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.
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.