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.

 

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Posted on BrainLine December 15, 2008. Reviewed August 9, 2018.

About the Author

Dr. Seymour Solomon is a neurologist in Bronx, New York and is affiliated with multiple hospitals in the area, including Burke Rehabilitation Hospital and Montefiore Medical Center. He received his medical degree from Medical College of Wisconsin and has been in practice for more than 20 years. He is one of 41 doctors at Burke Rehabilitation Hospital and one of 78 at Montefiore Medical Center who specialize in Neurology.

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

Comments (503)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I was reaching for peanut butter in the top shelf. I’m pretty short so I was tip towing and didn’t see the can of dog food on top of the peanut butter. My head ache travels to the other side of my head where it wasn’t hit. I lost time for about 4 hours. We didn’t realize until we woke the next day I didn’t remember much.

I have headache from head injury a year ago and also neck pain back pain and still suffering also i have no a doctor to help me.

hey bro I am facing same problem from neck pain back pain nd forhead ache can i talk to u

I had a head injury on August 2nd 2020 where at work the building I was cleaning a window had opened on my head where the corner of window was impaled in my head, I am still to this day getting head aches and my scar throbs where I had eight stitches, after on month I had a ct scan and results were clear, I've told my doctor I am still getting head aches, but most recently I have been getting mood swing and feeling anxious about almost everything which my doctor just snarled at. Because of covid I feel doctors don't care. Can you advise me more please

Don't be discouraged. I'm sure there's help available, just keep going don't give up. I had a head injury, fractured my skull in a RTC in 2002. It still throbs now, especially when I'm stressed.
Maybe try some pilates, deep breathing, relaxation techniques, they might help. Keep going! :)

I agree. My doctor seems kind of crabby and disinterested in my concerns lately.

I was hit 3 times in my head by my second cousin. After 1 hour i think, i started throwing up inside my classroom. 5 years later, i experienced depression, anxiety, and over thinking and my family doesn't know that because they think that i was okay. That the headache of mine is just a simple migraine. I hope it is not something dangerous 'coz i'm still taking my meds because of my eyes, blood, and bruises (diabetic).

I was rear ended in a car accident 3 years ago and still have on going headaches in the front part of my head. The neurologist told me that my headaches are caused by TBI. How long can these headaches last ? The only real relief I get from the headaches is when I take 1600 mg. Of ibuprofen but I can't take it anymore because of kidney problems. Any suggestions? Thanks

2 years ago I got hit in the head with a knee at a hockey game. Ever since that day I have had non stop headaches. Almost like migrains. They never go away. How do I get rid of these headaches for good.

Hello: I had a major brain injury at 20 years old and I was recently "one year ago" hit by a car I woke up in the CT scan machine. I am now 50. I have had mild headaches on the top of my skull as if the pain everyday was a mohawk area of pain. Any ideas?

I was punched in the eye 3 weeks ago and still get extremely bad headaches

I have had headaches ever since I fell when I was 7. I am 50 now. I haven't found a doctor or medication that helps my headaches. I get them on the back of the skull and right side of my head and right ear. Any suggestions?

Yes look into piracetam, or aniracetam with choline as a precursor

Hello Doctor 7 months before I fall down from bike and I get my left side upper of ear small scratch. But I don't feel any TBI Symptoms, then after one week, I feel pins and needles pain in my backside of my head and top of the head left side I check with doctor and check MRI scan but not find any abnormalities. But still, my left side head feels wounded pain, pins and needle pain in injured place, ear, cheek, jaw, back and top of the head. The pain is changing in different places. If fall in bet my pillow hurting my left side head, sometimes I feel stiffness in my neck and back and lightheadedness.

Hello I am reaching out for help. My son was shot in the back of his head during a robbery at his work it's been a year and a half now and all of the sudden he is getting major head pains. Keeps us up at night and he is suffering. The pieces of the bullet is still in his head. What kind of doctor should he see. The Nero doc signed off saying he is fine. Clearly he isn't fine. Please advise who we should see

When I was 10 I got kicked in the head by my horse ended up with a fractured skull. I recovered great after having surgery. 15 years later while pregnant with my second child I started getting migraines. I have had them now for 12yrs. I started a new medication in January it was working great I was down to only having them once a month but now I have had a migraine for 3 weeks now it's effecting my work now too. I just started a Medrol dose pack to hopefully break the cycle. I have had a recent MRI neurologist and PCP both say it looks good does show my past skull fracture. Has anyone heard of migraines getting worse as the years go on?

