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 (431)

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.

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.

Hi Jessica,

Yes! Headache to some degree every waking moment, for me when I do lay down (both going to bed at night and waking in the morning), is when my headaches feel the worst. I think at least partly it has to do with activity distracting us from the pain.

As someone else said, we need a different name for this kind of headache that never goes away. It's not plural, it's constant. One neurologist called the condition "chronic daily headaches", but again it's the same one all the time. I'm in year 42 now.

Hope there's relief in sight for all who suffer!

Yes! This happens to me often now. I try to do very little which is quite frustrating. I find wearing sunglasses while grocery shopping helps.

I took a bad fall @ work while exiting the driver's side of truck @ about 3-4ft. I tried to break my fall in'so doing this I broke my wrist & hit the left side of my head (between eyebrow & temple) & got a black eye. Now I get these migraine type headaches that come 2-3 times a day since my fall six months now. Hard to do a lot of what I used to do. Now I'm being treated w/antidepressants & don't really understand why.

I got knocked out in a freak Staples Store accident and suffered these Post trauma Headaches. They went away completely at the year mark and never came back. Praying you will have this quick relief. I hope my answer provided some peace of mind.

I have been in 3 car accident's I get headaches that last 18 days. I've had a concussion for more then 4 years. I do get trigger point injections in my neck and shoulders that help some. According to my neurologist I can have these headaches for the rest of my life there no cure. I just wanted to share this to you.

I have had multiple concussions in the past this one was due to me being pinned against the metal pole cuz I was backed into by a truck and trailer that I was dizzy and nauseous on Sunday today I'm just a little bit disorientated and nauseous but my head wants to come off today the pounding between my eyes is phenomenal I'm putting a heating blanket on right now is that good

I don't believe heat is called for. They told me ice. In fact, I recently volunteered @ a food bank & while there I suffered a migraine attack and noticed I was by the walkin freezer, so I walk in it & it was cold but my migraine went away in seconds. With this said, cold helped mine. Hope this helps. God bless..pray it does WONDERS

Head injury 03-04-18 ran into a hanging light fixture - at restaurant no caution signs or verbal until after the accident. My doctor order a CT Scan. of my head.
Dull headaches and tenderness on my left side of skull. Hope nothing serious.
Headaches are dull now. My left side of Jaw is hard to open and dull pain.

My head feels like it is bruised where I hit my head and it was 10 or so years ago.

My daughter had a severe concussion during a game two years ago and we have been in and out of the hospital due to the severe headaches the only pain relief she gets is nerve block shots and they only last about 30 days. We have tried amatriptoline and topamax nothing helps and the insurance is starting to not want to pay.

Try taking her to a concussion clinic. They may work on soft tissue damage to the neck and shoulders. Sometimes it's not necessarily the head causing the trauma but other muscles and tissue.

I've been reading through this Reddit category for the last three months as I was diagnosed with post concussion syndrome and was feeling absolutely helpless.

Before I tell my story let me go ahead and start with the fact that I am getting MUCH BETTER. There have been times that I felt worse. Times that it went away momentarily and came back harder. Times that I thought I was going to die. I've blacked out, been hospitalized numerous times, almost committed suicide, and had given up completely at one point. But I'm telling you right now... Keep fighting.

Almost 3 months ago I was diagnosed with a concussion. I was at work two days after I took blows to the head and jaw area numerous times. That day at work I passed out and was sent to the ER where I got a cat scan done. The results of that test were clean. Just a little swelling.

Fast forward two weeks. I've got headaches, nausea, I've got problems with focus, balance, body temperature, I feel numbness in my head, I feel almost like I'm right about to pass out sometimes and catch myself, I have serious mood and depression issues, and I feel like everything is rattling in my head every time I take a step.

I was absolutely miserable.

**Pause here. I work in IT and sit in front of a computer all day. Then I come home and have work for college I do in front of a computer all day. This made things ten times worse. I didn't get adequate rest, and tried to resume normal life functions way too early.**

Finally, there was a day that i was in the bathroom and I don't know much of what happened other than that I blacked out. My brother and dad told me I was out for quite a while, and that I was mumbling incoherent things.

They took me to the hospital and I remember waking up half way into the ride there. The pressure of the turning while driving made me feel like I was floating outside of my body. Then I was put on a stretcher only to be told I'm fine after another CAT scan.

Fuck these hospital doctors. All they want to do is sit you in their ER so they can send you a bill and then kick you out. They don't know what the fuck they are talking about.

