Post-Traumatic Headache

Headache is one of the most common lingering symptoms of a traumatic brain injury. A traumatic brain injury (TBI) may be caused by many things: an assault on the brain from a blast, a blow to the head by an object, a motor vehicle accident and even a medical procedure.

When someone experiences a concussive injury with or without a loss of consciousness brain function is interrupted - "head trauma results in complex and chaotic brain motion." ¹ In terms of diagnosis, post traumatic headache is thought to be a secondary headache because the injury is from the head trauma, not another issue. Post traumatic headache (PTH) may be difficult to treat if a patient has Migraine and/or other underlying headache disorders.

Post traumatic headache is typical and may become apparent immediately after the TBI or within three to four days of the injury. There are some interesting figures from emergency rooms about the frequency of PTH after a traumatic brain injury. Between 31% -90% of patients with TBI who were seen in the ER reported having headache one month after the injury. At the two to three month mark, 32% - 78% complained of headache; while one year after the injury, 8% - 35% reported headache. Still two to four years later, 20%-24% of patients stated they had headaches.

The symptoms of PTH can feel similar to tension-type headache and/or a Migraine. Tension-type headache is described as a squeezing, band like sensation around the head, while Migraine pain can be moderate to severe, throbbing-like pain with light and sound sensitivity, nausea and tend to get worse with activity.

Other symptoms that accompany PTH include but are not limited to:

  • Decreased taste or smell
  • Depression, irritability and anxiety
  • Difficulty with concentration
  • Diminished sex drive
  • Dizziness
  • Fatigue
  • Hearing loss
  • Increased startle response
  • Sensitivity to sound and light
  • Short term memory loss
  • Staring episodes with no explanation
  • Tinnitus
  • Vertigo

Treating post traumatic headache starts with a caring doctor who is well-versed in this condition. A problem treating PTH is there are no successful controlled clinical studies of medication, but there have been short term case studies showing success with the short term use of IV DHE. Traditional methods such as Migraine preventive and abortive medications are used to treat PTH. As with any Migraine or headache disorder, care must be taken to avoid medication overuse headache. Alternative therapies like biofeedback, physical therapy, relaxation techniques, massage and counseling can all be incorporated along with a traditional regime. It's best for the patient to have the emotional support from family and friends which will aid in the recovery process.

When it comes to recovery of TBI, women seem to be at a greater risk for PTH and have a less favorable outcome. Of note is the position of your head during the injury, if it's at an angle or turned may put you at a greater risk for headache too. And after much controversy, most studies indicate that PTH occurs less often if the injury is more severe. Yes, you read that correctly.

I am one of the 1.7 million Americans who have (annually) suffered a TBI, in addition to one of the 37 million Americans with Migraine. The TBI changed my life forever; Migraines and other headache disorders have complicated my PTH. The short term memory loss, head pain and other symptoms I still experience are all evidence of that. As I was finishing this piece, I came across an interesting note in Drs. Young, Silberstein, Nahas and Marmuras book..."Note that failure to respond to treatment is not evidence of psychogenicity."  It's nice to know it is not all in our heads.

References 1. Young, William B.; Silberstein, Stephen D.; Nahas, Stephanie J.; Marmura, Michael J. Jefferson Headache Manual. New York, N.Y. Demos Medical Publishing. 2011. 2. Headache Attributed to Head and/or Neck Trauma. International Headache Society. International Classification of Headache Disorders, 2nd Edition. 3.

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