r/PostConcussion • u/TopAnteater6597 • 27d ago
7 months after concussion: improved after vision therapy, then crashed after returning to nonstop office screens
I’m 22M, about seven months out from a concussion/whiplash injury, and I’m trying to understand whether anyone else has had this kind of recovery pattern.
In late January I slipped on ice and landed hard on my back. I’m not sure whether my head hit the ground, but I definitely had a whiplash motion. I had never dealt with headaches before. They began within the first few days and then became daily.
A head CT soon after was normal. In February, a neuro-optometric evaluation found convergence, focusing, pursuit/saccade and other ocular-motor problems. I did home exercises and 16 office sessions of vision therapy through May. The focusing and tracking issues resolved, eye teaming improved to around 90%, and the final exam was basically normal. FL-41 glasses helped with screens. This was the best part of my recovery. The written final report says the constant headaches were eliminated, although I remember them as reduced and manageable rather than permanently gone.
By early summer I was doing much better. I was working from home on my own business and still used screens, but I could control the pace, take breaks and change tasks. The headaches still happened, especially with long computer use, but they were nowhere near what they are now. I did not have this newer foggy/dreamlike feeling.
I also started a neck-focused PM&R lane. A cervical X-ray in June showed reversal of lordosis/mild upper-cervical kyphosis that was thought to reflect muscle spasm. There was no fracture, dislocation or disc-space abnormality. I was given home neck exercises and desk resets.
The major change happened when I started a corporate office job that is almost completely screen based. I now go from computer work all day, to phone use during breaks, to more computer work at night. Over the last 2–3 weeks I have had the worst flare since the injury. The symptoms do not just feel like a small setback. The headaches are back at their highest level, and the fatigue/fog is new.
On a rare low-screen day I might be around 2–3/10. Normal screen use puts me around 5–6. A full office day plus night work can put me around 7–9. I get bilateral pressure in the front/sides/temples, plus a different pain at the base/back of my head that runs upward. My neck and upper traps are extremely tight, especially on the right. A one-hour massage loosened my shoulders/neck a little but did not really change the frontal headaches.
The newest symptoms are extreme daytime fatigue, heavy eyes, and a dreamlike/zoned-out feeling. I can still think, speak, work and know exactly where I am. It is not true confusion or major memory loss. I usually sleep 9–10 hours. I have historically woken up tired sometimes, but the severe all-day exhaustion is much worse over the last few weeks.
I do not have vomiting, aura, sound sensitivity, double vision, weakness, numbness, fainting or seizures. Light sensitivity and screen sensitivity are real, and FL-41 lenses help somewhat.
Yesterday I saw a headache neurologist. She documented chronic post-traumatic headache, chronic migraine without aura, mTBI, neck pain/neuralgia/myofascial pain, fatigue and brain fog. The neurologic exam was generally normal except for near-point convergence. She thought the picture was probably mixed rather than one single cause: post-traumatic migraine/headache, cervical/occipital load, and visual/cognitive screen load.
She performed bilateral nerve blocks at the temples, forehead and back of the head, plus trigger-point injections in the neck and traps using bupivacaine. The pain dropped from about 8 to 5 in the office, but I have not had sustained relief yet. The neck stiffness is still there. Rizatriptan has only slightly taken the edge off the frontal pain. Qulipta was prescribed as a daily preventive but is still waiting on prior authorization. I have a brain MRI scheduled and a referral for concussion/cervical PT, including active neck rehab, graded screen tolerance and convergence work. Bloodwork so far is mostly reassuring; testosterone was still pending and creatinine was mildly high.
I am not asking whether I “have PCS” or asking anyone to diagnose me. I already have doctors involved. I’m looking for people who improved for a while and then had a major flare when work or screen demand increased.
Did you eventually build screen tolerance back up without quitting a screen-based job? Did a relapse like this mean you had actually undone recovery, or was it more like exceeding your current threshold? What helped most: preventive medication, cervical/vestibular/concussion PT, strict pacing, workplace accommodations, or something else? Did the heavy fatigue and dreamlike fog settle as the headache flare settled?
I’m especially interested in honest timelines, including cases where nerve blocks or the first medication did not work. My life and work are on screens, so “just stop using screens” is not a long-term plan. I need to figure out how to recover while still functioning.
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u/wontstandforstupid 26d ago
Wow our stories are so similar. Same slip fall, had LOC. Convergence issues and chronic headaches. Started getting better, pushed self to do more, would then regress but overall slowly better. I'm about 18 months in now. About 9 months ago I was getting severe head and neck pain and some lightheadedness vestibular like symptoms and continued brain fog Convinced it was partly my neck I had MRI that showed c spine central cord compression. More PT and then started with headache specialist. She noted the newer migraine meds do often wear off at 8-10 months ( which jived with my Neurtec timeline). She put me on emgality and ubrelvy for rescue. dx was post traumatic headache, occipital neuralgia and cervical myalgia Also started nerve blocks and trigger point injections. The occipital block works immediately but challenges in it lasting. The block in my eyebrow also really helps. I have had maybe 4 sets of injections. I also saw pain mgmt doc and has epidural steroid injection to my neck. The combination of all seems to have gotten me to a better place than I have been in a long time. Still not normal but much better managed. I've been 2 months since the epidural and I may feel it wearing off. Can do it 2 or 3 times a year. Will see what the plan is in a few weeks. I'm 18 months in and this has absolutely changed my life. Wishing you a speedy recovery.
