• What can make a headache?

  • Common headaches affect a huge majority of the population. But some are symptoms of serious conditions like stroke, an aneurysm or concussion. In fact, headaches are one of the top 5 reasons why people go to an ER. And why you should go to Littleton Hospital's ER.  

    Our expert neurologists, neuro-intervention specialists, and neurosurgeons are on call 24/7/365. Littleton Hospital also provides ImPACT testing for all ER concussion patients and is the only hospital in the area to provide personalized follow-up phone screenings by a concussion specialist.

    So if you notice any of the following symptoms with a headache, call 9-1-1 immediately. Because every minute counts.

    • Sudden, intense, severe headache
    • Nausea, dizziness, or blurred vision
    • Seizures or loss of consciousness
    • Memory loss, confusion, loss of balance, speech/vision problems, or numbness

    Read more about headaches, head injuries and the latest treatments by Littleton Hospital head specialists:

  • About 2.7 million people in the United States have a brain aneurysm every year. While the number of ruptured aneurysms is low, the risk of death can be up to 50 percent.

    A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. It often resembles a berry hanging from a stem. When it breaks, it causes bleeding into the brain.

    The most common surgical procedure to treat a ruptured aneurysm involves placing a small clip across the neck of the aneurysm to block the normal blood flow from entering the aneurysm. Four neurosurgeons at Littleton Hospital specialize in this aneurysm surgery.

    Advancements in interventional neuroradiology offer treatments that are less invasive and result in faster recovery times, says Christopher Nichols, MD, a neurologist with Littleton Adventist Hospital.  Nichols is the only neurologist specializing in interventional neuroradiology in Colorado.

    Interventional neuroradiology uses minimally invasive techniques rather than standard surgical procedures to treat vascular diseases of the central nervous system. In these procedures, a small catheter (a long tube about the size of a string of spaghetti) is guided into the brain through arteries in the neck. Using this catheter, physicians are able to completely cut off the blood supply to the aneurysm, which increases the chances of a permanent cure. These advancements are minimally-invasive and do not require open surgery. Three highly specialized devices are now available:

    • Coils: Using a catheter, a neuroradiologist inserts coils into the aneurysm, preventing blood from entering. Advancements in coils allow them to be packed much more densely so they completely cover the aneurysm neck, or the “doorway” between the artery and the aneurysm.
    •  Flow diverting stents: These stents are placed at the neck of the and redirect blood flow away from the aneurysm.
    • Liquid embolic agents: Liquid agents can now be injected into aneurysms that harden as they come into contact with the blood, filling up and closing the aneurysm without closing normal blood vessels in the head.


    Your daughter took a hard hit and fell during her soccer match. Is it worth a trip to the ER?

    The headache, dizziness and nausea soon disappear and she appears to be back to normal. Except your once straight-A student is suddenly getting C’s in geography, and it takes her a minute to understand you when you ask her a question.

    What’s the problem? Your daughter might be experiencing what brain experts call “cognitive deficits”  – problems with memory, attention, speed of processing. These are the No. 1 unrecognized symptoms of concussion.

    Learn the signs of a concussion.

    Enter Jesse Polewchak, a speech-language pathologist with Littleton Adventist Hospital who spends her days calling patients who were treated in the hospital’s emergency room for concussions to find out whether they’re continuing to experience any of those subtle symptoms.

    As part of what she calls Littleton Hospital’s “full-circle service,” Polewchak picks up where the ImPACT Testing leaves off. The test measures concussion symptoms such as attention span, memory, response, problem solving and reaction time. The scores from the test performed in the ER are sent to Polewchak, who reviews the results and then calls every patient between 10 to 14 days after the patient’s trip to the ER to follow up.

    “The test score doesn’t necessarily matter,” Polewchak says. “I can personalize the phone call based on the deficits they had in theoriginal test. I’m looking at what issues they are facing in real life.”

    For example, ability to pay attention might be a deficit, but what does that mean if you’re a student or you’ve gone back to work?

    “For a 16-year-old, it means: Am I retaining what I’m being told in class? For an adult, it means: If my boss tells me to do something, am I able to recall it long enough to do it? Or if I’m writing an email and the phone rings or the dog barks, can I get back to what I was doing.”

    It’s those everyday tasks that people sometimes have trouble with and which Polewchak can flag by asking the right questions.

    She also makes sure that patients know they should see their primary care physician after a concussion. That’s particularly important for young athletes before they get back on the field.

    If patients are still experiencing symptoms, they can be re-evaluated with another test and then be given options for further treatment if necessary.

    Get the Facts About Concussion

    Your teenage son recently suffered a concussion during a basketball game with friends, but he wants to get back out on the court. What should you do?

    According to the Centers for Disease Control and Prevention (CDC), a concussion is a type of traumatic brain injury that occurs following a bump, blow, or jolt to the head or body that causes jarring of the brain. Falls, car accidents, and sports injuries are common causes of concussion.

    What Are The Symptoms?

    You may notice some concussion symptoms immediately following a fall or blow to the head, while others may not develop until hours or even days later. The CDC separates concussion symptoms into the following four categories:

    1. Cognition: difficulty thinking clearly, concentrating, or remembering new information; feeling slowed down
    2. Physical: headache, nausea or vomiting (shortly after the injury), sensitivity to noise or light, feeling tired or drained of energy, fuzzy or blurry vision, dizziness, balance problems
    3. Mood: irritability, sadness, emotional sensitivity, nervousness, anxiety
    4. Sleep: sleeping more or less than usual, trouble falling asleep

    Headache Help

    "Pacemaker" for brain short circuits headache pain.

    Chronic daily headaches affect about 5 percent of Americans. Thankfully, most are short-lived or can be relieved with medication. But in about 1 percent of patients, medication doesn't relieve the headaches - usually migraine or cluster headaches.

