Headaches After Head Injuries — Post-Traumatic Headaches

Seymour Solomon, MD, Headache Unit, Montefiore Medical Center, Albert Einstein College of Medicine
Headaches After Head Injuries — Post-Traumatic Headaches

Headache immediately following a head injury usually clears after minutes or days but sometimes headaches may persist for months or rarely years. The long-term headaches are called post-traumatic or post-concussion headaches.

One can understand why headaches may follow a moderate or severe injury to the brain such as a concussion (bruise) or laceration (tear). What has been more difficult to understand and has presented an ongoing controversy are chronic headaches following mild head injuries.

Mild injuries of the brain are characterized as a concussion (a brief disturbance of brain function causing loss of consciousness or transient difficulty in thought processes).

Because the neurological examination after mild head injury is normal and standard tests as well as imaging studies (such as MRI or CT of the head) similarly fail to reveal abnormalities, many thought that the symptoms following mild head injury were psychological.

But microscopic studies have shown disruption of the nerve fibers in the brain due to the stretching or shearing forces of the trauma. Other subtle changes have been noted in brain functioning.

The clinical features of post traumatic headache may vary from one individual to another. Most headaches would be now classified as chronic tension-type headache. These headaches are typically a steady ache affecting both sides of the head and occurring daily or almost everyday. They are of slight to moderate intensity but intermittently, upon this base of low grade headache bouts of severe or moderately severe headache may occur and these often are similar to, if not identical with migraine (one sided throbbing pain associated with nausea and sensitivity to light and noise).

Unfortunately, people who experience post traumatic headaches also experience other symptoms of the post-traumatic or post-concussion syndrome. There may be other neurological symptoms such as dizziness, ringing in the ears, vague blurring of vision, psychological symptoms occur such as depression, anxiety, personality change, disturbance in sleep, and impairment libido.

Finally, people with the post-concussion syndrome have changes in their mental functioning, primarily difficulty in concentration, inability to work efficiently and associated difficulty maintaining attention and retaining memory.

The treatment of post-traumatic headache, as well as other features of the post-traumatic syndrome is symptomatic. That is each symptom is treated individually because, unfortunately, there is no medication that will alter the underlying disturbance in the brain.

Most often treatment of the chronic tension-type headache consists of such medications as the tricyclic antidepressants (for example amitriptyline). These agents not only diminish depression but also decrease pain.

The periodic worsening of headaches, if they have characteristics of migraine, are treated with typical migraine medications (for example, sumatriptan for an acute attack).

Non-drug methods of therapy are also advisable. Healthy habits should be encouraged by elimination of nicotine and alcohol, by recommendations for regularity with regard to sleep and meal time and by exercise at least every other day. Relaxation techniques may be helpful. These can be learned by biofeedback techniques as well as by such methods as meditation.

Last but not least is attention to psychological factors. The family, friends, and employer or teacher should be educated so the fact that headaches are not purely psychological but have a basis related to the disturbed structure and chemical functions of the brain. A psychologist may be helpful in teaching pain coping techniques and in treating the psychological symptoms that are part of the post-traumatic syndrome.

Fortunately, most headaches following head injury gradually taper off within the first three to six months. Even those unfortunate individuals who experience symptoms much longer can be helped.

Posted on BrainLine December 15, 2008

From Help for Headaches. www.headache-help.org.

Comments

Thank you for this important and relevant information!

My daughter slip and fell flat on her back twice in two weeks last December and hit behind her head, now she's having headaches once there is noises around, now she's feeling dizzy and nausea. What should I do

I think this is a good article and explains a lot Betty

Hello I have a question.

So my grandma tripped on 11/4/17 and hit her head on the right side temple. Went to the ER. Ran CT scan, xrays, ect. All came back good.

Last week she started feeling a pressure in the area. She said it doesn't hurt, but it's annoying. Went to the Dr. He said he thinks it just post concussive tension headache. It's just weird that it came up almost 2 months after.

He said if it continues he will order another CT scan but he doesn't think it's anything serious.

And I over reacting and over thinking? I need some awnsers.

