Traumatic Brain Injury & Migraine
Every year close to 1.7 million Americans suffer a traumatic brain injury (TBI). Most people will recover after a few days of rest and return to their normal activities without any residual effects. Others will have a long, arduous road to recovery due to the extent of their trauma and may have lingering problems for years to come.
Then there are those with TBI who can experience lasting headaches and/or Migraine, the most common symptom, in addition to dizziness, fatigue and cognitive issues. Treating these tends to be a challenging for patient and doctor due to the persistent nature of these symptoms.
After a TBI, when a person is experiencing increased head pain, nausea and/or vomiting, feeling excessively sleepy, has weak limbs and/or seizures, and is having trouble speaking during a headache, an urgent visit to the doctor is warranted. The immediate care after a TBI is allowing the brain to rest, taking care not to over stimulate it. In addition to rest, additional treatments used to reduce head pain or Migraine attacks are extremely individualized. Modifications to a patient's lifestyle include:
- Steering clear of heavy activities
- Staying away from things that require prolonged mental activity - computer work, texting, video games
- Staying hydrated
- If you have trouble remembering things, use a journal, calendar or app to help you stay on track
- Maintain a proper sleep schedule
- Do not skip meals
- Limit caffeine or no caffeine
- Avoid any foods that may trigger a Migraine attack
- Use cold packs or heat on neck and or head
- Staying away from alcohol is imperative
- Acetaminophen for headache - not to be taken more than two to three days a week. This will help reduce the risk of medication overuse headache
In addition to lifestyle changes, complementary therapies such as physical therapy, massage, biofeedback, acupuncture, and meditation are often employed while trying to reduce head pain. Seeing a therapist is another treatment patients can utilize. Therapists trained in disease management or chronic pain may prove helpful to a TBI patient. These therapists can teach coping skills that may help them manage their head pain. Many of these alternative therapies are used in combination with traditional medicine.
Prescription medications are also used to treat headache and Migraine after a TBI. There are quite a few medications used off-label for Migraine and headache prevention. Here is a small sample:
- Anti seizure medications - Topamax, Zonegran, Lamictal.
- Anti-depressants - Elavil, Pamelor, Wellbutrin, Cymbalta.
- Beta-blockers - Inderal and Blocadren (both FDA approved for Migraine prevention), Toprol, Lopressor
- Calcium channel blockers - Norvasc, Cardizem, Calan aka verapmil.
- Muscle relaxers - Skelaxin, Zanaflex
- Carbonic anhydrase inhibitor - Neptazane, Diamox
Dietary Supplements can be useful, but patients should check with their doctor before starting any new dietary supplement or herb. According to the FDA "...some supplements pose health risks. They may contain harmful ingredients or be improperly manufactured or handled. Some of the supplements that have been used in Migraine and head pain include:
The most important part of TBI recovery is making sure the brain has time to heal. This means it must have plenty of rest and be symptom free before resuming normal activity. By pushing ourselves too hard during the recovery process, not only will this set back our improvement, but it will also delay the healing process.
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