    Dr. Mariel Szapiel

    Many of these patients can now find relief with a new, relatively simple procedure called peripheral neurostimulation. During this procedure, a neurosurgeon places an electrode under the patient's skin in the back of the neck, or cervical spine. The electrode is connected to a battery that is implanted on the chest beneath the clavicle - similar to the way heart pacemakers are. The electrode delivers mild electrical pulses to the nerves that affect migraine and cluster headaches. The mild shocks "break" the feedback loop of pain.

    "Recent studies have shown that patients with frequent and intense headaches for more than six months had an 'overwhelmingly positive' response to nerve stimulation," says Mariel Szapiel, MD, a neurosurgeon on staff at Littleton Adventist Hospital who specializes in neurosurgery procedures to treat headaches, movement disorders, depression, and other psychological diseases. "The studies also concluded that the risks from the procedure are minimal.

    The most frequent type of peripheral neurostimulation for chronic headaches is called occipital nerve stimulation. Neurosurgeons implant the electrode over the occipital nerves on the back of the neck. Most patients receive continuous stimulation from the probe and get a remote control to adjust the intensity of the pulses. The procedure has shown to be effective with intractable occipital neuralgia, chronic cluster headaches, and refractory chronic migraine headaches.

    Although the procedure is not completely effective in every patient, Dr. Szapiel says, "Given the severe disability these chronic headaches cause, coupled with the relatively rare occurrence of serious complications from the procedure, we believe that any reduction in pain or the use of pain medication outweighs the risks."


    For major head injuries, timing is everything.

    “The first half hour makes a huge difference in the outcome,” says Steven Kim, MD, trauma medical director at Littleton Adventist Hospital. “In trauma, the cases that kill people are either the intracranial brain injuries or cases where you have to operate right away or they bleed to death. Those are cases where a few minutes can mean life or death.”

    At Littleton Hospital, a Level II American College of Surgeons-verified trauma center:

    • A trauma surgeon along with an emergency doctor meet patients coming into the ER.
    • An operating room and staff, including an anesthesiologist, are available 24/7/365.
    • A CT scanner is in the ER so an ER patient can be scanned in less than a minute.
    • Four neurosurgeons are on staff and at least one is available 24 hours a day.

    Littleton Hospital treats about two dozen patients with head injuries that require emergency surgery a year.

    Timing was critical in the case of a 16-year-old boy who got tackled during a football game. He was brought into the ER when he began to act woozy and confused. Doctors discovered he had an epidural hematoma, an accumulation of blood between the skull and the membrane called dura mater outside the brain.

    “He had significant bleeding. We got him into the operating room within half an hour. The neurosurgeon was able to decompress and control the bleeding.”

    “He walked out of here without any deficits,” Kim says. “He’s a huge success story.”

    Another success story is Jennifer Woeste, who was hit in the head by a fence stake that had been yanked out by a mule. A scan revealed she had an epidural hematoma and she was taken into surgery immediately. She, too, was released from the hospital with no problems.

    Littleton Hospital added its fourth neurosurgeon to the staff recently, and Kim says that’s a rare commitment among hospitals nationwide.

     “Nationally there seems to be a shortage of neurosurgeons who do trauma work. A limiting factor at some hospitals is you don’t have enough coverage for neurosurgery. You need at least two for adequate coverage. I feel very fortunate here. It’s really a coordinated effort.”

    Think of strokes and you probably picture someone in their 70s or older. But an alarming number of stroke victims these days are young parents or even high school students. Alcohol use and poor diets are two culprits.

    “We’re seeing a huge increase in younger patients with stroke,” says Mihaela Alexander, MD, medical director of the stroke program and neurology at Littleton Adventist Hospital. “CDC (Centers for Disease Control) studies from 1995 to 2008 showed that in men 15 to 34 years old and 35 to 44 years old, the number of strokes has almost doubled. The number of females under the age of 45 who suffered strokes also doubled.”

    Alexander’s youngest stroke patient was a 16-year-old girl, and she says it’s not unusual to treat patients in their 20s, 30s and 40s. “These are people who are still working, who are trying to support their families.”

    Fast action saves brain damage. Learn the symptoms of a stroke.

    The risk factors are the same as in older patients. Almost a third of those 15-34 and one half of those 35-44 had high blood pressure—the leading risk factor for stroke. More than a quarter of those 35-44 had diabetes and a third of men younger than 44 and women 35-44 used tobacco, according to the CDC study.

    Alexander also sees a surge in alcohol abuse among young people today. They often don’t eat healthy diets, and they’re less likely to go to the doctor for an annual physical.

    The effects can be devastating. Strokes are the fourth leading cause of death and the No. 1 cause of disability in the U.S.

    Mortality among young stroke victims can be higher because their brains haven’t atrophied as older victims’ brains have. “If a young patient has a large stroke, there’s a lot of swelling in the brain,” Alexander says. “They are at a much higher risk of having increased intracranial pressure. So they wind up having surgery to remove part of the skull bone to relieve the swelling.”

    The good news is that young patients who survive typically have a better recovery and less disability. Their stamina is better and they don’t have as many health issues that get in the way of rehabilitation

    Littleton Adventist Hospital’s award-winning stroke program provides rapid response and comprehensive care to stroke victims in the southern Denver metro area. As an Acute Certified Stroke Center with Comprehensive Capabilities—the highest designation possible—our neurologists, neurosurgeons and neurointerventionists are available 24/7/365. In the hospital’s stroke unit, nurses are specifically trained to care for stroke patients. The hospital’s protocol requires that physical, occupational and speech therapy departments are involved in the first 24 hours of admissions. Alexander and her team review every stroke patient’s case in monthly meetings and send feedback to all health care providers involved in the patient’s care.

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