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Headaches After Traumatic Brain Injury

Comments [9]

Kathleen R. Bell, MD, Jeanne Hoffman, PhD, and Thomas Watanabe, MD, Model Systems Knowledge Translation Center

Headaches After Traumatic Brain Injury

Headache is one of the most common symptoms after traumatic brain injury (often called “post-traumatic headache”). Over 30% of people report having headaches which continue long after injury.

Why are headaches a problem after brain injury?

Headaches after TBI can be long-lasting, coming and going even past one year. Headaches can make it hard for you to carry out daily activities or can cause you to have more difficulty thinking and remembering things.

Why do headaches happen after brain injury?

Right after a severe TBI, people may have headaches because of the surgery on their skulls or because they have small collections of blood or fluid inside the skull.

Headaches can also occur after mild to moderate injury or, in the case of severe TBI, after the initial healing has taken place. These headaches can be caused by a variety of conditions, including a change in the brain caused by the injury, neck and skull injuries that have not yet fully healed, tension and stress, or side effects from medication.

What are some typical kinds of headaches after TBI?

Migraine headaches

These kinds of headaches happen because an area of the brain becomes hypersensitive and can trigger a pain signal that spreads out to other parts of the brain (like the ripples that spread out after you drop a pebble in water). These headaches typically have the following features:

  • Dull, throbbing sensation, usually on one side of the head.
  • Nausea or vomiting.
  • Light and sound sensitivity.
  • Pain level rated as moderate to severe.
  • You might get a “warning” signal that a migraine is coming on, such as seeing spots or bright lights. This is called an “aura.”

Tension-type headaches

These headaches are associated with muscle tension or muscle spasms and stress. They usually have the following features:

  • Tight, squeezing sensation, often around the entire head or on both sides.
  • Pain level rated as mild to moderate.
  • Occur later in the day.

Cervicogenic headaches

This type of headache can occur when there has been some injury to the muscles and soft tissues in the neck and the back of the head. Many nerves that are located in the tissues and bones of the neck have branches that travel to the skull and scalp and can result in head pain. This type of headache usually has these features:

  • Often start in the neck, shoulders and back of the head, and sometimes travel over the top of the head.
  • Neck movement or positioning can make the pain worse.
  • These headaches are not usually associated with nausea and can range from mild to severe.

Rebound headaches

Sometimes the very medicines used to treat headaches can actually cause headaches. When pain medicines are taken daily on a regular schedule, missing one or two doses can result in a headache.

You also can develop a rebound headache if you decrease the amount of caffeine you use. For example, if you normally drink a lot of coffee, tea or energy drinks but don’t get your usual amount, you may get a headache.

Other facts about headaches

Although there are many other types of headaches, these are the most frequent. It is not unusual for someone to have two different types of headache. For certain headaches like migraine, a family history is common.

Should I worry about having a headache?

Most headaches are not dangerous. In the first few days after a concussion or head injury, a person should see a health care professional experienced in treating persons with brain injuries IF the following occurs:

  • Your headache gets worse.
  • You have nausea and/or vomiting with a headache.
  • You develop arm or leg weakness or problems speaking along with a headache.
  • You have increasing sleepiness with headache.

Do I need special tests to diagnose a headache?

In the first few days after a head injury, doctors will often order a CT scan of your brain to make sure there is no bleeding in your head. After that, a brain scan or other test is rarely needed in order to diagnose a headache accurately.

Usually, the health care provider will rely on your history and symptoms to sort out what kind of headache you are having and how to treat it.

What can be used to treat a headache after TBI?

This will depend on each individual case. It’s important to discuss your headaches with your doctor and to keep track of headaches and your response to treatment. Many people use a headache diary to help them do this.

Lifestyle changes to help prevent headaches

The first steps in treating any type of headache don’t involve drugs or other therapy. Many times, lifestyle factors can trigger headaches or make headaches worse. Making simple changes can often make a big difference in whether or not headaches occur. Try to:

  • Get enough sleep.
  • Get daily exercise. Aerobic exercise such as walking and good stretching often help to prevent headaches by improving sleep and decreasing triggers. If a headache is worsened by any particular exercise, check with your health care provider.
  • Avoid caffeine.
  • Avoid certain foods that may trigger a headache, like red wine, monosodium glutamate (MSG, a common food additive) or certain cheeses.
  • Avoid taking pain medicines on a daily basis unless your health care provider prescribes it.

Common types of treatment for occasional headaches include:

  • Over-the-counter pain medicines like acetaminophen (Tylenol®) or ibuprofen.
  • Prescription medicines for migraine headache like sumatriptan (Imitrex®).
  • Relaxation therapy/meditation.
  • Biofeedback therapy.
  • Stretching and self-massage.
  • Acupuncture.
  • Local injections (numbing medication or steroids, or for example) to muscles, nerves or joints of the cervical spine.
  • Therapeutic massage.
  • Heat or ice packs.

Treatments for recurrent headaches that happen more than twice a week

Headaches that occur frequently may require a prescription from your physician. The following medications may be used to treat headaches following TBI:

  • Antidepressants.
  • Antiseizure medicines (like gabapentin, also called Neurontin®).
  • Certain blood pressure medication called beta-blockers (like propranolol).
  • Botulinum toxin (Botox) injections.

