INDIANAPOLIS -- DeShone Kizer refused to use his migraine as an excuse for his poor second half in Baltimore, but two independent neurologists say it may have contributed regardless.

If that's the case, Kizer's three interceptions in what he described as "one of my worst performances ever in any sport I've ever played'' may have all been migraine related.

"Most of my patients, say 'yeah, I'm able to function, I'm able to do my job, but I just don't feel that I'm 100 percent or able to give 100 percent,'' Dr. MaryAnn Mays, a neurologist for The Cleveland Clinic's Center for Neuro-Restoration, who has not treated Kizer, told cleveland.com. "In fact, they've done some studies looking at the millions and millions of dollars lost each year because of employees' reduced ability to work with a migraine.''

Mays added that, "I don't think it would be far-fetched'' to surmise that Kizer's bad second half was migraine-related, despite the fact he wasn't experiencing symptoms.



Returning to the game was totally fine

"He certainly wasn't causing any harm to himself by going back in and playing with a migraine, but you might not want to judge him off that game,'' she said. "When we think of migraine, yes it's the head pain, but that's only part of the disability associated with migraine. People get light and sound sensitive, they can get nauseated. A lot of patients report feeling dizzy or unsteady so the balance is off.''

Kizer, who will face the Colts here on Sunday, left Sunday's 24-10 loss to the Ravens in the second quarter after experiencing symptoms on a first-quarter drive that ended with an interception. It began with a vision disturbance and then segued into a mental lapse on a screen pass to Duke Johnson, when he forgot to put a man in motion and then went to the wrong side with the ball.

The pass glanced off Johnson's hand and was picked off for Kizer's first interception of the game.

Coach Hue Jackson, sensing something was wrong, called for an evaluation by the medical staff. In the locker room, doctors first ruled out a concussion, and then diagnosed a migraine, something the rookie has suffered with since he was a child.

After taking medication, Kizer assured the medical staff that his symptoms were gone, and he was cleared to return midway through the third quarter. But even though there's no medical risk in returning to the game with a migraine, Kizer may not have been operating at peak efficiency, the doctors said.

"Most people with a migraine won't return to normal very quickly,'' Mays said. "Some migrainers will start to get relief within a half an hour, but most people would say if 'I could get my headache under control within two hours, it's pretty quick.'''

After returning to the game, Kizer completed only nine of 20 attempts for 101 yards, with two interceptions for a 21.04 rating. But he shook off the easy excuse after the game.

"Maybe the last drive (before he left in the second quarter) when I first started getting some of the visual things it was pretty difficult,'' Kizer told cleveland.com. "But by the time I was back out there, I honestly really wasn't feeling the symptoms.

"I had a couple of 'hangover' headaches later after the game, but while I was out there I felt 100 percent."

Both Mays and Dr. Vernon Williams, sports neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine in Los Angeles and a consulting team physician for the Rams, suggested Kizer may have been affected without realizing it. They described the "postdrome phase" of a migraine, where the headache is gone, but performance is still impacted.

The Browns declined a request by cleveland.com to speak to their team doctors about migraines.

"Most people say that even after the headache is successfully treated they have kind of the leftover phase,'' Mays said. "They feel like they've been run over by a semi-truck. ... There's usually some lingering symptoms that (patients) have to deal with whether it's due to the migraine or even the side effects of the medication used to treat the headache.''

Williams agreed.

"There's absenteeism -- people who can't go to work because they have a migraine -- but there's a condition that we call 'presenteeism' -- they can get there, they can be there, they can be at work, but that migraine still has an effect on their productivity, their accuracy. So it's certainly within the realm of possibility that the headache was improved or gone but there could still be some residual effect of the migraine.''

Williams noted that "after the pain is gone, there's still a period of time where the brain kind of re-establishes normalcy.''

Kizer, who hasn't suffered a migraine during a game since high school, insists he was totally fine.

"If we felt as if I wasn't 100 percent myself, then I would've never stepped out there,'' he said.

Everyone believes the episodes are behind him

Describing an in-game migraine as 'one of my worst nightmares,' Kizer doesn't believe he'll have another one because they typically only happen twice a year.

Jackson has also been assured by the medical staff that it won't be an issue, so much so that he'll dress only two quarterbacks for the game again in Indy.

"I feel very comfortable with our medical team and the information given to me,'' said Jackson. "We're going to know more. And believe me, we are going to work through that. And if we need to, we will (dress three). But I feel comfortable that those things, hopefully, are behind us right now."

Head impact can trigger a migraine

Kizer was hit hard a couple of times in the first half, including one nullified sack by C.J. Mosley on which the back of his helmet hit the ground. Mays said such a blow can trigger a migraine.

"Certainly head traumas can cause migraines, but even just a milder hit to the head, when you you have a headache already ongoing, can worsen the pain,'' she said. "A lot of my migrainers tell me bending over to pick things up sometimes -- even that small type of exertion can trigger a headache. So either getting hit in the head or kind of twisting the neck can sometimes trigger migraines."

Williams stressed that it's not difficult to differentiate between a migraine and a concussion during a game.

"Many (players) have had them for years and know what the onset is like,'' he said.

How to prevent another migraine

Both Mays and Williams said Kizer can prevent another episode by regulating his sleep.

"We know that by and large the brain likes consistency,'' said Williams. "So to the extent that individuals can regulate their sleep, regulate their nutritional status, regulate and hydrate appropriately, those kinds of things we believe are going to mitigate against (an episode).''

Williams stressed that if Kizer experiences any symptoms at all during or after practicing or playing in the future, it shouldn't be assumed they're another migraine.

"Whether they feel they're consistent with the migraine episodes or not, they should have a concussion assessment, concussion testing, and balance testing,'' said Williams. "A physical examination can tease out whether what's being experienced is a concussive episode or whether it represents a migraine.''