Just wanted to share that our 8yo son collided with another child in a slippery slide! (The other child was coming up as he was going down a tube slide, so couldnt see each other)
More than 8 months on and he is still suffering from headaches.
We have found that Bowen works wondeers for easing his headaches, but he needs it every 2 weeks pretty much. We'd like a longer term solution, so have begun using a blend of Essential Oils tat we used on oir 3yo with consussion a couple weeks ago. For her, the vomiting wouldnt stop with panadol, but relief eas almost immediate with the oils!
If anyone is interested, the oils are Cypress, sandalwood, frankincense. 8 drops each in a 10ml roller topped with a carrier oil like fractiknated coconut oil.

My God! You need to call the police on that husband of yours and get out of that situation NOW!

I have gotten 4 concussions from sports, 3 in the past year and I’m only 20 years old. I got my 4th one this past August and I am still getting headaches every day. I powered through the semester at college but it was very very hard because having painful headaches every day is difficult. The only relief I have found is to take amitriptyline and I also have been in physical therapy since October and have been improving. One thing of advice to every one dealing with these headaches is not to let them define you and try to focus on something good that is going to happen that day. I have been reminding myself of this quote, “everyday may not be good, but there is something good in every day”. Hang in there everyone one day it will pass!! Don’t give up hope!!

I have gotten 4 concussions, 3 in the past year and I am still dealing with the 4th one. What I found helped is taking amitriptyline and I also go to physical therapy! If your son is still getting headaches and if you haven’t tried those suggestions I highly recommend them! Hope he gets relief soon!

I got assaulted last year in work, nose was broke and I was severely black and blue for seven weeks. That was a year ago, I have been getting headaches on a daily basis, real bad ones, suffered from memory loss, blackouts depression etc. recently I have been diagnosed with post traumatic headaches and post concussive syndrome, I have been put on amtripilyne, it’s disgusting, makes me feel so sick!!! And my job want to put me back on full duties, I think it’s crazy

my partner got physically hit by a car this past March, he since has gotten headaches that worsen and don’t get better. It’s been 9 months since his accident. And the results stay the same. The doctors keep giving him antidepressants that aren’t even helping him. And my partner doesn’t want to switch doctors even though it’s probably a good idea and I’m just lost at a point. any suggestions?

I am sorry that you are going through this. I arrived to this website searching for information to help me. I have struggled all year with continuous mild to moderate headaches, lack of concentration and memory. It has completely affected my life. I was not sure what was going on with me and I finallly realized a month ago that it all started and has continued to a lesser degree since I fell a year ago. It is hard for people to understand the what we describe or experience. When I explain my symptoms, almost everyone replies, oh yeah, stress does that to all of us, oh yeah i suffer from headaches too, oh yeah i don't have a good memory anymore either. It took a lot for me to realize what was wrong with me and to make a big effort that i did not have any of these problems before i fell.
I suggest you to keep looking for help, and keep trying to explain your symptoms even when people try to minimize them, please don't give up, try to pray a bit more and ask God to help you get the help that you need from doctors and others.

Hi Dave, I am sorry to hear of your circumstance. I was wondering if you have considered seeing a chiropractor and/or an acupuncturist to see if you can find relief from your headache? My son got a concussion back in February and he had a very difficult time with post concussion syndrome. He missed so much school because of stroke mimicking migraines that he made no academic progress from Feb-June, and had to have a tutor over the summer. Finally, in July, a light bulb went off and I brought him to a chiropractor. After his second visit, he wasn't experiencing the debilitating migraines and after his 4th visit he was feeling almost 100%. Thankfully he and busted his butt to get back on track academically. I hope that you are able to find some relief, Dave. Best of luck!

In 2014 I was beaten up by 3 men with baseball bats. The headaches I still get are demoralizing and I have memory problems too. I just want help but no one is interested. Honestly, if it wasn't for my kids I'd finish it. I've been waiting for god knows how long to see a neurologist and now I'm being told I'm fit for work. Is there anything I can take to relieve the pain? I need to and want to work again but don't feel I can while I'm suffering this.

Good article. Especially dealing with PTSD. For years now complex PTSD. It's actually considered an anxiety disorder. More education needed on PTSD. It's not just veterans these days but it can happen to anyone living through TRAUMA. Car accidents, abuse violence etc.

I hurt my head with a glass and since then I've been having headaches and memory loss. This happened 5 years ago.

