Rose* has never been one to take pills to combat pain.
But in March 2003, she found herself regularly visiting the first-aid officer at her Dunedin firm, seeking respite from headaches that had been with her for a fortnight.
Earlier that month, on a Saturday night, someone had attempted to close a car boot, not knowing Rose's head was in the way.
Though she had the sensation her eyes "were going to pop out", she wasn't knocked unconscious.
Still, she can't recall what happened in the 36 hours between the accident and showing up for work at her Dunedin office on the Monday morning.
She carried on for a couple of weeks, working in an office "with computers and stuff", Rose recalls.
Then that first-aid officer - also the company's pay clerk and keeper of the paracetamol - suggested her colleague see a doctor.
Rose did. She was promptly sent to Dunedin Hospital.
"I didn't remember much about it. I couldn't keep my eyes open when I was in the waiting room. Someone must have come through and seen me.
"The next thing I recall was being told that, yes, I had concussion and that someone would be doing an eye test and somebody would be in touch.
"So off home I went, back to work the next day and two weeks after that I got into strife at work for being abusive, which is not me . . ."
Five years later, having suffered memory lapses, intense fatigue, cognitive impairment and depression, among other problems, Rose can say with certainty she has post-concussion syndrome.
According to the Brain Injury Association of New Zealand, about 10% of people who are concussed have symptoms that can last for months, sometimes years.
Known as post-concussion syndrome, other problems include emotional and behavioural issues.
The BIA estimates 24,000 New Zealanders are concussed each year, with many more going unreported and undiagnosed.
The majority of concussions - also termed mild traumatic brain injury - are suffered through road-related accidents, sport and recreation and the highest risk groups are children, males between 15 and 30 and anyone over 65.
Organised by the Brain Injury Association of New Zealand, Brain Injury Awareness Week is an annual campaign aimed at raising awareness and understanding of brain injury and its effects.
This year's campaign, "Knocking Out Concussion: concussion in recreation and sport", began earlier this week and continues until Tuesday.
Dr Jane Millichamp, a lecturer in the University of Otago Dunedin School of Medicine's psychological medicine department, says the campaign has an important wider message: early diagnosis and treatment of concussion (in fact, any brain injury) is crucial.
Those who have received a head injury, even a mild one, may lack insight into the nature of their injury and not seek medical assistance, Dr Millichamp explains.
Others may not realise what has happened - "they may think they fainted".
"Brain injuries are very much under-reported. A lot of people receive a bump on the head and some even lose consciousness, which is generally indicative of a more serious brain injury. Many people just get up and carry on."
The results of an untreated concussion can be significant, Dr Millichamp says.
A person who has been concussed can suffer from balance, vision, fatigue and cognitive (eg., confusion) problems, meaning they are more likely to receive another knock.
Their brains are also in a more vulnerable state.
It's a case of one plus one sometimes equalling 10, with repeated concussions resulting in a cumulative effect.
A related problem is second impact syndrome - where a person suffers a second concussion before the first one has healed.
This can create serious problems requiring medical intervention and, in rare cases, can even be fatal.
"Once the brain has been compromised several times within a short period, there may be far more severe effects.
"Suffering three or more concussions increases a person's chances of developing other conditions, such as depression, memory loss and early onset of Alzheimer's disease," Dr Millichamp says.
"There are a number of major barriers in society to getting help. The first barrier is getting people to recognise that even when you haven't lost consciousness, it's a good idea to get medical assistance as soon as possible ...
"If in doubt, get to a medical centre. I think that for some people, such as those playing professional or competitive sports, where they are used to pushing the limits of pain and endurance, there is still a bit of that macho attitude - `I am all right, it's no big deal'," Dr Millichamp says.
"I think for some sports professionals or even people playing more amateur sports, there is a bit of the macho thing - `I'm all right'," Dr Millichamp says.
Rose likes being active. She always has done.
Now in her 60s, the mother of two adult children goes walking, plays bowls (outdoor and indoor) and mows the lawns of her 1500sq m section in Dunedin.
Still, she makes sure she paces herself. Fatigue is an ongoing problem.
The year 2003 wasn't a good one for Rose.
In June, three months after that first knock on the head, she fell and broke her hip (she only found out the extent of the damage when she underwent a hip replacement operation last year) and in September, she suffered a second concussion, banging her head while loading a computer into a car.
Rose laughs as she recalls the computer, believed to be faulty, in fact required no fixing, but there is a cruel irony in the incident.
Her own processing faculties have been compromised.
"It's like a sore finger; you always knock it," she reflects, adding: "That upset the apple cart again."
In October, Rose was made redundant from the office job she had held for more than nine years.
Following her initial injury, she had used up fortnightly blocks of sick leave in an attempt to balance her symptoms with a determination to return to work.
By August, she was working an hourly shift three times a week, "but that was bedlam".
"I sat down on the floor sometimes, with my head in my hands, just trying to stop my head from spinning," Rose says, adding she was surprised at a lack of support from both friends and colleagues.
"Not one staff member rang me at home to see how I was coping . . . I tell you what - my friends changed.
"The people I thought would support me never came near. I have a whole range of new friends now.
"My GP at the time said if only I had a sticking plaster on my head I'd get sympathy. Because I looked normal and tried to carry on as if nothing had happened, there was no support."
Dr Millichamp agrees.
A lack of insight is not limited to those with brain injuries. Because TBI sufferers often look "normal", the injury is invisible.
"People often assume they should be functioning at full level and often they are not . . . You don't see the damage that has been done and people are often swift to judge.
"Families do because they've seen the life-support systems and know it was really serious and that they nearly died, but if you're just an outside observer . . ."
A knock on the head from a car boot? A ding while loading a vehicle? It could happen to anyone.
Yet the extent to which Rose's life has changed is significant. Certainly, it has made her a little wary around the house.
"When I open a cupboard door or bend down to pat the cat, I make sure I take two steps backwards before I stand up.
"I didn't realise the things that could go wrong: the depression, the fatigue, the memory loss . . . It got me down to start with, but after a couple of years I started to laugh at myself.
"If I did something stupid I'd tell someone because that was my way of coping."
* Surname withheld at request.
Concussion facts
Within concussion (or mild brain injury) there are three grades.
• Grade 1: Person doesn't lose consciousness, might be dazed and confused for a short time. Usually normal behaviour returns within about 20 minutes of the injury.
• Grade 2: Person doesn't lose consciousness but not thinking clearly 20 minutes after accident.
• Grade 3: Person has lost consciousness for short time (considered more risky).
ACC facts
• Accident Compensation Corporation figures reveal that of 258 head injuries received across all sports in New Zealand in 2006-2007, rugby union led the way with 46, followed by horse riding (24), motorsport (23), cycling (22), and rugby league (17).
• Although ACC's statistics don't differentiate between the nature of the head injuries - concussions are listed in the same category as moderate and severe injuries - a look at ongoing costs of treatment related to those sports suggests participants in sports other than rugby union are at risk of a worse head injury.
• Divide the cost of care by the number of reported brain injuries within each sport and a different picture emerges: in terms of brain rehabilitation spending, motorsport leads the way with an average of $12,056 per person, followed by mountainbiking ($8504), horse riding ($6815) and cycling ($6620). Rugby comes in at $2883.