Hi - I started getting severe migraines, went to all sorts of doctors, and on my own realized that it was due to aspartame. Once I cut all diet drinks and yogurt containing aspartame out of my diet, the headaches completely went away. I did try to experiment and as soon as I ingest something containing aspartame I have a migraine within 48 hours. Prior to my early 40’s I never had a problem with it, I guess the body changes. Hope this helps.

Yesterday, My mother took in the Hospital because she fall out of balance in the bathroom. Bumped her head on the floor. Got all test CT scan, blood test and EKG. Its all normal except she's dehydrated and her kidney is elevated. We got home on that day. No medicine given to my mother. Today she feel pain in her head. Why is it there's pain even all test had done is normal? By the way my mother is 81 yrs. Old

My mother fell from stairs. CT showed hemorrhagic contusion 14x11mm which reduced to 11x10mm after four days in CT. For five days she was given pain killer signoflam BDS. From sixth day, doctor stopped. Now, she's suffering from lack of sleep and severe headache at night. For this we give her pain killer every night. But she sleeps only for 3-4 hours. Please advice what to do. Her present medicines:
Stumetil MD one time night
Vertin 8mg- one time
Tryptomer 5mg- BDS
Naxdom 500 (SOS) on headache

Please advice what to do.

I obstruct head on road but no symptoms created but almost 6months later area of obstruct on head start little pain like needle on head pls concern something

I fell downstairs last Thursday causing major bruising & swelling on my left eye. I've had a headache since. Will these subside?

I had a fall and head injury two weeks ago and had a headache the first day. It went away but now getting mild headache on side that was hurt. Do I need to see a doctor?

I fellover banged my head 4 weeks ago n now gettin pains in my head

I had a horrible head injury. Never got it checked out though. I don't get headaches like you guys, I get a sudden pulsating pain that starts at pain level 5, and throbs like it's turning on and off like a light switch. (Like someone is flipping a light switch on and off every 2 seconds) Everytime "the light switch" comes back on, it hurts more and more until I'm screaming and crying for it to stop. Then it just stops. Usually lasts 2 minutes or less. For example.
On 5. Off. On 7. Off. On 9. Off.
I can't take it anymore.
The head injury was the back of my head and that's where the pain is, but it spreads out a little.
It only happens when I strain. Like if I'm constipated and strain it hurts, I have to put my head down for it to stop. Or if I'm coughing hard if I'm sick, it hurts. Does anyone know if this is serious. Just don't like doctors or public places. I'm agoraphobic.
I'm traumatized by the pain. Its horrible.

Your symptoms require you to see a doctor. Try to see one or check if there's a physician who can do a home visit. You will probably need a head scan to rule out anything serious. But, it's for the best.

Fell 3 weeks ago now have a pain in right side off my head it's not like head ache it more on my head than in my temples I thought I was ok this has on started this week

A few days ago I was hit over the head with a full wine bottle. I had to have stitches in the side of my head and ear. I’ve had bad headaches ever since then! I’ve seen headaches can last for months! I hope it doesn’t last that long but should I have any concerns or anyone think there could’ve been any brain damage?

Feb 28th 2019 I was in a accident in my Tractor Trailer I was hit in the rear of the trailer 2 times my head hit the window of the drivers seat I have had headaches everyday since then. I went to physical therapy seen a brain and spine specialist. The end of August I was given injections on both sides of my neck at C5-C6. 3 weeks later I was driving and don't even remember driving over 100 miles when i did I called 911 and got parked I was taken to local hospital then transferred to a large hospital by a helicopter The last thing I remember was the staff taking me towards the ER around the 20th of Sept. I was told that I had a brain Hemorrhage and a stroke. 5 or 6 days latter my friend come to AZ and took me back to TN. I don't know anything about this I was sent to the hospital in TN 3 more times where I had a second Hemorrhage and stroke was in ICU and told my family they didn't think I was going to make it. It wasn't until the end of OCT that i remember anything I was released from the hospital Nov 6st Since then its been Physical Therapy Speech Therapy and seeing all kinds of Dr's except for the Dr that did the injections and all his staff wanted to do is give me more injections. I don't know if the problems I have had anything to do with the injections but I still have the headaches and from reading my medical reports they are mild compared to when I was in the hospitals I never had a CAT scan or a MRI of my head/ brain until I was taken to the hospital in AZ. The Brain and Spine Dr sent me back to work said I was fine but he still did the injections a few weeks later I just don't understand why i got the injections if I was ok But this injection would help the headaches I just wish I could have a Dr look at all my medical reports and give me a honest opinion. In my little area I ask drs to look at them and they said that the Brain an Spine Dr said they where not related Ive lost my job I now use a cane (no more walker) My speech has improved but not great and my hand writing has gotten better, Not great I cant multi task anymore I get so mad when the words are there but wont come out I have been a truck driver for almost 40 years and have trouble remembering how to get anywhere Sorry for ranting on but this is the first time I have put everything together in my mind And finding out it could be 5-10 years before I can return to being a Truck Driver by then I will be two old to safely drive

