Allison Kasacavage, 17, a junior at Downingtown East High School, copes with headaches - "all the time" - plus nausea, dizziness, and light-sensitivity, despite a heavy regimen of meds and occasional trips to the emergency room.
While she stayed home most of sophomore year and still misses some days, Kasacavage now is shooting for a 3.9 grade-point average and to attend college to become a neonatal physician's assistant.
"I used to be the athlete," she said. "Now I'm the girl with concussions."
Two years after their plights were documented in The Inquirer and on Dateline NBC, the road to recovery for Thomas, Kasacavage, and four other girls has entered a quieter, perhaps more critical, stretch. Today, their battle against pain and depression is tied to the work of medical researchers seeking to learn more about the longer-term effects of sports concussions and to develop therapies to treat chronic symptoms.
"We're definitely seeing a subset of kids with very complicated, prolonged recoveries, and we're not sure why that is," said Christina L. Master, a sports-medicine specialist and concussion researcher at the Children's Hospital of Philadelphia.
Master said researchers had long believed the overwhelming number of young athletes recovered quickly from a concussion, but evidence is increasing that up to 20 percent suffer prolonged symptoms. A smaller percentage have serious chronic pain. She said researchers were looking at a variety of factors, from genetic predisposition to the growing intensity of youth sports.
Several recent studies have identified a higher head-injury risk in girls' soccer.
Kasacavage and Jenna Rohr, 17, also a junior at Downingtown East, are about to begin treatment at Children's Center for Amplified Musculoskeletal Pain Syndrome, or AMPS - an intensive program that seeks to get young pain sufferers off medication and desensitize them to their symptoms.
They will spend a grueling eight hours a day for three to five weeks "retraining the nerves" to get them back to normal, said the program's director, David Sherry.
"We address the pain directly," he said, adding that the success rate was 85 percent to 90 percent. "If you can't walk, we make you walk. If it hurts to touch, we touch. If it hurts to read in a loud room, we put you in a loud room with lights and make you read."
Eastern Chester County, where youth soccer rules, has a high stake in the progress of treating adolescent head injuries.
As the girls enter their junior and senior years of high school, their stories of pain and perseverance remain tightly wound.
Only Casey Biddle, 17, a senior at Twin Valley High School - who, after three concussions and whiplash, needed to take two naps daily in the nurse's office to get through school - said she finally was functioning almost normally, although with frequent headaches. "I have a high threshold for pain. Two Advil in the morning," she said, "and I'm good to go."
She, too, thought she would return to soccer, but now channels her energies into a job at a preschool and her dream of being a teacher.
Rohr - who had been avidly playing soccer since she was 6, but suffered a run of concussions - has been to Bryn Mawr Rehab three times and tried Botox, which relaxes muscles and may reduce pain.
Still, her headaches are 24/7 and usually a Level 7 or 8 on a scale of 1 to 10. She also copes with severe anxiety attacks.
While she has missed considerable school time, Rohr said she was up to five classes a day now; she has dreams of attending the Fashion Institute of Technology and has high hopes that the pain program at Children's will cure her headaches.
Only one of the girls has gone back to soccer - as a coach. Kimmie Zeffert, 17, is helping her brother manage a travel team of 13-and-younger girls. One of her jobs, she said, is to check the other players for concussions. "If they take a weird hit to the head, I know to look in their eyes. Or if I see them staggering around, I'll ask them if their head hurts and have a headache," she said. She still has daily headaches that sometimes require trips to the emergency room.
Schoolwork, not sports, is her main priority now. She's determined to be a sports-medicine doctor and concedes that she sometimes "works so hard I'll make myself sick."
Thomas, a junior at Downingtown West, said it was hard to even get out of bed some mornings to start her daily regimen of seven or so different pills for pain, depression, and anxiety. She doesn't think she will ever get better, so she focuses on acceptance and her aim of becoming a psychologist.
"I like reaching out to people and sharing my story," she said, "because I've been through the wringer and back."
The stress has taken a huge a toll on their parents, too. Zeffert's mother, Wendy Zeffert, said she quit her job as a teacher in Tredyffrin/Easttown to work as a nanny and have more flexible hours for trips to rehab or for dealing with other issues.
"Once, she texted me and said, 'I'm passing out,' " Wendy Zeffert recalled. "I said I was on my way and called the nurse to give her a heads-up. The nurse showed up with a wheelchair. Boy, was she mad at me - but I didn't know what to do."
In addition to pain and depression, Caitlyn Murphy, 17, said she has experienced blackouts. The worst was in English class when she was talking and "couldn't answer," she said, "because I didn't know what was going on."
Through it all, the girls are pushing forward with the normal teenage rites of passage, even as friendships falter because they miss so much school. Murphy is the only one who has not gotten her driver's license. The junior and senior proms are coming up, and Zeffert urges Kasacavage to go with her, since Kasacavage just broke up with her boyfriend.
One of the problems, said Kasacavage, was that he often complained of his own issues.
"He was out of school with a Level 1 headache," she said incredulously to the other girls, who all understood.
Said Murphy: "I wish I had a Level 1 headache."