References

  1. Hoge CW, McGurk D, Thomas JL, Cox, AL, Engel CC, Castro C A (2008). Mild traumatic brain injury in u.S. Soldiers returning from iraq. N Engl J Med, 358(5), 453-463.
  2. Lahz S, Bryant RA (1996). Incidence of chronic pain following traumatic brain injury. Arch Phys Med Rehabil, 77(9), 889-891.
  3. Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC (2006). Characteristics and treatment of headache after traumatic brain injury: A focused review. Am J Phys Med Rehabil, 85(7), 619-627.
  4. Marcus DA (2003). Disability and chronic posttraumatic headache. Headache, 43(2), 117-121.
  5. Mihalik JP, Stump JE, Collins MW, Lovell MR, Field M, Maroon JC (2005). Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg, 102(5), 850-855.

Headaches After Traumatic Brain Injury was developed by Kathleen R. Bell, MD, Jeanne Hoffman, PhD, and Thomas Watanabe, MD, in collaboration with the Model Systems Knowledge Translation Center. Copyright © 2010 by University of Washington/MSKTC. http://www.msktc.org. Please check the MSKTC site for any recent updates on this article.

Comments [9]

Three years ago I had an Acoustic Neuroma removed on my right side.  The doctor got all of the tumor but left me with 100% hearing loss on my right side.  Since waking up from the surgery, I have had constant headpain.....not headache...but head pain.  I have been to numerous doctors, specialists, Neurologists, and have tried every medicine under the sun.  I get comfort in perocoset about every 2 - 3 hours daily.  Most nights not needed, but an occasional night, but few and far between.  I have come to the conclusion that when they operated, they damaged the nerves in my head and cannot be detected.  I'm at my wits end.  I've never thought of this as a tbi, but, i should change my way of thinking as I believe it is.

Feb 20th, 2014 3:43pm

I have got a tbi 15 yrs ago and  I use to have headaches everyday of my life. I gotta new doctor  4 yrs ago he did a lot of research and put me on topamax and it was the answer. I

Jan 12th, 2014 5:56pm

Approx 13 yrs ago I had a lg bleed in my brain and am lucky to be alive. I too appear physically fine. The defects are all hidden and therefore life as difficult as my brain makes it, is made more difficult. The hardest symptom is that for 13 years not one day has passed that I have not had a headache. The only difference is the level. Triggers can be stress, expectations of others, the weather or I just wake up in severe pain. It is a horrendous way to live and only one person, my doctor, ever understood. Unfortunately he suddenly passed also of heart failure. 3 children a husband and elderly mother. They know but after 13 years, still no clue of all symptoms because I look good. Everyday is so hard. I even have neighbors taking photos of me if I go outside I guess trying to show I'm fine and one was a trained special ed teacher. scary.

Oct 30th, 2013 8:27am

Ive had multiple TBI's medical marijuana is the best pain management treatment i have experienced as far as side effects go

Oct 6th, 2013 8:54pm

My headaches were non stop for about 14 months after TBI. I medicated every day..but first tried to go without it until headache was unbearable. Every day it got longer and longer before I needed pain meds. Today..4 years later, I still take nightime pain meds or I wake with a headache. I too gained a lot of weight and have still many balance issues. I use Visalus protein shakes for good nutrition and weight management. I am now researching how to regain, or retrain my balance so that I will stop falling.

Aug 27th, 2013 8:40pm

I have had a persistent headache following a closed head injury for the past six weeks. The headaches are often accompanied by nausea, left ear earache, and pressure and pain on the left side of my neck. I have been seeing a pain specialist who has administered two injections at the base of my skull only to have them offer very little relief. He finally put me in the hospital for five days with a dilaudid pain pump to ease the pain and for those few days I felt a tremendous amount of relief. After discharge from the hospital the headaches came back in full force and I am miserable. Any suggestions about what course of action I should take next to get rid of these blasted headaches would be welcomed. Thank you

Jun 10th, 2013 10:47pm

I treat brain injury patients in my role as a pain management specialist in a prominent rehab hospital in Atlanta. I see a lot of post-traumatic headache and have found sphenopalatine ganglion block to be an extremely helpful treatment which is generally well tolerated and very low side effect profile.

May 19th, 2013 10:16am

You should also mention Chiropractic and Physical Therapy as treatment options. These are some of the most helpful treatments for cervicogenic headache. If the head/brain has received a trauma it is highly likely that the neck sustained a trauma as well. The neck can become unstable/weak and proper restoration of joint motion and muscle reactivation will speed the neck recovery. Massage or stretching alone will usually only help to reset a tight muscle but not necessarily facilitate the deep flexors for stability (longus colli, longus capitis). This can lead to a chronic condition where the compensatory muscles continue to become overworked and necessitate regular treatment. Additionally, the dysfunction/compensation can work it's way into the thoracic spine as well leading to altered neck function persisting the cervicogenic headache. Make sure a complete exam is done by your healthcare provider and don't consider the overlook evaluating the entire system. Doug Maxeiner, DC

May 19th, 2013 7:51am

my poor husband is 10 mts after his Brain Trauma and not one day goes by without a servere headache.The headach increases if he tries to do any form of exercise and also he gets internal tremors and tinnitus changes to a very high pitch. It has totally ruined our lives. He sits for most of the day and as a result has gained over 3 stone in weight. His MRI was normal. We are going crazy can anyone help. Our Neurologist has changed his meds again and it isn't easy

May 15th, 2013 3:03am


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