What’s all the fuss about sleep hygiene? 

Well to put it simply, sleep is an essential part of healing and restoring our body to optimal functioning. We all feel miserable after a poor night’s sleep! 

When it comes to headaches, migraine and concussion sleep is a crucial piece of the puzzle to help improve brain function and allow healing to occur.  

Most adults require about 7-9 hours of nightly sleep. Teenagers between the ages of 14 and 17 years need 8 to 10 hours sleep. Children and teenagers between 6 and 13 years need more sleep, about 9-11 hours.   

Our internal body clock is known as the circadian rhythm. It is a 24-hour cycle which, after waking in the morning, makes a feel increasingly more tired as the day progresses. This peaks in the evening when leading up to bed time. Light influences the circadian rhythm as it signals to the brain whether it is day or night. As the light starts to disappear in the evening our body releases melatonin, a hormone that induces drowsiness.  Therefore, we do not want too much artificial light at night time as we don’t want to disrupt our circadian rhythm. 

As we wake in the morning the light from the sun helps our body release cortisol that promotes energy and alertness. A walk outdoors does wonders to absorb natural light whether it is off to the train for work, to school or walking the dog. Who knew that releasing melatonin could be your new motivation to put on those walking shoes! 

TOP 10 TIPS FOR BETTER SLEEP 

1. Avoid napping during the day 
2. Avoid stimulants such as caffeine, nicotine, high sugar or heavy spicy food, vigorous exercise leading up to bed time. A light snack rich in magnesium and that promotes melatonin production may be helpful – fruit such as strawberries, bananas, cherries, nuts like almonds, oatmeal are some ideas. Herbal teas with no caffeine can be a nice way to calm the mind and relax the body ready for sleep.  
3. Keep the same bedtime and wake up time. Stick to it, even on the weekends. 
4. Wake up and enjoying sunlight in the morning can help set the melatonin released for that night’s sleep.
5. Cooler, rather than warm temperature, is more conducive to sleep. As the weather (hopefully!) warms up think about cooler sheets.
6. Consider a screen ban in the bedroom: TV’s, computers, tablets, mobile phones another electronic devices. The blue light emitted from screens trick the brain into thinking it is still daytime. Your brain then works hard to stay awake. 
7. Exercise during the day can help your body wind down and prepare for sleep by the evening. 
8. Create a bedtime routine. Our brain recognises the sequence of activities as a precursor to sleep. We probably teach our children this but forget to do it as an adult! It all helps…Keep your mind focused on relaxation, calming the sympathetic nervous system down ready for sleep. 
9. Some nice routine ideas include: cup of herbal tea, relaxing bath with essential oils like lavender, vetiver, roman chamomile, listen to calming music or ambient noise. The years of COVID has meant the calming apps out there are plentiful. How does listening to rain falling sound??  
10. Choose your favourite stretches, Yoga, deep breathing, especially nose breathing. Progressive Muscle Relaxation technique (PMR) is a wonderful way to relieve tension and be mindful of your body. We can teach you here at Sydney Headache and Migraine Centre. Meditation and Mindfulness all go along way in reducing stress, managing emotions. 

Many people have heard of migraine but are not sure of what vestibular migraine is all about. It is a migraine event where vertigo is the main symptom. It is one of the common causes of episodic vertigo in children and adults. Episodes can last for minutes or up to a few days. 

Vertigo – a sense of spinning either the room or yourself, can be sitting still (no trigger, spontaneous) or when changing positions (triggered by positional change, head movement)

Nausea and Vomiting

Headache – during or after the episode 

Disequilibrium – rocking, tilting, swaying, unstable on feet, floor under feet feels like it is moving

Visual Motion Sensitivity – feel nauseous or unwell with vision not matching up with surrounds

Anxiety – fear avoidance of certain movements of head, body. Panicked feeling, shortness of breath.

Dissociation symptoms – disconnection from your body or from the environment around you

Dissociation symptoms – disconnection from your body or from the environment around you

Light / Sound/ Smell Sensitivity – sensitive to light such as light coming through trees, car lights, fluorescent lights in office; sensitivity to sounds such as loud noises, busy restaurants, concerts or muffled hearing or ear pressure; sensitivity to certain smells like strong perfumes, cooking smells.

The assessment

Practitioners at Sydney Headache and Migraine Centre take a thorough medical history of our patients and then perform a physical examination of the Vestibular System, Balance and Cervical Spine. 

We use specialised goggles that detect any abnormal eye movements known as nystagmus (jerky eye movements). These eye movements can mimic conditions like BPPV, Meniere’s disease or Vestibular Neuritis. These conditions can also coexist with Vestibular Migraine making it complicated.

The treatment

Treatment involves Vestibular Rehabilitation exercises to improve dizziness and imbalance. These exercises may not prevent an episode of vestibular migraine occurring, but they help reduce the symptoms and improve daily functioning.

Migraine-specific neck treatments, using the highly renowned Watson Headache® Approach, is an exceptional treatment option for headache and migraine conditions. This involves physically assessing the Upper Cervical Spine (UCS) for stiffness and pain, with particular interest in referral of pain from the neck into the head. It is particularly effective in treating those with dizziness as the main migraine symptom.

