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.

Thank you for sharing your story,my daughter suffered a sport related concussion while at school. The school of course tried to cover up the accident by lying, we eventually discovered the truth but it doesn\\\\\\\'t change the fact my daughter recieved a concussion, spent 5 days in the hospital in misery, as a result was diagnosed with a TBI and now 5 months later is still sufferring from post concussion syndrome. I felt crazy at times because it is hard to pinpoint all facts especially if you never experienced a TBI or known anyone who has gone through it. Its very frustrating for everyone involved. Its been a life changing event for not only my 10 year old daughter but our entire family. My daughter is currently seeing a speech pathologist, TBI specialist, Neurologist, neuro- spychologist, physical therapist, and we are trying to get her in to some therapeutic stuff as well. It wasn\\\\\\\'t without a battle though. I dont think people can\\\\\\\"t really understand and want to tell you how its \\\\\\\"supose\\\\\\\" to happen but nothing they told us has been accurate. She will recovery in 3-6 months...not true its been 5 and finally everyone realizes its worse than \\\\\\\"usual\\\\\\\". I have tried to be my daughters advocate but its difficult when you have no idea yourself how to handle the sittuation. I felt like I had to convince people too.. I finally told the dr.\\\\\\\'s you may have hundreds of patients but this is my one and only daughter and I know her better than anyone NOW listen to us!!!. Dont underestimate your point of view, fight for yourself!!
At 16, I was in the passenger seat when our VW was hit by a drunk driver who ran a stop sign. I did a header through the passenger window (even though I had a seat belt on) my thick wool hat probably saved my life. I received a severe side impact head/neck injury. I'd never had a headache before then. Since the injury (after which I'd received EEG's confirming brain damage and more recently MRI's that showed a small lesion on the right side of my brain). The specialist doctors who treated me at the time seemed to be trying to prove that I was a liar and making up all my symptoms. I suppose they were being paid by the insurance of the woman who hit me, and I imagine they assumed we would sue. We did not. But if you find yourself in similar situations please make sure the doctors who treat you are on your team. Frankly, considering how severely my life was impacted by this injury, no amount of money would have made up for the loss of a promising life of creativity and productivity. All my symptoms were as listed in this article along with a few more. In addition to vision disturbances, chronic migraine headaches, ringing in the ears, nausea, difficulty concentrating, difficulty doing certain types of thinking which I'd been skilled at previously, and reduced emotional resilience, I also suffer from balance disturbances, and occasional totally incapacitating vertigo. I had been quite an easy going happy teenager (I know that's hard to believe but true) previously. I had been a straight A student with excellent rapport with teachers and peers. It has now been 20+ years since the accident. I have had more than 50 short term jobs in my life. I haven't lost jobs due to behavioral problems, but rather because of the amount of sick days I required. I could not work on those migraine days, and at least 3 or 4 per month was enough to let me go, or suggest I find another field. I can't take exposure to hardly any strong smells or chemicals, nor can I even handle riding in a car over bumps. Recently those 3 or 4 per month have become 2-4 per week, so now I can no longer hold any job. In addition to arthritic bone growth in my neck, which cause more pressure on nerves in my cervical spine, MRI's also showed an old lesion in my brain. No preventatives, pain medications or any of the 'Triptans' taken at onset seem to help at all anymore. I am all but totally house-bound and bed-ridden. I've been coping with this for decades, but now feel like there is very little to keep me going. Despite all this I was rarely depressed until recently. For anyone else reading this, if you have a TBI, take it seriously immediately when it happens and don't let anyone, doctors or family, belittle you or make you feel like you are imagining your symptoms. Keep at it until you find someone (doctors and therapists) who will help you. No one took my injuries seriously, until it was far too late. Now at 45 there is nothing anyone can do, even the wonderful specialists at Mayo Clinic who finally took me seriously and at least validated that my symptoms were based on something real.
This information was very helpful and it definately educated me more on this condition, which my daughter is suffering from at age 15. Thanks

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