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 (468)

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 have also been dealing with a post traumatic concussion. While researching, I came across an article that talked about finding the right vestibular therapist or neurologist who can identify where your headaches are actually originating from. Honestly, for both of you who are experiencing such top of the head sensitivity, I think it would be wise to ask you doctor about getting an MRI to rule out a hematoma. But, some of the people who were experiencing long lasting headaches, benefitted from having their pain pathway diagnosed. You may want to look at occipital nerve pathways and see if this pathway correlates to where you are experiencing your head/scalp pain. Good luck to both of you!

I got my 3rd concussion on may 29th 2018. For me it was headaches memory issues, cognitive issues, neck pain, eye pain and moodiness. Nothing was seeming to work. The chiropractor seemed to be the best in the begining. I found some research on hyberbaric oxygen therapy and decided to give it a shot. I dont know if its a placebo or if it actually works but my brain fog lifted and i started to feel halfway normal again. Insurance does not cover this of course so it can get quite pricey but it seems to have helped me. Im 5 months into this and finally seeing some light at the end of the tunnel. Im just hoping my memory comes back now.

I am 2.5 years out from my concussion. It sucks so many different pains in my head daily. I refuse meds instead I'm trying to eat paleo style and try to start walking more also gonna try cbc oil I've heard good things. Already tried chiropractors, nucca doctors, , vitamins, massage, sacral cranial therapy, accupuncture, physical therapy started to feel doomed :(

Please don't feel doomed. Our daughter is over 3 years out from her concussion. She has lived with an intractable migraine ever since. Our fight for her recovery is ongoing. She has tried all the items you listed and many, many more. Medications have been completely ineffective so far. If you don't have one already, please find a good doctor. One who is willing to keep trying even if the ideas are out of the box. Get a therapist who specializes in chronic pain. Seek out a support group. Going through this alone is not good. We do not have a cure or an answer for our daughter but we will not give up trying and I so hope you don't give up either.

Ideas to try if you haven’t already...functional neurologist chiropractor, hyperbaric oxygen chamber therapy, botox injections, see an endocrinologist familiar with pituitary issues from head trauma. Have them check for hypopituitary issues. Very common to get post concussion. Google it. Hang in there!!

I suffered a concussion in 2017, service elevator door came down on my head. its now a year later and still suffering. Head pain everyday, still have balance issues and memory. I have been going to therapy and now doing a series of tests. It is very hard to work for a full shift as I get tired quickly. I do take multi vitamins but not sure if they are doing anything. Rest helps but then affects my back. I feel every ones pain and understand completely, its hard to relay that to some one who has not suffered the same type of injury. I persevere and hope one day my pain will go away.

I was wandering if it was possible to get a concussion from a car door hitting your
head and causing a 2 inch laceration.

Thank you

Yes, it is definitely possible

My brain swelled after iI cracked my head in three places on the pavement. I had a subdural hematoma. I was on life support and had tubes draining my brain. I still have no cover where the skull was removed. I was 39 min or so till death. I’m lucky. However 20 years later my headaches are back harder than ever. Why?

As a teenager I was involved in a bike accident with a car and I was knocked out
For 40 minutes after suffering a serious concussion (TBI). I woke up in a
Hospital bed.
I feel that I am susceptible to a headache more having suffered a serious
Concussion. I don’t know if other people with a TBI have this, but
Sometimes I feel as if I have been hit over the head with a sharp
Hammer and feel a sharp intense pain that lasts only a short time. Then
Im ok again a minute or so later.
Some days it would be just a dull blunt headache that may last
A while and require medication.
At the hospital after the accident they did scans and x-rays and said i
Had not fractured my skull and had had a nasty bang on my head.
Now just the occasional headache but those short, sharp hammer blow
Headaches occasionally occur. Very strange.

I had blunt force trauma to my head 9 yrs ago I get sharp shooting pain and severe headaches to this day I take no meds for it.

