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. http://www.cdc.gov/TraumaticBrainInjury/-

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (10)
  • Kristen Newman
    7 years ago

    This s what I suffer from, what is IV DHE mentioned in this article?

  • Nancy Harris Bonk
    7 years ago

    Hi Kristen,

    Sorry about that, I should have explained that better in the article. IV DHE is intravenous Dihydroergotamine, which is used for intractable Migraines (Migraines that are difficult to end).

  • Michelle Metcalf
    7 years ago

    I had an accident, 3 weeks ago. I was told I suffered a minor concussion, after the fact. I had a headache that night, at least that is what my friend tells me. I don’t remember it. I remember the one the next day. I suffer from migraines, and honestly since my accident I have had some small headaches, but none that have taken complete control of my life like regular ones do. I am going to go for more testing, because of the concussion, but I can tell you that my when my neck is “out” it brings the Migraines full force.

  • Nancy Harris Bonk
    7 years ago

    Yes, and there are studies to back you up on that! Neck is often a symptom of Migraine but goes undiagnosed and untreated as such.

  • Andrea Kayy
    7 years ago

    I feel off a bunkbead when I was child directly onto the floor from the top bunk. Soon afterward when I was in a bike seat not properly attached to the bicycle, the seat fell backwards and I landed on my skull. I suffered a concussion both times. In addition, I suffered a concussion after falling down the stairs at night about a year ago. When I was 25 I was hit from behind by a Suburban going about 50 MPH when I was at a dead stop in my new Mustang and had a severe neck/head injury. I have headaches every day but not one has ever asked me about my head injuries – they just give me a lecture about not eating certain foods and one says he does not take any meds when he gets them and just reluctantly gives me a small prescription of medicine to cope with them. He would rather throw up in front of his patients than take medicine himself. I wish I could find a doctor who seriously cares for others with migraines than just think you should work through the day vomiting and in serious pain just because its not ok to call in sick….I stare at a computer all day. There is no way I can work sometimes and my headaches have become worse and worse over time.

  • Michelle Metcalf
    7 years ago

    I know how you feel about the car accident. I was hit three weeks ago, head on. I was traveling about 25-30 miles an hour and the gal that hit me was going about that fast. I was told I suffered a minor concussion…and it all makes sense after reading this. Good luck!!

  • Lynnette Kepler
    7 years ago

    I have had migraines since a neck injury from a car accident 7 years ago. Now I have confirmation that it is from this injury. Thank you!

  • Nancy Harris Bonk
    7 years ago

    I’m glad this helped.

  • Jennifer Bradley Bundy
    7 years ago

    I suffered a concussion when I was 4 years old. I have had headaches regularly since then. I am now 42. I also had a head injury with no concussion at age 14. I am CONVINCED that since nothing has worked for my headaches, and 2 MRI’s have shown nothing organically wrong, that they are partially caused by my concussion. Note I said partially because I do have tension-type headaches. But I am convinced that something is either wired wrong or that something broke deep inside my brain and that they haven’t been able to find it because they haven’t looked for it. I’m certainly no doctor, but that’s my theory and I’m sticking to it!

  • Nancy Harris Bonk
    7 years ago

    Hi Jenn,
    No concussion with a head injury – that sounds a bit off….Anyway, a doctor specializing in headache disorders and Migraine may not be a bad idea at this point. http://migraine.com/blog/living-with-migraine/the-mrf-directory-of-headache-and-migraine-specialists/ Of course that is just my two cents worth!

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