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 (486)

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 hate to have to tell you this but, I have had a headache for over 21 years. I underwent sinus surgery and woke up with a headache. It is normally a 4/10 and gets worse as the day goes on, up to 7/10 most days. I have tried everything from beta blockers to antidepressants to seizure meds. Narcotics are useless, except Diluadid*, which puts me to sleep and allows my headache to reset. I am currently taking Keppra and Zomig. The only problem is Zomig is restricted to twice a week. The only abortive medication that works for me is Fioricet, but the doctor won’t give it to me because it causes rebound headaches. My argument is, if I have a headache every day, what difference does it make what causes it? As for a lack of sex drive, I have been celibate since my husband died going on 18 years. I hate to be the bearer of bad news but I not having any luck with the doctors. I also take antidepressants to fight the depression caused by being in constant pain. I have also been seen by the Diamond Headache Clinic in Chicago.

Similar to you Sally, I also experience a constant headache, although for a way shorter amount of time, that has been going on for 4 and a half years. I got 3 concussions in one week playing soccer when I was a freshman in high school. Since I was 15 at the time, I was unaware of how serious head injuries are. Since then I've tried numerous medications, physical therapy, chiropractor, four rounds of botox, two different styles of acupuncture, Aimovig shots, hyperbaric chamber, four rounds of anesthetic shots, but not once have I every felt just a little bit of relief to the pain level I have. My last two neurologists have told me that I will have a constant headache for the rest of my life. Currently, I'm on no medication and haven’t seen a neurologist in about 8 months. I'm always looking for articles online talking about constant headaches from head injuries, but I have found little to no information on the topic. I've learned to just get used to my constant pain I'm in, but having to study for long hours at a time now that I'm in college has been very difficult to accomplish.

I had concussion in Dec 2018. My 5 y.o. son fell off climbing equipment and landed on the left part of my forehead. I had concussion and nasal fracture. Even though it's been 4 month post injury, I am still having headaches.

I also feel all concussion symptoms after even minor hits, bumps or when vehicle stops suddenly. I started to be so sensitive to touch, noises, light and any minor traumas, that people normally forget within 15 min.

The other day, I stood up after a flight and hit the top of my head. I was in agonising pain for entire week.

I would like to find out if it is a minor concussions or increased sensitivity?

i fell approximately 8ft hitting multiple objects finally landed hitting my head on railroad tracks..
this happened 3/29/19.
stayed in hospital 4 days when released i have arm weakness in both arms..whole back is sore and right leg pain comes and goes...
i have trouble with motion and bright lights ..
worst thing is the doctor's that the company is sending me to only prescribed tylenol for the pain..yes i have a constant headache and sore neck hard to move head

Holly crap!! I cant believe you walked away from that? Most unfortunate that it has left you in a painful state! I dont have any advice for you! I just wanted to let you know I hear you! I wish you all the best!

When I was about 10 I was laughing really hard and hit my head on the back right side, and ever since then, I only ever get migraines. Not headaches. Migraines. And only ever on the right side. Sometimes it gets so bad I pass out from the pain, other times medicine or caffeine helps, other times I just throw up and go to sleep with a pounding migraine. Since then as well, when I get up after sleeping, napping, or even just sitting down for 30 seconds in a chair, I get extreme and random waves of numbness and confusion throughout my whole body. What should I do? I'm 16, so this started 6 years ago. I can't see a doctor and the only one who believes me is my mom, and she can't do anything either seeing as I don't live with her anymore. Help?

I also have a similar situation and just wondered if I should have myself checked and I 'm kinda relieved that I'm not the only one. I also got punched very bad at my right head during a boxing match and lost conciousness for few seconds. After the match my right eye was inflamed for a month and I suffered bad migraines. It recovered afterwards but I would always get migraines at the right side only ever since. It would really get bad especially before my period, but it feels like the usual headaches I would have but after that match I would only get migraines on the right side. It is only until recently that I realised I only have migraines now which wasn't the case before my match. It's been 3 years but I think it would be wise if I have myself checked as well. My right eye has been extremely sensitive to light after that as well and it's getting worse every year.