Brenda I sympathize with your headaches. I have lots of pain relief medication for any potential headaches at home and always carry a packet of tablets with me all the time at work and when I go out.
The other thing is I avoid exposure to bright lights, especially sunlight, which can bring on a headache and so wear permanent transition lenses that block sunlight effectively by darkening like sunglasses.
There really good and have been helpful enormously. They go clear again at night of course. I also avoid noisy places which can give me a headache. You have to do what best suits you. All the best

I was diagnosed with a concussion Mar. 25, 2017 after I accidentally walked into a glass door. A neurologist put me on Topiramate and increased the dosage, but it still did not work. It was very hard on my stomach and I refused to take any more. Tried acupuncture and that did not work either. Then I received Botox injections, and it turned out I was allergic to Botox and suffered from swelling of the throat and choking. Couldn't eat solid food for 2 weeks. Still partly numb in my throat after 5 months. Botox decreased the frequency of the headaches for a while, but now after 5 months, I have headaches 3-5 days a week. Terrible pressure on my forehead. Not even 2 extra-strength Excedrin will dull it and is not worth the side effects. I think I'll try a chiropractor next.

Try a functional neurologist chiropractor. They specialize in fixing brain injury. Also see an endocrinologist who can test you for pituitary issues as a result of your head injury. Very common .

Mine took 16 years remembering the traumatic injury. And I forgot every hallucinations I have had throughout childhood and adolescents.. The headaches were straight agony when they happened. Like a monkey wrench thrown into a a running engine. Throwing everything inside in disruption. Forgetting yesterday for years. Not being able to concentrate in school. I got so fixiated on music and what the theological twist inside cause I forgot my yesterday for years.

Wow, it's sad that there are so many people suffering as I do. It's been over a year now since my fall/accident on the job. I've shared here earlier this year. But going to Church I found a real doctor that showed me that CBD's really work, this is not advice, just a suggestion. I will share that this type of treatment for my headache/migraines has helped more than pharmaceutical medication. God bless

My concussion/TBI happened at work too. Almost 6 months horrible pain still.Do u think u get treated dif. At the doctor because of work comp?

Pick your own doctor

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

Wow, it's sad that there's so many people suffering as I do. It's been over a year now since my fall/accident on the job. I've shared here earlier this year. But going to Church (CCLA) I found a real Doctor that showed me that CBD's really work, this' not advice, jst a suggestion. I will share that this type of treatment for my headache/mI grains has helped more than pharmaceutical medication. God bless

guys, it is sad to see so many people in pain. I had a mild concussion during kickboxing more than a year ago. Dizziness, headaches, ringing in the ear have not stopped ever since, with some weeks better and worse. I try to avoid strong medication smoking CBD, but it sometimes is not enough. The only route I think seems to make sense after having my ears, eyes, neck, brain etc checked is actually my dentist who said it seems that my jaws got slightly displaced with the blow. Together with grinding my teeth at night that would cause CMD (cmd craniomandibular disorder) which can cause EXACTLY the same symptoms as PCS. I`ll give it a try with a mix craniosacral therapy and neurokinesiotherapy. You might want to look into that.

Heavy head feeling most time and a throb sometimes in arm and neck is this normal

I got a wicked concussion in October when I slipped and fell on a tiled floor. Knocked myself out for about 15 seconds. I was getting better and back to work full time when I bumped my head on the freezer door. I bent down to pick something up that fell when I opened the freezer door and when I got up the door had swung closed a little and I banged my head. It wasn't a hard hit but I felt a sudden searing pain in my head that lasted a few seconds (I think) and after that I feel like I've taken several steps back. My head hurts, it feels like it's full of fiberglass, my ears are ringing, I'm clumsy and off balance and I'm living in a fog.

Not happy about this.

I have had moderate to severe migraines 12-15 days a month for 39 years. They have interrupted every aspect of my life.

Diagnosed common with no aura, BUT....I have always told Neurologists no head trauma because I believed this to be true. My medical records from the service were not made available to me, and when I finally received them, I found out I had a TBI. I was involved in an accident on base at the age of 18 and ER report says I hit my head on the roof of the vehicle. I had tremors, dizziness etc. I had a x-ray, and was released for duty. No follow up care.

Now, this article explains why I wake up with migraines and head pain often, wearing a baseball cap too long will trigger one as well, along with other issues.

I am detoxing off Topamax which I have been on for prophylactic treatment for 15 years because of research this med is not healthy for your brain. I’m refuse to damage my brain with chemicals, also anti-depressants, they are very damaging and cause imbalance. I came off 20 years of those, 6 months ago.

I do not remember the accident at all. I reportedly went back to the ER three days later, arms shaking and dizzy. This was a travesty, and the VA is dealing with this mistake. But, this was an awakening article as to why I wake up in pain for years.