No matter how long ago it doesn't matter.
I'm sorry they handled it so casually for you back then.
Sometimes I still think we live in the dark ages.
Find a head specialist and go to them.
You need to find out if there is plaque on your brain that could be causing
problems throughout your life.
There are medications and maybe things they could do to help you.
I hope you look into it.

CAR ACCIDENT 2004 SMASHED MY HEAD OTHER SERIOUS INJURIES AFTER HIT AND RUN KILLED MY FRIEND IN THE CAR. LEFT ME TO DIE. I TOOK AMITRIPTYLINE BROUGHT DOWN MY BP TO 89.46 SO WE STOPPED IT. I HAVE HORRIBLE HEADACHES THEY SAY DUE TO PLATYBASIA AND CHIARI MALFORMATION 1 6 HEADACHES SO FAR THIS MONTH ON MAXALT. I REMEMBER THE CAR HITTING US TAKING OFF THEN WENT OUT ALL IS BLANK AFTER THAT. STABLE PLATYBASIA RIGHT NOW GO BACK FEBRUARY 13TH FOR CHECK UP STANFORD

Same thing happened to me still having a rough time.

Hey, you actually can get hormone tests on the NHS - JUst ask your GP and it can be added to a standard blood test.

There are also health centres around the UK that offer reduced rate nutritional testing on certain days. It's worth calling aroundany health centres close to you to see if there's anything in your area.

My son is 12. Same scenario. Desperate to find relief.

My son 13 at the time was hit in the eye with a baseball, he lost all sight in his right eye June 3 last year and has had a terrible head ache ever since. NOTHING works to ease it please if anyone has suggestions... I am not sure where to go from here!!!! HELP

I had a really old chest freezer lid come down on my head. It almost knocked me out. After, I had terrible headaches, nausea and dizziness and neck pain. I went to my chiropractor. She said my neck was out of alignment as was my skull. After just one visit my headaches, nausea and dizziness went away. I go back once in awhile when my neck starts hurting and the symptoms start coming back. I hope this helps you.

Thank you for sharing this info. I too have fallen on the ice and cracked the left back of my skull. I find your information interesting! Sounds like I need to try out these as my primary care doctor does not know what to do. I've been sent to a neurologist who does not seem to care what I have going on. The prescriptions I have been given leave me unable to function and actually make me worse. I hope you are doing better and might have an update.

I have used Zipsor 25mg for the pain in my head from TBI. It is very helpful. The medicine is very new and my neurologist prescribed it for me. Hopefully it will help you too! God Bless!

a year and a half ago I had an overhanging work lamp come loose on the left side, swing down and hit me on the left side of my head and neck, knocking me down. Since then I have daily migraines, vision problems, dizzy spells, memory problems , panic attacks, and other things I just cant think of at the moment. I get panic attacks when I am at the store or public functions and dont like to go anywhere anymore.

Vena, please call a domestic violence support network. They will get you the medical treatment you need.

My husband of 11 years hit me in the head on my right temple with a broom handle last year... now I'm having random throbbing in the same spot a year later and the internal little knot there has never gone away! You can't see it but you can feel the difference from the right side of my head to the left... don't have insurance right now and today it throbbed when I was just swallowing a bottle of water... so scared that something's internally wrong!

Iam sorry.we feel that way too.i rub peppermint t sometimes on my husband's head it helps some I agree w holistic approach.i just cut my hubby off adville today..I know I cant make him suffer in pain.so.i won't hold out but I don't want his reliance on it to hurt his liver..I have a product that orgionsted w Chinese and it's a balm I use it on.my knee.it gets cold if you need cold it gets hot if you need hot perhaps on a achy mucsle...I have had ,6 knee surgery s and an expermental one at Due..and days I can't hardly walk it gets me up so we use on us mevh and it does help..I hope the gentleman above reads about this..I can't function would it..if anyone is interested I can put u in touch w the woman who I get it from..God bless you buddy..you may request our number and we will be support..if you can support us too.you know sometimes all you need in that moment is someone to care..that's medicine too...

