Over 45 million people in the U.S. suffer from acute or chronic headaches, with one headache-related emergency room visit occurring every 10 seconds. Migraines affect 18% of women and 8% of men aged 18–55, and if diagnostic criteria are broadened, the number of individuals experiencing debilitating headaches likely more than doubles.
Headaches are the second leading cause of disability in the U.S. and a major contributor to lost workplace productivity. Despite their impact, headaches are often underdiagnosed, as they are not yet fully recognized by the medical community as a distinct medical condition.
Head injuries can affect any part of the head—including the skull, brain, blood vessels, skin, and cartilage—and range in severity from minor cuts and abrasions to skull fractures, internal bleeding, or brain trauma. These injuries may result from seemingly mild incidents or from significant trauma. In fact, brain injuries can occur without a direct blow to the head, such as in whiplash, where rapid acceleration and deceleration cause internal movement of the brain.
But what if you feel fine?
Feeling “normal” doesn’t necessarily mean your brain has fully recovered. The brain is especially vulnerable because it can be injured in two key ways:
While the skull and cartilage offer some protection, softer tissues like the brain, blood vessels, and skin are much more susceptible to injury—even from relatively minor force.
Nerves can become pinched or irritated at various points, including the neck, back, shoulders, elbows, wrists, hips, and knees. However, nerve damage can also occur away from joints—often starting in the feet—without compression. Conditions such as diabetes, thyroid disorders, autoimmune diseases, and vitamin deficiencies can increase the risk of nerve damage.
Diagnosis may involve:
Treatment varies based on the type and location of the nerve injury.
While many associate seizures with dramatic “grand mal” episodes involving full-body shaking and loss of consciousness, there are many types of seizures. Partial seizures, for example, may cause:
Workup may include an MRI, EEG, and blood tests, and a wide range of treatments are available once the diagnosis is confirmed.
Dizziness can result from many causes—some benign, others more serious. Common causes include:
Accurate diagnosis is essential. Though dizziness can be challenging to treat, identifying the root cause is key to effective management.
One emerging link is brain fog—a term that has gained attention recently in the context of long COVID but is also a familiar complaint among neurologists, especially in patients with migraine and concussion.
Patients describe it as feeling mentally “slow,” unfocused, or not operating at their usual level. Common symptoms include difficulty with concentration, attention, and memory, though the overall feeling tends to be vague and hard to define.
In migraines, the cause of brain fog isn’t fully understood. It may stem from impaired brain metabolism during or between migraine attacks, particularly in individuals with frequent or prolonged migraines. However, there is a known component of neurovascular inflammation—involving the brain, meninges, and blood vessels.
Similarly, in COVID-19, scientists now recognize that vascular inflammation may underlie brain fog. This has led to the hypothesis that inflammation may be the shared mechanism between post-COVID brain fog and migraine-related cognitive symptoms.
For patients experiencing brain fog—especially those with a history of migraines, head injuries, or COVID-19—diagnostic tests like brain MRI or EEG may be considered. Symptom monitoring and appropriate treatment options are available, depending on the underlying condition.
By: Audrey Halpern, MD
October 20, 2020
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