I also often get them anytime through the day, sometimes at noon. I cannot sleep on a pillow. I have tried every position possible, to no avail. Trigger points, Botox, everything. Very very temporary relief. It’s a shame these migraine meds affect our blood vessels the way they do. I hate that I have had to inject and ingest 39 years worth of these. I know the risk is stroke whether you have an aura or not. These meds constrict vessels. Come on! Shame. I don’t drink, little caffeine, no food triggers, quit smoking. It’s brain trauma. And, to boot, depression on and off. I also have PTSD from severe trauma, so oh boy. My faith in God has seen me thru everything. I sure wish there was an answer other than medications. I worked in tissue recover in the medical field for donation before disability ( migraines) so I am not a chiropractor fan. I have seen too many deaths from “ accidents” from those. I will not go to a chiropractor. I take great supplements and eat very healthy, and walk over 30 miles a month. I do all I can, but, I am doomed. Great article.

30 miles a month isn't that much exercise at all. I walk 5-6 miles a day, not that it helps my headaches at all but it keeps me fit and healthy.

I’ve had headaches everyday for 5years now, sometimes I’ll go a month without them but their back as soon as they stopped.
Sometimes they get so bad that half of my face will go completely numb, a couple times even swelling up. And they almost always come with dizziness, loss of vision, or nausea.
They started when I got my first concussion and I’ve had a couple more concussions since that.
I don’t know if this is just normal or if something is actually wrong....

Sounds like migraines...

I recently had a MVA and after the airbags blew, the drivers one has such a force it pushed my head against the drivers window and I smashed it, I passed out for I honestly cant remember, woke up to someone yelling miss are you of.
My mom passed away 4 years after a blow to her head, she had a concussion then she slowly starting losing her mind. I cant remember small things right now, I repeat myself and have severe put me out of commission headaches, I've been off work for coming 3 weeks, super nervous about going back, but maybe it will keep my mind going . I am 53 and about to start a 2 year school apprenticeship , this is done while working and schooling at night. I have read that we lose a part of your brain function for each hit? is this true?

I’ve been dealing with my post concussion headaches for 10 months now I thought I was getting better than bam a week straight of intense headaches but I need to be strong for myself and my family reading many of these comments make the fight to get better a bit easier knowing that I’m not alone there’s many of us trying to survive and get through this no matter how bad I just give thanks to god that it wasn’t a tumor or worse and I can and will get better as I hope the same for everyone else here suffering from this keep up the good fight.

I'm on my second concussion in 3 years, this past hit on my head was the worst. Headaches everyday, head, skull, neck, shoulders, everything hurts, so tired of the daily pain. I'm going to try acupuncture soon.

Thank you for sharing.

I’m 5 years and 4 months post injury. These headaches have been debilitating at times. But they are usually a reminder that I have been doing too much and need to slow down and rest more.

You are definitely not alone. You’ve got this; but listen to your body.

I had a concussion while playing football. For a few days after i was fine then i was dizzy ti the point of blacking out, vomiting, splitting headaches and now nearly 4 weeks later, my neck hurts, which is making my head hurt and light hurts, sounds hurt, im still dizzy and it's all getting worse. I haven't been able to work because of it!!

Has anyone tried going to a chiropractor? Maybe it's possible that when your heads were hit, some bones got out of place and they are pinching nerves? Especially if your neck or back hurts too

Brittany my son also had concussion while playing football which resulted in bad headaches. My chiropractor found that he had whiplash as a result of hitting his head on the ground and this was causing the headaches. Treatment for this stopped the headaches. I hope this helps.

Hello everyone, sorry to hear about the headaches and other issues. My son had a bad ski accident about 5 months ago going off a jump and landing on his head. He was unconscious for over 10 minutes. He suffered a TBI (traumatic brain injury) and here is what is helping after many doctor visits, therapy, etc.;

first, it is not too late to seek treatment. There is a concussion specialist in town and she did some evaluations. He immediately went to a physical therapist who dealt with the body's fight/flight issues. A few simple exercises physically resets the brain. Once you graduate through those, you move on to a few new ones. This helped with balance, dizziness, etc. He also has vision issues so a qualified eye doc prescribed prism glasses to help with dizziness, double vision, and light sensitivity. PT again for vision work to re-align the eyes has been helpful and he has made progress. Very limited screen time, computers, tv. Audiobooks, music, and meditation. Meditating has been the most helpful for when the headaches are really bad. Also, a whole bunch of supplements that help the brain recovery: Vitamin D, B, Riboflavin, probiotics, DHEA, Magnesium, cortisol and melatonin. Some help with sleep. Orthopedic docs who specifically deal with concussions and who have resources are good. Also seeing a Neurologist and Neuropsychologist to help with coping behaviors. Meds have not been very effective. Trouble sleeping and Trazadone helps but headaches keep him awake. Tried Amitriptyline, tried Proplanaolol, now trying Gabapentin and nothing really works. Ibuprophen, ice packs, peppermint and meditation are the most effective. Most of these injuries can heal and time seems to be one thing that helps along with sleep. It's not too late to get PT and other help to improve your quality of life. Not an easy road. Don't give up, keep looking for the right help.