The other day my bf n I was having a disagreement, n he held my head (I already have neck spasms n back pain) downwards. I was trying to get away, the more I resisted, he held me harder. When I got out of the hold he punched me in the face. I think I knocked out, when I came to I attacked him in defense.
But since than I have terrible headaches, behind my eyeballs hurt, my neck is stiff, when I bend over I feel funny, it hurts to shake my hands. I have no medical insurance so I can't afford to go to a doctor. I am concerned because it doesn't feel right, I can't sit too long.

concussion problems. Chronic headache sufferer here. Its not been great waking up and pretending my head is not splitting. This site gave me some answers though on why i may be having this insane headache. It seems there may be no way to cure these headaches.

Exactly what I am experiencing. The emergency room doctor says migraine and acts like the headaches and fall are unrelated. It's a very good thing that the treatment for both is the same.
Im 32 my name david beynon I had a football accident 3 weeks ago I clashed heads with my team mate I took the most on the inpacked I was knocked out for 5 too 10mins but after I came around i had a massive lump on my eye it was like a golf ball but I carried on playing football but a day or two I went to A&E for scans and stuff but broke a cheek bone and had concussion but ever since the accident iv had headache all the time can u give me any advice .
I got a head injury from work 6 months ago and still get headaches nausea vomitting and mood swings that you couldnt believ

Hi just came along this article,I've had 4 concussions,but particularly my 3rd one in 2006 I had a severe concussion and was unconscious for 2 days with amnesia from about a week before and after,it is 2017 ,I still get an abnormal amount of headaches and dizziness,could this some how be related(post concussion trauma)?

I was injured in January 2007, and was not taken to A&E until about an hour afterwards. I was given two painkillers and sent home. I have had all the symptoms of postoncussion syndrome since that day, with my head pain being constant but fluctuating. I had experienced migraines earlier in my life but had eliminated them with diet. Since my injury I have experienced a new kind of migraine - auras and dizziness, whereas I used to just vomit. My condition has worsened and now I also have fibromyalgia and M.E. along with deafness and balance problems from the damage.. It upsets me a lot that doctors pay little to no regard to us; prescribing various medications when's what we really need is a holistic approach to the problem. The books I have dipped into and the research I have seen all point to hormone and nutritional imbalances. I cannot obtain tests for these however, as they are not available on the NHS. I cannot exercise because when I try, the pain becomes unbearable. My weight has gone up because of my sedentary lifestyle and need to rest. I feel like I have bee n abandoned.
I'm almost 4 years into recovery and I have the worst pressure in front of my head. In my forehead and eyes

I am 52 years old and 38 years ago I was helping my uncle build fence and was driving a T-post in when I raised the driver off the post and when I brought it back down I hit the edge of the driver on top of the post and brought the driver down on top of my head. The vibration going thru my head broke both my front teeth off at the gum line and my head was bleeding profusely. Went to small local hospital and after sitting in waiting room for over an hour they sent me to a doctors office who just sowed my head up and sent me home. Now I am having headaches and memory issues and swings in my emotions. Don't know what I can do after so many years.