They send you home with almost no reassurance, no advice, nothing. Let me tell you what you need. Sleep. Stay away from screens. Sleep. Stay away from loud noises. Sleep. Don't stress yourself out. Sleep. Take time off work. Sleep. Eat healthy. Sleep more. Drink LOTS of water. Super B complex (a vitamin that is sold at CVS and Walgreens), some GENTLE ear plugs for times you have to be in a loud environment, some UV resistant glasses for times you have to be looking at a screen (search "Prospek" on Amazon.com), and finally lots of love and understanding from the people that are around you (I couldn't have survived this without my girlfriend and brother. I'm not kidding. I genuinely think I would have committed suicide and this is not to make you feel sorry for me. This is truly what I believe.)

No tests, no MRIs, no CAT scans, no EEG will show anything. Do a little research and you will find millions of people who say the same thing. Now this is not to say that you shouldn't get them done. Def get them done to make sure there are no other issues going on.

Stay away from things that will make you mad or upset. I can recall this one weekend... I got into a fight with a family member. I ran out of the house and drove off. I found myself in a parking lot wanting to do the unthinkable. I won't go too much into detail. The point is.. stay calm.

You really have to be patient and kind to yourself... Eventually some of the symptoms will go away. Not all of them. It was weird. Some symptoms left and some were added. The numbness went away, the headaches started. The confusion went away, the dizziness started. But you are healing. Talk to people about what you are feeling. Know that there are tons of people out there who love you and care about you and that there are people who are going through what you are going through.

You will get better.

I only have a few symptoms left... And I think it's time for me to start exercising slowly... Just some light aerobic exercise... I will definitely update and let you all know how that makes me feel and what I do and don't do.

Please stay strong
Meditate
Stretch
Get tons of sleep
Stay strong
Stay strong
Stay strong.

Don't listen to the people here who say you have to just take this for the rest of your life. Fuck that. Let's fight this together.

Feel free to reach out to me if you have anything you want to know!

Hi I wish I could get your email as I was in car accident last Dec,still having problems,not sure if you want to post it on here

Thank you so much for your love and concern for us.

This comment is the one thing that's given me hope since I got my concussion. Lubby, I appreciate you sharing your story and encouragement. I know this is a strange request but would you be open to sharing an email address or a way for me to reach you to ask questions? I've felt very alone throughout this and you seem to be the one sliver of hope I've found. thanks.

Thanks so much

Many thanks for sharing your experience. Your inputs shall help many people like it is of great help to me. Hope you shall be fully normal very shortly. I am watching my symptoms which are similar to yours , but to a lesser extent.

Your experience and feedback would definitely helpful to get rid of lots of confusion about headache. Your remedy is really effective one.

Thanks for sharing and God bless you...

Hey Lubby,
Your comment really spoke to me. I've been struggling for 16 months now with the ups and downs of post-concussion syndrome. I also feel incredibly frustrated by doctors who can't give me any information, and the lack of direction or guidance about what to do.
Thanks for sharing. I hear you and I'm with you, too.

My son who is 14 was hit in the eye while batting at a baseball All Stars game 6/4/2016 and he still suffers EVERYDAY with terrible headaches and NONE of the meds work at all we have tried everything. So I'm hopeful that he will get some relief. All of his test are good, but he is 90% blind in his right eye but the eye is stable.

Hopeful and need any advise.

This makes me have hope. Thank You! I don't know me after a concussion and these headaches are driving me off the edge after 27 days straight. I won't give up:)

Cheered me up thanks

I have had post concussion headaches for over 14 months. They are severe. They are tension type headaches. I have a history of migraines, but I am on Botox and no longer get migraines. I am unable to take a lot of pain meds because of other health issues. I get my headaches when or after I do too much. Usually after. I hear you. I have started kinesiology and have been trying to get out of the house more to exercise. I have also done vision therapy. As well, I do NUCCA. None of these are making a significant dent.

Thank you so much for this. I seriously have no idea who I was before my concussion and have just hoped what I'm dealing with is normal. Before this I was never upset easily never had a headache in my life; for the last week if I'm up more than a hour or so I start to black out. Your right Drs don't seem to care they say this isn't condusive to a concussion:( But from anything I have read this is exactly what happens from a concussion. How soon did you get back to normal life?

Thank you so much for your encouraging post.

I have severe migraine type pain which wakes me, about 6/7 weeks after hitting my head in a swimming pool. CT scan was clear. I also have a virtual constant low grade headache. But it's the heavy migraine type pain that's the worst for me.

I'm having acupuncture and doing gentle physio advised neck / head movements. The vertigo that started immediately after the accident is still with me but much improved. The worse thing is the head pain, usually one sided and wakes me up. Painkillers dont really help much.

