Welcome back for part 2 of our Nutrition & Concussion series! This post is a case study on a 13 year old female that sustained a concussion playing basketball. She completed treatment and her return to play protocol, although was still complaining of a 5 minute headache on a daily basis. This headache was not associated with any activity in particular, and in fact went away with physical activity. At this time, with no known cause of the headaches, I had the athlete journal her eating habits for 2 weeks everyday. This included what she ate/drank, when she ate/drank, and when the headache occurred and for how long. We noticed a trend: her headache occurred within 30 minutes after consuming any gluten. I hated to put her on a specific lifestyle change at such a young, influential age, however it was the only thing we had not tried to get rid of her headaches once and for all. The athlete and parent were both more than willing to try going gluten free for 4 weeks to see what happened. Sure enough, the headaches stopped altogether once she substituted her foods with gluten free products. Now, 6 months later, the athlete has completed a gluten re-introduction process and is able to tolerate small amounts of gluten at a time without remorse. She waited until she knew her body was ready (this was a very mindful 13 year old) and listened to her body when it started becoming symptomatic again, by taking out the foods that caused her the headache. With mindfulness and guidance, we can help our athletes reach their goals and change their life long term for the better.
Symptom provocation after suffering from a concussion/TBI is different among each individual I see. Each day I see someone, I start out with a history of what they have been up to, how much water they’ve been intaking, what they’ve been eating (many times people are not getting enough calories), what their sleep quality is like, and then end the subjective portion of my session with them filling out a symptom survey. This symptom survey is especially important for objective documentation because it gives you, the clinician, and insurance an idea of how the patient is processing their symptom provocation. I do all of this before I even consider what their session will consist of that day. When someone approaches me with significant headache, nausea, or dizziness those are the “Big 3” red flags that tell me this person is not going to benefit from initiating visual, vestibular, or cognitive skills right away; they need symptom management first so their brain and body benefit from the therapeutic exercise. It is not until someone reports to me asymptomatic and with complaints of visual dysfunction, difficulty focusing, memory loss, etc. that I begin a session with therapeutic exercise. This is when it is appropriate to push their brain and body to work effectively together as one system.