Headaches A er Head Injuries — Post-

Traumatic Headaches
Seymour Solomon, MD, Headache Unit, Monte ore Medical Center, Albert Einstein College of
Medicine

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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.
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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 di cult 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 di culty 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 bers 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 classi ed as chronic tension-type headache.
These headaches are typically a steady ache a ecting 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 di culty in concentration, inability to work e ciently and
associated di culty 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 o within the rst
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 a liated with
multiple hospitals in the area, including Burke Rehabilitation Hospital and
Monte ore 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 Monte ore Medical
Center who specialize in Neurology.

From Help for Headaches. www.headache-help.org (http://www.headache-

help.org).