I'm 19 and have extremely bad headaches after hitting my head of a celling , these appear everyday for sometime of the day ,I also suffer with bright lights which strain my eyes and cause blures/flashy lights and Sometimes my ears ring , this is the worse thing I have experienced , I've had these sypthomes for over a month and have been to the doctors various times there's not any medication that helps with this , just thought I would let other people know as I was conserned I could of had a bleeding to the brain but is very clear I don't :)
I was hit in the head playing rugby. Not that hard but received great whiplash and concussion. I have on going headaches and pains in my head. It has lasted for almost 3 weeks now I need help.
I was swiped in the left occipital by a vehicle, impacting areas in the head all over. It was explained because I did not roll over from the hit, taking it standing has brought the concussive impact to both sides of the brain. It is also from my experience, not completely verified, that the brain becomes very sensitive at this point. I say this because it was months in when I started developing nausea and vomit. This has progressed now where I can't sit calmly through a whole movie. Trying to make sense of what the damage has been is increasingly tough psychologically. Mostly because I have to come face to face with what might be my limitations. I'm a student but this has to be true for anyone realizing that there are some things that I may not be able to do as easily. Something as simple as reading or watching Dark Knight Rises without clutching nausea pills. Thank you for writing this post. The worst part of all this, aside from the excruciating pain, is the idea I'm alone and now lesser in every value so I need help. The challenge here is without knowing the right people, from doctors to lawyers, a person can disappear without ever getting the right diagnosis. So a victim of concussion is just a (fill in the blank). This can begin to negate confidence in oneself and open a void. That vacancy that gets created from the injury as life begins to shift can be like mine for a time, supplication into what I can do. That kind of impairment is one of the worst to be at the mercy of the injury. I'm still at the post-concussion syndrome phase and have not got the opportunity to get the high density or the nerve damaged x ray. I don't know if a concussion is one of those things that can never fully be explained but getting the proper help has been just as difficult as explaining it. If there are more resources, please share. Thanks
In May 1999 On was on the back of a moped in Cancun, Mexico & a bus hit me. My parents had to front $24, 900.00 to get the medical team to come get me from the US. I was in a hospital w/5 beds dirty sinks & on the second floor with no elevator. We paid $7,800 to the hospital before they would release me. Once in San Diego we found out I broke every bone in my face (jaw 4 places, 52 screws in my mouth/jaw, 12 plates rebuild my palate.) they took bone from my hip to give me a new nose & fat for my cheeks. My cheeks were so badly broken they took tweezers to pick the bone out & mix w/a bone paste to give me cheeks. Around my eyes have metal & my teeth were laying in my mouth. I've had over 10 reconstructive surgeries. After having a TBI I now suffer w/memory problems, anxiety issues, cognitive difficulties, over 18 migraines a month, delayed sleep disorder, other sleep issues. I also have ringing in my ears. I had terrible earaches in the hospital, but no one understood why. I have been tested & an intolerant to many foods that trigger migraines. They can just take a blood test to tell you what foods can do it. I also tried chryotherapy & that brought me some relief. I've been desperate to find anything to help.
I was just wondering if anyone had and input, my doctor's for years can't figure out, but liesions and blackouts with meds. I want to know a why. Not looking for pity party. Just years ago was in an abusive relationship which always ended up with blows to the head, knocking​ me out. Last one from. That relationship shattered my face, my brain swelled. Left that relationship. Found another man years later, all seemed great, years later same thing, went threw this twice. Now it's all behind me. Bit what stayed is these horrible headaches that stay with me for weeks at a time, so light or sound. Sight comes and goes. At times I joke just give me a bullet. It's pure agony. I can't shower alone, I black out, neurologist says seizures. 9 years of this. I'm afraid to be alone, and nobody has a clue what to do? Anyone else go thru this? I did have a stroke 4 years ago, luckily all is well, just high blood pressure. I'm at a loss! And input would be greatly appreciated!!! Thank you!

My daughter is 18 and ready to go off to college. She suffered a concussion during softball (had a fall) and has had a headache daily ever since. It has been almost 2 1/2 yrs now. We did concussion therapy, PT, OT and medications. Topomax, Imitrex and Motrin. She cannot handle the meds other than the motrin. Topomax and Imitrex gave her sever chest pains, anxiety and difficulty breathing. Although the dizziness and sensitivity to light has gone away she still has daily nausea and even tingling of her hands. Lately she says the headaches have changed and feel more like pressure building up. I am really concerned about sending her away to school. She has been cleared and still plays ball but her quality of life because of these headaches is not what it should be for a young woman. I am also wondering if she is having rebound headaches from too much motrin...feel so helpless as a mom and then seeing a new story about a mom of 4 who passed after an aneurysm  that she thought was a migraine petrifies me.

I am 19 and I suffer from headaches that occur almost every day. They started occurring after being hit by a vehicle. It has changed a lot in me, the way I sleep, the way I eat and the way I concentrate in class. I need help.