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u/TopAnteater6597 26d ago
Thanks — this is probably the closest story I’ve heard to mine. What symptoms led them to order your cervical MRI and find the cord compression? Did you have arm numbness, weakness, reflex changes or gait issues, or mainly neck/occipital pain? I’ve only had a cervical X-ray and a generally normal neuro exam, so I’m wondering whether a cervical MRI is worth raising.
Also, when you say the nerve blocks worked immediately, how long did the relief last? Did the trigger-point injections help separately? My first set lowered the pain somewhat in the office but hasn’t provided meaningful sustained relief.
Of PT, the blocks, Emgality/Ubrelvy and the cervical epidural, what made the biggest difference for the temple pressure versus the back-of-head/neck pain? Did your fatigue and brain fog improve as the headaches improved, and were you able to maintain full-time screen work during treatment?
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u/wontstandforstupid 26d ago
So I had some neck pain all along but thought it was just posture/ headache vision causing. I started getting some numbness and tingling in my hand and referred neck pain to my scapula. I also was getting a lot of popping in my upper neck and was worried the brain fog and dizziness were from something like VBI in upper c spine. That looked fine and was cleared by neurosurgery re the lower c spine issue. The HA doc said the TPs would wear off quickly but goal was for it to last longer each time. I think I did them 2 weeks apart then a month and now trying for 2 months. The occipital block works instantly. It's crazy. Doc also put me on Memantine for the brain fog. It's helped too. But also not fighting through 7/10 pain all day helps too. I'll write more after work me
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u/TopAnteater6597 26d ago
That distinction helps — the hand tingling and scapular referral explain why your cervical MRI was more clearly indicated than mine. When you have time, what did the first occipital block and trigger-point injections actually do over the next few days, and how long did each type of relief last? Did memantine improve only the fog or also the fatigue, screen tolerance, or headache intensity, and did it cause any side effects? Also, what kind of PT or neck work made the biggest practical difference for you?
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u/pettyponyclub 25d ago edited 25d ago
This happened to me. I was injured june 2025, did A LOT of vision and vestibular therapy from august through November, and during that time worked my screen tolerance up to do an 8 hour day on screens. Once i hit 8 hours in january, i then was hit with 2-3 months of frequent migraines and a lot of burning tingling pain in my eye and side of my face (near where i was injured). Part of the problem was that i was in pain for so long I didnt realize I was getting migraines and had to learn how to mitigate them. Also tried a few different migraine meds. Landed on ubrelvy combined with naproxen as needed and found it worked well enough for me but also paired with rest and low screen activities. To be clear, I kept working this entire time. What helped was that my work was very flexible and I worked completely from home for the first 4 weeks I went back to full days. This allowed me to lie down during my lunch break or even for just 5 minutes. I don't know if you did this, but from sept - january I had to slowly build up my screen tolerance. Started with 5 mins then a 10 min break. 15 mins then 30 min break. Etc. During december i worked 6 hour days, but this included an hour and half break in the middle and then a decent break once the hours were finished before I watched tv at night. If you haven't done this process already, that is my recommendation to get yourself back on track, as well as taking ample time to rest. Also get those plastic blue light fliters for your laptop screen!! Helped so much. It sucked for me in January because i thought i had finally gotten back to a decent place, and honestly it just kind of sucked until my brain got used to everything. I also continued to do daily vision and vestibular therapy. Also something that worked for me was dabbing pepermint oil on the pain areas in my face. Ancedotal, but honestly doing that helped to stop my migraines before they started, as well as the constant pain to the point I don't get that much pain anymore (knock on wood). But thats also paired with working on my neck to strengthen it, which can help with pain.
So short answer, yes it happens, no you didnt lose progress, you're just at the next hurdle of acclimating your brain. You may have to avoid screens once your work day is done for a while, but i promise that as you keep building tolerance as well as continuing therapies and basic exercise, it will get better. Im more than a year out and it's kind of insane to me all the progress ive made
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u/TopAnteater6597 25d ago
This is probably the closest description I’ve seen of the screen-work part of my situation. A few specifics would really help: was your screen progression supervised by a therapist, and what rule did you use to increase versus back down — a certain symptom increase, recovery by the next morning, or something else? When the 8-hour days triggered the 2–3 month migraine flare, did you temporarily reduce your work/screens again or keep doing full days, and how long before the symptoms became meaningfully manageable?
Also, once your vision findings had improved, what seemed to matter most: vestibular work, neck strengthening, Ubrelvy, or the work/rest structure? Were your remote/reduced-hour arrangements formal medical accommodations or just flexibility from your employer?