Find a functional neurologist chiropractor near you. Amazing what they can do! Hang in there!!!

Erica, You REALLY need to go to a doctor. I'm so sorry that you've been dealing with this for 10 years.

I was hit in the head with a softball on my forehead right above my eyebrow (left side) on July 6, 2018. I had a concussion and bone bruising. I am still getting headaches 8 months later and swelling/pain from the bone bruise. Everyone keeps telling me I should be healed by now, but I am not. My headaches are not as frequent and not as painful, but I never had headaches on this spot in my head before I got hit. So, I know it is because of the concussion. The left side of my head still feels different than the right side. It is frustrating because I want to feel normal again. It makes it more frustrating to feel like people don't believe me when I say I am not completely healed yet.

I just had the trunk of my car come down and hit me hard on the head. Had a scan test no bleeding, but I have this pounding headache. From reading others comment, I'm in for a long haul. Were y'all able to resume your daily activities?

Wow, I had this exact same thing happen to! The whole top of my head is so painful, it wakes me up! I'm waiting to see my dr.

I was able to resume daily activities. Though, I do find myself having to take breaks often, and I get worn out quicker. Unfortunately, it just takes time. Don't push yourself. Good luck. Take care.

I had a pretty bad concussion from playing soccer when I was in highschool. I probably went back too early to play as well. I experienced nasty headaches on and off and loss of concentration and emotional flooding. In college, I experienced some of the worst headaches of my life and they were in the same spot that my concussion happened. Well 10 years later, I still experience headaches in the region of my concussion, and while they aren't as bad as before, they can still be frustrating and take a lot out of me.

I suffered major head trauma from a fall after running around the pool in 2007, I'm only 24 now and I still experience headaches now! Which can sometimes result in my being in bed all day with no light whatsoever.. So I'm glad I'm not the only one going through this frustration!

I fell backwards while sitting on a wobbly chair and hit the back of my head against the edge of tv stand... I had a concussion and was barfing all night with a severe headache.... I didn’t go to the hostpital or see my family doctor.... it’s been over 5 years and if I do anything to my head I will get really bad headaches like a migraine that will come and go, for example, I was going sliding with the kids, and I just hit a couple big bumps, now my head hurts :/ or if I were to head bang to metal music, my head can’t handle it either.... it’s feels like i brought back my concussion... I’m struggling... my boyfriend said that im pathetic... I don’t want to be like this anymore :’(

If someone is not supportive of you in your search for answers, they need to go! He is pathetic for saying that. You obviously didn't choose to be injured, you just want to feel better. Go see a neurologist.

Dump the boyfriend. I am 15 months post injury. I have headaches n nausea all the time. This is a challenging injury to deal with.

I had a concussion 3 years ago. There have been several times that my head has been jarred and I get a horrible headache almost immediately, nauseous and sensitive to light and sound. It's almost like the migraines I used to have. I feel your pain.

I understand your pain! I fell from a ladder and fractured my lower back; hit and lacerated the right side back of my head on a concete block in 2007. I passed out and was taken to the hospital but released that same day. I had severe dizziness, profound taste disphoria, vertigo with certain head movements and I still in 2019 get sharp localized pain at the injury site almost daily. I still at odd time get bouts of vertigo for no apparent reason. I had to seek disability for the back injury but the head trauma was just as debilitating!

Your boyfriend doesn’t know pain period. he has not a hint of what post concussion syndrome is like

6 months ago I had a concussion but when the symptoms were almost gone I drank A LOT of alcohol on it. I have paid for this every day since, so no need to lecture. I now know as well as anybody how bad alcohol is for a concussion. My headaches have been constant, severe and I never get relief. I am posting this because I cannot find any similar stories. If anyone knows someone who this happened to or if it happened to you, please share. I am feeling hopeless. Is this permanent? Will the constant headaches EVER stop? It is affecting every aspect of my life tremendously and I am a shell of who I once was. PLEASE respond if you know anything.

I feel for you as I am going through a similar situation. My head smashed against the side of a boat when it hit a huge wave, and I was in bed for over a week with major concussion symptoms.