I find acpuncture is helping and also topical ice packs on my face, head, eye, ear area where the main pain is.

I will look into other things on you tube too, take the multi vit B you suggest.

I am also taking curcumin and fish oil which are recommended to heal after a brain injury. And as you say, I sleep a lot more which I read is healing for the brain. And a calm life as much as I can.

Hoping all find some improvement, and a full improvement would be a joy for us all!

Thank you soo much, your article on all that you went through has helped me in so many ways. I fell off my company truck @work broke my wrist & hit the left side of my head didn't think much about hitting my head on the asphalt but for the last 6-7 months it's been a nightmare

err,...I have had chronic headpains since 1993. This due to a blow to my head from a head -on highway auto accident. I lost my profession. The pain is relentless. It is constant,..24 hours a day ,...ALWAYS. The only difference is the intensity of the pains. I have 5 types that come and go,...tho worst is the nerve burning pain. Too many doctors,...too many drugs/therapy. Nothing helps. It looks like its me till I die. I am just happy that after legal battles,...etc,...I have been on disability pension and this has allowed me to survive. I have met many others like myself. It sucks.

My son was in a car accident on Jan. 17, 2017. He was hit from behind suffered whiplash and a concussion. Has had chronic daily headaches since the accident not one day with out a headache. Tried every medicine and therapy available up to Botox nothing helped. Out of desperation never have believed in it but got approved for a Medical Marijuana card. The head pain goes completely away for at least 6 hours at a time till he takes more the only downfall in this is that he gets dizzy from it but he says he can take the dizziness over the head pain any day! On a side note he cant work and has got on disability so he was able to try the MM.

My husband has had headaches since 1980 they are now 12/10 every day since October 2006, nothing works. How is the Marijuana administered? Is it easy to get a Medical card, would appreciate anything you can tell me.

Art, I feel your pain and I’m sick of doctors and trials of every sort. Strong Pain Meds help but can only take a few per day. The rest of the time is just misery...

I’m so sorry to hear u got into a head on collision, but I’m so glad u survived. That right there is a miracle. I would like to ask u about the nerve burning pain u said u get. I have been experiencing that lately. It feels like a tingly burning sensation all over my brain. It’s really concerning me. I hit my head about a week and a half ago.

Thank you so much for posting. I hit my head last Friday on some ice right outside our house. When I fell I fell backward straight on the back of my head. I wound up crawling back to the house and did a 12-hour shift after that. I am a hairdresser that is very busy at the salon most times. The second day I did a four-hour shift and after that became very nauseated. Decided that I needed to go in. They thought it was less than 1% chance that I would have a brain bleed, so I decided to just go home and rest. It is now been a week and I still have a headache and I am not irritated. Very discouraged and emotional and still not feeling myself. I didn't realize how dangerous it was to fall this hard on your head. I expected to maybe take a day and it would feel better. It has not! I feel emotional, hot feverish like, definitely fatigued, and have nausea. It's extremely hard for me to sit but I find myself needing to lay down a lot. Thank you so much for your input. I do feel quite emotional.

Finding myself getting very discouraged. Thank you for letting me know that this takes time it has helped a lot reading your post

Wow Lubby power to you for being so strong. Going on 2 years and have lots of symptoms still. Not being able to function at times. Fatigue headaches light noise too much movement around me makes me worst. In darkness and in the house all the time. I have not so bad in the mornings but feel like shutting down and need to be in a quiet place to sustain some sanity. No one has helped all the doctors want is your money have gotten no relief! Depressed and fatigued and sleeping is all messed up. I go to bed normally around 11:00 pm up and down all night and trouble falling asleep. Although when I hit a wall I shut Down totally. Thanks for reading this. Hopeless

I'm going through now, I actually went backwards again, and I'm just at a stand still. If I had the support I know things would be much better however, right now I do not and that sucks. I understand things will get better soon enough and I am taking things very slowly.

Stay strong god is healing you. Faith and patience.

After 25+ years of constant 24hour headpains,...I do not have hope. sorry

Inspiring story to hear you are getting better. I too have had a similar experience where I spend a lot of time in front of a screen and the continuing concussion symptoms were making things miserable. However, I found some things that DEFINITELY make an impact and have made me feel better with time.

I will recommend a lot of the following, with regular consistency:
- massage therapy on your neck and head
- acupuncture on your neck and head
- static stretching for the neck and head (look on YouTube)
- chiropractic adjustments

which have helped me very nearly fully recover--often, the symptoms remaining from a concussion months after are due to tension in the neck and the spine (possibly being out of alignment due to whiplash or just recovery from the injury). Hope this info helps you. Again, best of luck with your journey back to health.

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