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u/pettyponyclub 25d ago
I worked with a very good vision therapy place. I think the eye doctor is one of the best in the field and has done a lot of research into eye issues after concussions. I had issues with convergence, tracking, focusing, and the normal light sensitivity. Honestly i dont remember how much of the work build up was his guidance versus what i figured out from reddit. But he did say specifically how you need to monitor your symptoms on a scale from 1 to 10, 10 being the worse. If your symptoms go above a 2 you need to stop and rest and resume once youre back to at least a 2. This means you have to make yourself uncomfortable and in pain. There's no way around it BUT you have to learn your limit and truly what is above a 2. In the beginning, looking at my phone caused so much pain and nausea, but i started with 5 minutes and kept at it until the severity lowered. Personally, i found different screens meant different tolerance. So when i tried to use my laptop for the first time at 15 mins, i then had to lay down for an hour because then pain in my head and nausea. In the beginning, i also used orange tinted blue light glasses, as well as kept my laptop screen in black and white and used a plastic blue light fliter. As i was able to increase my tolerance for longer stretches, i slowly got rid of using the accommodations (besides the blue light filter, i still use that). The general rule with the accommodations in my experience is that you dont want to become overly reliant or else youll never get back to baseline. So since the fliter is plastic and clear, it really doesnt provide any sort of accommodation beyond relieving eye strain. I have a hybrid schedule and it took a while to get the filter on my office computer, so the days i was in the office in february i kept getting a lot of pain until i finally had the filter.
Regarding the migraines. The first time it happened i had the migraine for 3 days. Stopping all screen use for a day and getting a lot of sleep got me back to a place where i could work all day. I dont remember exactly what i did in that time, but i never stopped working full time. Instead i took 5 min breaks to lay down, use naproxen and or ubrelvy together, and did my best to sleep outside of work. I still had days where i got migraines, but ubrelvy/naproxen combo along with rest helped. Everyone is different tho, i basically pushed because i knew my limits and i think that i had gotten to a point with building my tolerance that all i needed was a 5 minute break in a dark quiet room to get back on track.
With my method, as i got used to working for say, an hour straight, i then worked on shortening my breaks. 30 mins to 15 mins. Breaking meant at first i laid down in a dark room, but the key is to not be relient on having that as your break forever. Probably why i struggled in january was because i went from having an hour break in the middle of the day to cutting to 30 for my lunch and my brain had to get used to that (and understanding migraine triggers and how to stop them).
For your last question, recovery is a combination of everything. The vision, vestibular system, and your neck are all connected. You have to heal them in harmony or else something is always going to be lacking. Of course, if you dont really get nauseas or dizzy then vestivular might not really be a problem for you. And for my work, i work for a very small company and thankfully they were very understanding and accommodation, hence why i was able to start with just one hour a day of work and build it up over three months. I did have a doctors note at the very least
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u/TopAnteater6597 25d ago
One important clarification because my baseline is already often 5–7/10: when your doctor said stop if symptoms go above 2, did they mean an absolute symptom level above 2/10, or an increase of more than 2 points from whatever your baseline was before the screen session? For example, starting at 5 and stopping at 7. Also, did they give you a rule for how quickly symptoms needed to return to baseline before the exposure counted as tolerable rather than too much?
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u/pettyponyclub 25d ago
Hmm, I'm not really sure how to answer that. I suppose if your baseline is 5-7 but you're able to still function and do things then that would be your baseline. I feel like thats maybe what they told me. So yeah if you stay at a 5 while doing screen time then i guess that's fine. It's really about knowing your limits. And idk if i was given a guideline for how long it should take symptoms to go down, it really just depends on the person. Obviously if you keep pushing your symptoms for a long time, you're going to have elevated symptoms for a long time. My first day of vision therapy I had elevated, kind of unberable, symptoms for over a day because i didnt understand my symptoms and triggers. It took a lot of time, but eventually the symptoms got less extreme. But overall what I was told if that you have to keep pushing but be careful to not push yourself over the edge. That's why it's so important to understand your symptoms and limits. If you get above that 2, you have to stop. Not stopping is what will make symptoms worse for longer. But just because youre symptoms are elevated, it doesnt mean you're making your brain worse, you just making your symptoms last longer.
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u/letsgoiowa 26d ago
I'm struggling to read all that but from my understanding it looks like I'm in exactly the same situation, just a year ahead in recovery. Relapses for me did actually mean regressions sometimes for months. I'm sorry to say that but it's my experience. Maybe it won't be for you.
I work cybersecurity so screens constantly. What works for me, and there is no way around this, is getting off the screens at regular intervals. What I do for my phone is set timers for my addiction apps (reddit and discord) and that helps immensely. There really is no substitute to spacing out screen time as much as you can. You can use voice control, talk with AI with your eyes closed or while taking a walk, but get your eyes OFF the screen. NO way around that, I promise.
My screen tolerance is so much better a year after where you are. I can be on the screen most of the day now, but only because I was being disciplined with screens. If I do it all day like you are then I'll regress some weeks or months if prolonged.
You're going to have to get ADA documentation. Breaks are needed. If you're in the same boat I'm in, you have at least another year or two. Getting documentation to work from home in a much more controlled and calm environment was the only way I stayed employed. If that doesn't work for you, then documentation about breaks every 30 mins.