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 (469)

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 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.

If nothing can be done ,how about Ayurvedic treatment, like oiling the hair. Sri Lanka has very good Ayurvedic doctors. Or may be acupuncture. Good luck to you. Hope everything will be fine soon.

I'm Isaac. I'm 18. I got in a severe motorcycle wreck sometime around my 17th birthday. Since then I have had persistent headaches from the time I wake up to the time I go to bed. The wreck was bad enough that I have these clear fluids that drain from my ears and discharges into my throat from my nasal passageway. The doctor said it's gonna drain however long it takes to heal. It has also turned my life upside down.

The big thing tho is I found a good girl after my 18 birthday. A year later she knows all my problems. I laid them all out there, and she still loves me for me. That is the best medicine I could ask for

I had a fall at work 21 years ago while attempting to stand on a chair. During the attempt the chair tipped toward me and I went up and over hitting the floor head first. The impact was shared between my chin and right shin. I thought I came out unscathed. The physical therapist who witnessed the fall was amazed I was still breathing on my own. But I was able to jump up and walk away from it. A few weeks later I began having headaches but immediately at the time of the fall I noticed word-finding problems. It is now now years, decades, since that fall. I have had to go on disability and attempts to re-educate myself to go back to work have failed because of memory problems. I replied to your post because CBD oil did nothing for me.

What is CBD oil ? Is it useful for headaches ? What is the age limit to use the CBD oil?

I would say if you have tried everything else, then CBD is an option. If your parents are reluctant to allow you to try it, then you need to educate them as to all aspects of it. Do some research and find out other similar situations where it has been used beneficially. They need to understand that CBD is an extracted oil and not a hallucinogen. I have numerous medical issues from TBI to PN, Agent Orange Dioxin exposure, etc., etc. I know that if you do decide to try CBD, there may be mild side effects which can vary from person to person. What I did was to try a small dose for several days to find out if my system could tolerate it. Assuming it does, then you need to start with a high dose for several days or a week until you find that your symptoms begin to moderate or disappear. After you reach this saturation point, then you can gradually decrease dosage until you start to see symptoms again. At that point, increase slightly until you reach a comfortable zone. This stuff sort of builds up within you so that when you find your proper zone, then you simply try to maintain that level within you, but you can always increase or decrease slightly to tweak it to perfection. Dr. Sanjay Gupta (sp?) spoke on this stuff a couple years ago and stated impressive results for TBI related injuries and recoveries. It is sometimes available at health food stores and such, but to me seems rather pricey but also well worth it if it can help one recover from such injuries.

At least you are seeing specialists who hopefully can steer you in the right directions. In my case, I lost or suppressed memories directly related to an anchor chain incident where I was hit in the head but only recently started to remember key info related to the injury, after 47 years. I asked the VA to do an MRI of my head and they found that I have a small piece of my brain missing likely due to a severe untreated concussion. I was 18 or 19 then and am now 67. No wonder I have numerous short term memory problems and continuous headaches. Oh, Well -- do the best you can while you can. Wish you the best with this. You seem intelligent enough to work your way through though -- Good Luck!

Someone hit my head so hard I feel so dizzy like I am going to die . Please give medical advice I feel scared .

I had blunt force trauma to the right front of my head. I still have severe headaches 9 yrs later. Sometimes headaches for days ..and into my eye.

I had an injury above my right ear about 12 years ago. I got staples. 4 years ago I started experiencing sort of phantom sharp aches near that area tha lasts for days. It can last for a few months and then its gone for months. they seem to get worse as time passes.

In May 2018 I hit my head on the corner of cabinet door. Hurt really bad but figured I would live. Got a nice dent in my head to go with it. I was in the middle of dealing with skin cancer & more concerned with how much of my nose was going to be removed. Headaches continued but then from surgery on nose & seasonal allergies got a sinus infection. Chalked headaches up to what turned into 3 sinius infections over the next 4 months. Now Im over the infections I still have headaches (only on right dide-which is side of head hit), blurred vision, nausea&vomiting, sleep maybe 2hrs at a time, neck pain, can't remember peoples names (I know them just can't find name immeadiately). Spoke to Dr about it this week. Going for CT next week. Ive missed a lot of work & not sure how much I can tell them. So now lets add some stress! Im really worried.

I have had 7 confirmed concussions from playing Lacrosse, Hockey and Rugby as well as boxing for 13 years. I have severe migraines that make me throw up quite often. I recently have started using marijuana and it works wonders. It has been over a month since I've had a migraine. As I've said 7 have been confirmed most likely have had more. I have severe depression and anxiety as well as memory loss where I will forgot what I'm talking about mid sentence. It's sad because I'm only 30. I will be donating my brain. Hopefully they will eventually will beable to confirm CTE without it being cut open.

Had a work place accident 03/29/2018 were fell 9’ off a bucket truck , landing on my head . I was unconscious for 20 minutes and received a large laceration to my head. I still have major headaches and sharp pains to were the impact was! Pain meds don’t help physical therapy helps a bit for a day but not more then a day. Still have not been able to return to work . There are days helpless, they keep telling me it will get better, but there are days I can’t get out of dark room because of the pain.

2 yrs ago I fell off my steps in the winter time . Landed in my drive way hitting the side of my head . Still get aweful headaches

My sister had a accident in which she had no bleeding ( outer) but when she combs her hair, somebody hits lightly, if her hairs are pulled lightly etc. her head starts paining. Can i get any idea how this pain is occurring plz

I had my accident at work. It happened on 8/7/18. I'm 51 yrs old
Where I was hit on my head, neck, shoulders. My hair still is sensitive to wash and comb. I have the same problem of if I pull my hair up it gives me extra pain in my head where it's pulled up. I have to pull it up due to hot flashes and where I have PT. I will pray for you.

I am wondering if anyone else has a constant throbbing on top of their heads too. The only thing that helps me is an ice pack. If I try to lay down it increases extremely. I can only sleep propped up.

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