to both Firmicutes and Bacteriodetes bacteria. You can increase their numbers by eating ‘prebiotics’ foods (i.e. those that feed these food bacteria — this includes garlic, leeks, onions, legumes and other fruits and vegetables.