If anyone is reading this Thank You it is good therapy to get this off my chest and to stop complaining to my dogs

Im sorry to hear this. I've been looking for answers too. I fell a mi th ago and didn't think to much of it but believe I hit my head bad. It hurts so bad now. I keep getting a bad pain that shoots to the top of my head. I know i should get che ked but im leaving in 2 days for the weekend woth my grandkids is why I havnt been seen yet. To scard they will admit me before I get to leave. Only be gone 3 days. Scard I waited to long n something will happen while I'm away with kids. Pray for each other. Amen

Hi, i was reading the comments on this site, my son had a fall last year and still has headaches. i am sorry for you pain I've read about. I will pray for your recovery. Pray to the Sacred Heart of Jesus and google it to learn about His Sacred Heart, it can't hurt. Just my own opinion. God Bless you guys having to deal with these headaches and other symptoms.

Hi, I'm not sure if i'm too late with my question, (most of the posts I saw were from 2019), but I have a question about how many years after a TBI can the headaches continue?

I had an anoxic TBI when I was 12, I am now 31, but I still get really bad headaches. I remember the headaches when I was recovering, (when I was 12 and 13), and they were quite bad, they didn't really feel like any other headache like a migraine, tension or dehydration headache, (I get migraines and clusters too so I know the headaches I get aren't those either).

I go through stages where my head will be fine for a week, and then after that the headaches are just there, like in the back of my mind, but painful. Not many pain tablets help, and when they do, they last about half an hour and then my head is just as sore. Could these headaches be a result of my brain injury? It was quite severe and I have other side-effects from this like an intentional tremor and poor short term memory etc.

Thanks

Hello I fell and got concussion it's been a month and my head still hurts ..went to hospital and got MRI they said brain looks ok, . but also my left ear feels like there's water in it and my teeth still hurt and are like numb and sore at the same time.. it hurts more when I eat? I want to start working out soon I'm.so depressed I'm starting to realize this is not going away ...is it?

Anon, consult your physician regarding whether or not they believe you may have trigeminal neuralgia. ENTs are typically pretty good at evaluating that specifically. They can also address your concern of aural fullness in your left ear. You will not know whether or not it will resolve until you've identified what the problem is and sought help for the problem. I wish you luck!

A couple of months ago (August of '19) I had a Forrest Gump moment where I just wanted to go running. I didn't fall or anything but after running up a hill, the back of my head felt like a burning sensation. I stopped after that but til this day I feel soreness on that same spot along with lower back pain. Both on the right side. IcyHot has zero effect on my back. I wonder if anyone else has this?

Brilliant article! Like to know what you think about functional

I got a head Injury almost 4yrs back and stiches all was ok at that time...now recently I'm getting back head pain in the right side of ma head could it be any side effect for that?

I was rear-ended while stopped at a red light on 12/19/20. It was by a Ford F250. I did not lose consciousness but did experience some brain fog about a half hour after the accident. A few days later developed awful headaches and dizziness. Almost felt like I was going to have a seizure trying to even watch TV. Also became very sensitive to light. Had neck pain at the base of my skull that went away that lessened after three weeks. Had some agitation and angry thoughts that went away after a few weeks as well.

Had a head CT that was fine in the ED an another one that revealed a sinus infection just a few days ago. I was put on Amoxicillin. However, my sinus pain has gotten worse and have a headache that seems to start one area of my head and go to another and has been like this continuously for the past three days.

I start with ENT next week and Neurology in March but seem to always be taking one step forward and two back. I feel like I will have post concussion for a while and never be the same person. My memory has worsened and feel like I cannot do my job.