My MRI came back normal, thank goodness, but the headaches, blurred vision on left side, fatigue, irritability, memory loss and just an overall feeling of being not quite right has been persistent.

My chiropractor has helped me the most physically and given me the support and understanding no one else has. The medical massages through his office have helped relax me, target nerve areas, and provided temporary relief. Ice has felt good on head and neck.

In the last two weeks, I had some debilitating headaches come on while drinking wine. I know there is a connection as I was laid up for so long with no wine, then I had some social opportunities that involved wine, and the effect was immediate.

Sadly, I have to accept I can’t have any alcohol for the immediate future and it’s just not worth the headaches (disclaimer- I enjoy in social situations or with nice meals..not an alcoholic) As I write this, I still feel a throbbing pain deep inside on my left side where impact was.

I’m just hoping time will heal all of this. It’s so frustrating!

Good luck to you!

I hit the back of my head a year and a half ago. I tried tons of medications and nothing worked unless it was a high enough dosage which also caused terrible side effects. You need to try botox injections. Each treatment is 31 shots around your forehead and back of head/neck. I don't like needles but the treatment is very quick ( 1-2 minutes). It is better than any pills with no side effects. Usually not until 3rd treatment (once every 3 months) until it takes full effect. Since it is an injection and does not effect organs you can continue other medication treatments at the same time until all botox treatments are done. Day or two after treatment your head will be sore from the injection sites but that goes away completely. It can be expensive though, the claim through insurance was $3,600 but it works so well I would pay out of pocket if I had to. Typically you have to try 3 different pill variations (SSRI, anti seizure meds, etc.) before botox is considered and insurance is more likely to cover for post concussion headaches (rather than just a migraine). Not my field at all but i've been reading medical publications and most studies show significant if not complete resolution of headaches following botox injections (for the FULL COURSE) for post concussion headaches with no side effects.

If your doctor does not do injections find a neurologist that does. And if you don't notice anything immediately just keep with the 3 month program it gets better.

Have you ever tried acupuncture and or chiropractic care specializing in concussions?

Please give the acupuncture a try - go for as many sessions as your insurance will allow. I went after suffering a nasty fall (injured my head). I fell six years ago and still have pain at the top of my head. Acupuncture offers relief - it's not immediate relief, but I felt a difference with 24 hours, and went back every 7 days for as long as I could . Now, I go whenever the pain becomes more than I can manage with over the counter meds.

I agree with the recommendation regarding accupuncture. I am 14 months post concussion and I go every week/ it helps with anxiety also headache and whiplash it doesn’t cure the symptoms but help tamp them down. I saw many providers PT, OT, psychologist, neurologist, chiropractor, massage and what has helped most was neuro optometrist with prismatic glasses, accupuncture, also very gentle yoga, meditation, gentle exercise-avoid alcohol, caffeine and people who aren’t supportive. It does get better but very slowly.

I have experienced almost the same thing, but I’m not an adult, and even if I were, I wouldn’t drink. I had a concussion eight months ago, and the headaches only started at the beginning of January. I find that doing relaxing things help with my headaches. I draw and shade dragons. I was doing that all day yesterday, and no headaches came on. So try doing relaxing things. Also, try to avoid loud noises. On the days I have band, I always have those flashes of pain. I hope this helped you

Hi, I've had concussion symptoms for 17 months. I drank a lot two days after a seemingly mild concussion and have had a persistent headache, among other things, ever since.

Honestly, I just wanted to say that one of the keys I have found to keep my headaches from bugging me is finding something in each day that I liked. I have had four concussions and even though I have had a lot of doctors and people around me who did not support me much or tell me what was going on and it drove me crazy for awhile I eventually found my peace. After my last concussion, I thought all hope was gone and that I would have headaches and pain forever. Now I still have them but when I do I go to someplace that I find comforting and lay there or even take a power nap. I don't know if this will be helpful at all to you but this is just my experience. It has been a couple years from my last concussion but I think I can honestly say for the first time that I am okay. You will be too. just find what makes you happy and hold onto that. What you believe affects you greatly. If you believe in yourself and that you have the courage to get through it then you can. Keep fighting and do only what you can. Don't try so hard that you end up just hurting yourself in the end.