My wife was hit on the head by a big umbrella post while working. Medication is hit and miss and often doesn't help. What has helped is treatment though an A.R.T specialist. It can be very uncomfortable and treatment is done from head to shoulders. The only problem is the cost of treatment/maintenance for those who don't have the spare income to attack the problem a couple times a week to start, then every few weeks and to the point where treatment can be spaced out over longer periods of time. The head is resilient yet the most difficult part of the body to treat

I fell 32 feet while in the service back in 1989, landed on my feet, came down I am guessing onto my back and onto my head. I was unconscious and revived for an unknown amount of time, but guessing it must have been fairly close to about 2-3 minutes as first responders usually took 5 minutes to arrive at that part of the base and was about 2 minutes when I was awake/revived.  In ambulance I lost consciousness again and was revived and once more in Naval Hospital.  I don't remember how long I was in the hospital for, honestly as I was on heavy doses of Morphine for T11 and C4 fracture breaks and at the time TBI was in it's infancy so it was not explored.  I was released on home medical leave with morphine packets and returned for an extensive amount of physical therapy.  I started experiencing tunnel vision and extremely horrible migraine headaches at that time with incidents not related to the headaches of vertigo.  I also complained of vertigo and bad ringing of my ears, which the doctors said would be normal as I "blew"/ruptured both ear drums in the fall.  I had major mood changes at that time and things just didn't seem to work out for me the way they did as easily as they had previously; normally I would rarely pickup a book to study and would do well on an exam, and after the accident I had a hard time just paying attention long enough to take an exam.  I was medically discharged from the service, and I played the tough guy for about the last 25 1/2 years and grinned and bared all the pain that I could between chronic low back pain, constant bouts of vertigo, and the migraines.  Unfortunately, like a light switch, my body decided one day to just shut off on one side...click it was done playing.  It started slowly with right side weakness in the leg, which the doctors passed it as a pinched sciatic nerve running down my leg and did extensive shots and nerve burns, but those didn't work and at one point had catastrophic results from physician error. Over the next two years my body has went downhill and the entire right side has been diagnosed and tested positive as hemiplegic as well as neuropathy.  The chronic migraines that started in '89 which occurred 5 times per month now have ramped up to 17 times per month, with some lasting 24/7 and most so unGodly that I wished that I hadn't survived the fall in '89.  I have tried all types of treatment, from acupuncture to Botox with minimal effect.  My MRI and MRA come up clean, yet when I have these migraine headaches my Neurologist who is 96 miles away has ordered our ER to take a MRI during Migraine, but they refuse...ideology at their best.  My Neurologist is checking the background on PTM and the years between accident and present...wasn't sure if it was feasible for such a delay. I am at my wits end as I cannot explain why it is happening, only explanation it could logically be would the accident from '89; any thoughts on this would be great.  E-Migraine In Yooper, MI

I'm 51 yrs old and just 2 months ago I had my third head injury. My first occurred when I was 12 I had gotten hit by a drunk driver and had a fractured skull. I spent 1 to 3 days in a coma, a permanent loss of hearing because of the impact, my ear drum was permanently damaged. I've had an incessant ringing in my ear and headaches. But other than that, I guess because of my age I made a pretty quick recovery. Then in 2004 I was assaulted by a teenaged girl that I was helping. She beat my forehead and face with brass-knuckles. I ended up with a concussion and Have had a small change in retaining my memory. Now I suffer from chronic pain from Fibromyalgia along with headaches. But, because of my injured eardrum I have balance problems. Well my 3rd head injury happened in January of this year I had lost my balance and fell onto the rim of my bedroom door and when I hit, I hit so hard it hurt my jaw I hit my left side of my forehead. Now I'm experiencing forgetfulness and I've been getting headaches at night and I can't sleep. These headaches come with a very loud ringing in my damaged ear. It's very frustrating because nothing can be done. Just wish there was something that can stop this.

My god that is terrible. I am feeling for you, buddy. Stay strong. I smashed my head snowboarding in a bad fall that slid me head first into a snow maker. Thank god I had a helmet or I'd be dead.

I was diagnosed with having a concussion three years ago. To this day, i still have splitting headaches where I was hit and can't seem to focus much on one thing (I'm a college student and it's affecting my ability to study). More recently, I've felt a ball near the area that I was hit that's very painful to the touch. Praying I was just imagining this, I had my fiance run his fingers down both sides of my temples and he felt it too. Following up with a neurologist this Monday. Just happy to know I'm not the only one suffering from long term headaches.

I played rugby and a year and a half ago I got a bad concussion but the doctors cleared me and regardless of the pain I continued to play and now for the past year and half I've been experiencing nausea and headaches amongst other things since the incident. What should I do ?

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