Anyone else feel like this and get better?

i am 55 years of age and have relapsing-remitting multiple sclerosis I fell off bed on December 2nd. doctors claim nothing is wrong . I do still have headaches in the middle of my eyes little swell , lack of concentration. i am also a writer. the pain is numbing and still. does not hurt as pain, no hurt simply like the beginning of a migraine. i still have some bruising and a part of my cheek appears to have a slight bump how long owuld all these symptoms disappear .. i am unable to focus on writing for my lack of concentration , my head feels always tired . best regards ritamarie recine

Good evening. I have bad headaches migraines and nausea following an accident when I fell down a flight of stairs.

I was involved in a accident 3 months ago and my left temple of my head hit pretty hard and I blacked out for about 5 minutes when I finally came to I was confused and it took me a while to get my bearings 3 days later I was showing concussion symptoms I went to the hospital and ct scan looked good and I'm still having headaches on my left temple

I had a seizure about three days ago and I fell and hit the right hand side of my head was brought into hospital and had a CT scan which showed a clear brain scan so all good. I have woke up this morning and for the first time since my fall my head is really sore I also have pain in my neck . I'm just wondering why pain would only start days after.

Im 19 and have had about 3-4 concussions within the past 7 years (dirt bike riding, falling down the stairs, passing out and hitting my head on the ground, and getting my head slammed in a car door) my most recent one was this past Jan when I fainted and hit the corner of my left temple on the ground. Since then my mental state has changed but I’ve also been experiencing more headaches but have noticed the headaches are localized to the areas where I had the head injuries and I was wondering if they were related at all

I hope you get better. my son had a fall and hit his temple, the headache and pain are in the same spot he got hit, Be careful and take things slow. i will pray for you and others dealing with head injuries

I don't know if I got a concussion, but I was hit on the side of my head by a ukelele (didn't know those hurt so bad), and now I have a lump above my temple and get headaches in that spot randomly. Any ideas?

I've got a cavernous sinus menengioma, collapsed a year ago and woke up on floor with a bump on right side of my head and still has severe pain on that side of my head everyday.

Get an xray. Seriously. Were you playing the ukulele? Try harmonica. Lighter, harder for people to grab. If xray shows crack, no worry too much. Still alive, so crack will heal, but get catscan.. maybe have TINY BUBBLES, in the BRAIN.. [Don Ho music joke, sorry. Had to. Whole life can pass without chance fo that one. If it make you feel better, I sorry, an Ii get BIG crack in skull, so no jokes, see doc!] Aloha!

My wife experienced a concussion at work in April 2019 and has not had a single symptom free day since then. Her Headaches have never been less than a 4/10 and sometimes they get as bad as a 12/10, shutting down her ability to communicate or walk down the stairs. Light and Sound sensitivity comes and goes with the severity of the headaches and she sometimes needs to take naps 2 or 3 times a day to recharge her batteries.

Worker's Comp is slow to help, but I'm curious if anyone has found relief through Vision Therapy or Cognitive Behavioral Therapy? These tend to not be covered by insurance (or seen as necessary by Worker's Comp).
With the high cost of Vision Therapy and the uncertainty of whether it would provide any relief from the debilitating headaches, we'd like to know more about it before we take the leap.
Also, if anyone has tried Vision Therapy or similar treatments and found them to be unhelpful or a waste of time, we'd appreciate a response.

Thanks and good luck to everyone out there suffering from TBI's and good luck to their families as well. This is not an easy road but I pray each of you finds the relief you seek. Perhaps if enough of our voices are heard by those in the medical community, the canned response of "...most symptoms go away after a few months ..." will turn into something more helpful for those of us dealing with long-term Concussions.

Have you tried Botox injections for the chronic headaches? Our concussion specialist indicated this has worked very well for her patients when the pharmacological routes fail. We are hopeful.

I was in a car accident in 2014, and like your wife has not had a symptom-free day since. Vision therapy was a great relief for me. I had severe convergence issues as a result of damage to my optic nerve. Doing the same re-training as little kids born with convergence issues the therapists were able to help immensely with the pain that was coming from reading, computer work and just looking with my eyes.

Vision therapy did not help with the noise and light sensitivity, lacks of focus or the pain from just thinking - but hey, it did make using my eyes hurt less. It was good. But of course our insurance would not pay for it.

Find treatment providers knowledgeable about concussion. Suggest you see a Neuro-optometrist for an evaluation. Prismatic glasses helped me a lot as did vision rehab. I am 14 months post concussion after what seemed like a minor car accident and still getting treatment. Get a worker’s comp attorney to handle your wife’s case. Good luck and hang in there.

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