Thank you for your post!

i fell and hit the back of my head on a wall and 5 years later the back of my head feels really weird to touch and i cant sleep on the it and i have constant headaches like every other day and i think they're migraines. i went and got an MRI and there was nothing wrong. the doctor said it was probably post traumtic headache and did nothing.

I suffered a concussion several years ago when I fell back full force on the back of my head on the concrete. Now whenever my allergies act up, that area where I hit my head is extremely sore, like the day I hit it almost. Why is that?

I understand. Same here. I take antioxidants. This really helps.

I suffered a fall in March 2018, falling on my left brow, resulting in a large goose egg on my left forehead and then a black eye. Went to the hospital emergency immediately after - I did not lose consciousness, I remembered what happened and did not suffer from headache at the time - they suggested that I likely didn't fracture as the bone above the eye is pretty strong. The swelling and bruising healed and in about June I started to feel not quite right. I felt weakness and would sleep very deeply although when I awoke I did not feel rested. I started to feel pressure behind my nose which would bother me at night. I had nose irritation and sometimes could feel my heart pounding in the roof of my mouth. I have lost some sense of smell and my sinuses feel like they are not draining properly - I have congestion although the mucous is clear and I have post nasal drip but my nostrils are dry. My doctor did blood tests, sent me for a CT scan and MRI which appeared normal - showing no sign of sinus infection either. The pressure in my head is constant now and it prevents me from getting a restful sleep. I am at wits end. I am waiting for an appointment with an ENT (2 months away!) and I don't know how I am going to last. I have tried everything - neti pot, holding my head over steam, nasal spray with cortisone, decongestants, etc. Could this be related to my fall or is it a sinus issue?

Hey Marnia,
My brother is having the same issue, stuffy nose, leaky fluid and hes been concussed for over 6 months. I was wondering if your nose cleared up? or if you were able to figure out what it was.

You sound like you have some orthostatic intolerance/pots like stuff going on. A cardiologist could test u for it. You might want to try Florinef to help? Talk to your doc about it. Also, find a functional neurologist chiropractor to help you out. They will help u quickly.

I did this 10 years ago, fell 11 feet ,broke fall with my forehead on concrete, and since then i get terrible headaches , pressure. My Ent said it was because the brain hit the forehead inside bones..where sinuses are. When the weather changes, harder to breathe and my back of head feels like strained muscles. Yes it is related to your injury. My headaches are weird. I lost the taste of salt and smell. Salt is a huge problem when cooking... Best to you!

I am not a doctor but it appears that your symptoms are very close to what I experienced years ago when I was diagnosed with a craniopharyngioma. It was centered directly behind my nose on my pituitary. After ten diagnoses and many doctors, at least 2 years of severe pain in my head and after gaining an enormous amount of weight (from 140lbs to 198 lbs) for no reasonable reason. I happened to see an ear, nose and throat doctor who told me that I should get a CT Scan as I might have a pituitary tumor. I went to M.D. in Houston, TX, and saw a doctor in the Brain center area. He extracted the tumor and I had to follow it up with six weeks of radiation. Now I see an endocrine specialist who checks my prolactin level as well as other functions. Apparently, prolactin levels indicate if the tumor is back. Also, the tumor was benign but still threatened to obstruct other areas of my brain. I recognize that you have had a CT scan and an MRI, but perhaps the right person didn't know what to look for. I would recommend that you see a brain specialist, redo the CT scan with and without contrast, and mention to them that you suspect a pituitary tumor such as a craniopharyngioma or... Believe me, I understand the pain you are going through. After a life free of aspirin or any pain killers, I couldn't swallow enough Tylenol or Advil to change the pain I felt in my brain. It's important that you see a brain doctor who understands pituitary tumors and such. Any other doctor only knows about their area and won't look for a brain tumor. I hope this helps and I wish you all the best.