Treatment for coexisting BPPV or other vestibular dysfunction will be done based on assessment findings as well as balance training to reduce falls risk.

Management of lifestyle factors such as diet, hydration, alcohol, sleep, exercise tolerance, managing stress and anxiety can also be very useful. We have a strong referral network should patients require specialised care in more specific areas.

Concussion injury can cause numerous issues to a variety of different body systems.  These include headache, dizziness, fatigue, light sensitivity, tinnitus, neck pain, poor concentration and confusion.

Diagnosis of Domains of Dysfunction is crucial to address all the areas effectively, thus enabling the most successful and speedy recovery.

Post-concussion syndrome occurs when a number of the common concussion symptoms continue for longer than six weeks, the usual maximum period of time for recovery. This is the generally accepted time period for the ‘energy’ dysfunction in the brain to recover.

Ongoing symptoms can be caused by any of the 8 Domains of Concussion Treatment outlined below:

Cervical spine (neck) 

 The actual concussion injury does not require a ‘knock’ to the head. Any whiplash type injury can also cause a concussion. If someone has sustained a concussion, we know there must have a whiplash injury to the neck as well. The neck can be a source of headaches, dizziness, eye or balance problems. Treatment focuses on restoring normal function of range and strength. Sydney Concussion Centre uses the Watson Headache® Approach to treat dysfunction in the upper neck to address these issues.

Vestibular, vertigo, dizziness 

The vestibular system in the ear can be affected by the acceleration/deceleration injury which causes concussion. This involves the release of ‘crystals’ called otoconia from the utricle into the semi-circular canals of the vestibular system affecting its function. Known as Benign Paroxysmal Positional Vertigo (BPPV), the result is vertigo where people feel like the room is spinning with a change of position, eg rolling over in bed or rising from lying. Nausea and vomiting can be associated with vertigo. Specialised assessment and treatment are required to restore the system to normal.

Oculo-motor. eye movement control 

The burst of activity in the brain that results in an ongoing fatigue state, affects its ability to control normal body functions; the eye muscles are one of those areas. When eyes aren’t tracking properly, it affects our ability to read and concentrate on tasks.

Balance, equilibrium

Our balance is controlled by a very refined system in our brain. Information from the three previous areas, the neck (muscle/proprioception), vestibular system (ears) and eyes (vision) is processed in the brain to help us maintain our balance. The disruption to the brain of a concussion can affect this processing system, leading to a feeling of disequilibrium or ‘floating’. This is often described as walking on a trampoline or boat. Specific exercises can target this problem however treatment may be required to attend to any dysfunction in the individual areas first. These are often a combination of eye movement exercises, neck treatment and balance retraining.

Physiological fitness and fatigue

A concussive episode can impact on a person’s physiological fitness in a number of ways. The initial period of inactivity is enough to start the process of losing physical fitness. Complicating this, concussion can often cause a disruption to the Autonomic Nervous System which controls how we respond to exercise. The Autonomic Nervous System looks after the increased blood flow to the areas that need more oxygen and removing waste products out of the system – we don’t have to think about it! When the body doesn’t respond appropriately to the required demands, our ability to exercise is significantly affected. This is the case in concussion – a person’s ability to exercise can be diminished very quickly.

Cognitive, Concentration, thought processes

Disruption to the brain function also affects our ability to think clearly. Often described as ‘brain fog’  it is characterised by its impact on executive function, ability to learn, memory & recall, ability to focus and slowed processing of information. Some recent research suggests post concussive amnesia may lead to more cognitive issues during recovery.

Anxiety, mood, psychological disorders

It is believed that symptoms of psychological (mood and anxiety) disorders have a contribution from the Limbic system, which includes the emotional centres of the brain. A concussion can potentially cause further disruption to this part of the brain, leading to an aggravation of symptoms that may already be present. Anyone with pre-existing symptoms of a psychological nature should be aware of this possibility and seek follow-up with their GP or trusted psychological health professional. Even without a pre-existing condition, some people who are rehabilitating from a concussion will benefit from psychological intervention, especially if symptoms persist for an extended period of time.

Post traumatic migraine 

Migraine is a severe headache involving significant neurological dysfunction and hypersensitivity, similar in many ways to concussion. This type of headache often has a strong genetic predisposition. There are 40 genetic factors associated with migraine, a majority only being isolated in recent years. Consequently, it is not surprising that a concussive episode can either trigger or exaggerate a person’s migraine frequency or intensity. There has been much debate in the medical literature as to the association between concussion and migraine are becoming more obvious.

The program carried out at Sydney Concussion Centre uses best practice techniques, established by the latest research to assess the Domains of Concussion This involves a wide range of assessments to determine where your concussion symptoms are originating. Once the areas of dysfunction are determined, a specific treatment and exercise program is developed to address the issues and expedite recovery.

Thanks for reading our blog on The 8 Domains of a Concussion Injury.

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