My son and now daughter have experienced severe concussions. The thing that has helped them the most with their headaches is taking them to a Neuro chiropractor. They specialize in exercises to heal the brain as well as adjusting the spine. As well, I’ve taken them for massages to relax the neck and stomach muscles. Diet plays a huge role in healing as well. My daughter was put on an AIP Paleo diet for 6 months to reduce swelling. She’s beginning to feel better.

If you're still alive and haven't already.. get yourself to an ER!
You could have a possible brain bleed and/or meningitis.
Much love brother hope you're okay!

I absolutely second this comment, I received a blunt force to the head recently and did a lot of research online (obviously I'm no doctor) but all your symptoms are falling under exactly that. It is extremely scary, you need to get yourself to the doctors asap.

I’ve done research and suffered from concussions, the only time I got neck pain was when my head bounced off the surface I hit and snapped forwards, so you probably have some whiplash

I unexpectedly fainted/collapsed in january of this year and hit my head on the concrete floor. I visited the gp a couple of days after due to headaches and dizziness. I was diagnosed with BPPV which is a form of vertigo caused by head injuries. We are now in April and the headaches and ear pain are worse than they were to begin with. Its ruining my life. Im under-performing at work due to being in pain, i cant take my young children out alone due to being in pain and feeling dizzy/unsteady and i am fed up. I had a CT scan which came back clear so the gps are at a dead end. I just need someone to help.

I got my concussion in January,as well, and it’s almost May and I’m still can’t move too fast without getting a headache.I’m a Cross Country runner,so not being able to exercise for this long makes me sad.

To Jules in previous post. Where are you located and how did you find your chiropractor?

I had a really bad concussion. The first symptoms that left were the bright lights and insomnia as well as dizzy ness that stopped after a few months, second set of almost no memory recal and poor attention stopped after 8. The loss of strength and no empathy and no emotions and delayed puberty started getting better after 2 years. The empathy and emotions got worse after 10 years and I got really bad headaches and one side of my skull was tender. My entire back was out too, and had been for years. Went to a chirpractor and he fixed me in 15 minutes. Everything. And no, I didn’t think it would work either. If your symptoms persist, don’t listen to this medication crap you just end up doped up and you never actually get better. Go to a good chiropractor specialist for brain injuries. Just try it, trust me.

I have post conccussive syndrome since 6 months ago.. a week ago I started going to achiro too and I think it's helping me after to adjustment to the c1 atlas vertebra i was being able to feel My self again for two days

I was in a car accident 9 months ago in which I was diagnosed with whiplash and a concussion. Almost every day since I have had a headache not like any I have had before. Pressure, dizzy, floaty, and tight muscles. I have tried everything from physical therapy, chiropractic, relaxation, water, and massage. I am so done with this and frustrated. I know my dr is sick of me. Will this ever go away?

Amy - I'm sorry you're going through this. I am on month 6 of the same situation and it is maddening, depressing, and frustrating. I sometimes go a day or two without a headache, but then it comes back to stay. I get mad at myself for not feeling better yet. So, I don't know if it will ever go away; but I do know that you're not alone. Hang in there - we can beat this!

I know what you mean by the extreme headaches. I really hate when people tell me "yeah headaches suck". They have no idea how bad they really are. My neurologist told me I could either be on strong drugs everyday or just deal with it. I had a concussion from a car accident this past Jan. This was less than three months after I experienced a concussion at work. I (we) need a different term for these types of headaches. Hang in there. I wish I could help more than just trying to relate.

Hi, I have PCS and was wondering if anyone's headaches are the same as mine?

I have a mild-to-moderate headache 24/7. If I do an activity, like go grocery shopping or do research on something, I am usually ok while I'm doing it, but it's when I go home and relax that I get my severe headache that I need to lie down for.

I was wondering if anyone else has their severe headaches happen after activities and not during??

Yes almost always. My accident was 9 months ago. I still go to the concussion center every week. I fighting but tired.

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