I have continued pain from a fall which caused me To hit the left rear of head was unconscious and required sutures to the wound

Hello Marnie! I was searching the internet to see if anyone else is suffering from this kind of facial/sinus pressure post concussion. I hit the closing edge of an automatic door, hard enough to have a laceration over my right eyebrow, in October 2018. In addition, the other edge of the door hit directly between my nose and right eye. I’ve since had clear drainage in my right nostril and down the back of my throat and facial pressure with clamping head pain. In the first couple of months, I also experienced numbness and tingling around my mouth, top of my pallet and at the top of the back of my throat. That has resolved, however, the headaches and pressure have not. I went to an ENT and he thought it unlikely that I would have a CSF leak, but agreed to test my clear nasal discharge. I could not get enough fluid to test. I’ve had 3 CT scans and now am going for an MRI with and without contrast. I’ll let you know if I find out anything after that. I do use a hot washcloth over my eyes when I lay down to go to sleep. I’m at least able to fall asleep when I do. I’m sorry for your frustration, I know exactly how you feel.

It might be unrelated to your concussion, I had similar sinus problems that I could not get diagnosed after multiple doctor visits. It ended up being a severe allergy to super glue (worked everyday with it), with a 20-hour delayed reaction, weird I know. Sneezing and pressure for 2 days after exposure, with nearly 6 months of unending sinus nightmare. Try to isloate some potential allergen in your life. New factory in your area of town? new detergent? new pet or aging pet (dander can change with pet age)? there are many strange and unsual things you can become allergic too and can drive your sinuses insane. I had problems for nearly 6 months before really figuring it out. Take a vacation and completely remove yourself from all possible allergens, just start trying to figure it out with process of elimination.

I use ice pack on my head and found it is helping for my head ache. I also take omega 3,6 and 9 capsule.

I had a TBI 27 years ago damaging front left temple, 2 fractures of the skull. Over the years my migraines are getting worse. I can have several in a week. Any help would be great. I've been on various tablets and had Botox.

I had TBI a year ago. The doctor recently prescribed Aimovig. Its an injection for migraines. They give it to me once a month. Try it.

Have you tried using medical marijuana? This helps tame mine down. TBI back 2014 with loss of consciousness greater than 24hrs

I fell down flight of steps 7 years ago and hit my right side of my head.
At the time no one seamed concerned about my head. I broke my arm and elbow.
I have had MRI a few of them all negative.
I have suffered they say post concussuin neuralgia.
When the weather changes i feel stinging. Wetness pain last for days.
This still causes me anxiety about it.
Wonder if anyone has experienced the same.

a 15 ft pole from a tent hit my head a few months ago. Everyday I have a symptom or more of headache, migraines, nausea, blurry vision, intermittent pain on the surface of my skull, intermittent pain inside my brain, around my eye socket, shuttering, upper neck pain radiant neck throb, inner shoulder pain, I too get pain that is worse if it's wet out. Aches that are stronger if wet outside. Pain around and behind my right ear. Sometimes the skin where I was hit feels like I was hit yesterday again, extreme tiredness. my pains are always on the right side same as my hit.

I'm 16, 2 months post injury. It feels like I have been through everything to help manage my pain, including; seeing a concussion specialist, chiropractor, neuropsychologist, psychiatrist, homeopathic chiropractor, seeing a CBT (cognitive behavioral therapy), having an MRI, and CT scan, I've also had other testing. I've changed how I eat, how I sleep, I'm exercising more,and meditating/doing yoga. I also ended up in an inpatient psychiatric unit for a week after severely spiraling into a deep depression and it was obvious that my anti-depressents needed to be changed. I have a headache from the moment I wake up to the moment I fall asleep. It increases and sometimes decreases throughout the day. Soon I will be going to a headache clinic. My injury has tuned my world upside down. I went from being a social butterfly, who excelled in school, and was into sports. Now I have very minimal energy, I have difficulties in school, and I'm not allowed to do my favorite sport, gymnastics. Medications don't work, some even make my head worse. I want to try CBD (since I've read about how it's helped a lot of people), but unfortunately I would have to have my parents approve. I'm so sorry for y'all who have been struggling way longer than I have. Bless your hearts.

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