Headaches are among the most common and difficult symptoms following a concussion or traumatic brain injury.
Some patients develop headaches for the first time. Others already experienced occasional migraines but find that the injury makes them more frequent, more intense, or nearly constant.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Gilbert Mbeo about persistent post-traumatic headaches, sensitive cranial nerves, and several emerging treatments designed to reduce pain without relying entirely on medication.
Brain Injuries Can Transform Existing Headaches
A traumatic brain injury may change the way a person experiences headaches.
Someone who previously had one migraine every few months may begin experiencing several each week. Another person may go from having no significant headache history to dealing with daily pain.
The location and quality of the pain may also change.
Patients may describe:
- Migraine-like throbbing
- Sharp pain around the eye
- Stabbing pain in the forehead
- Pain near the temple
- Burning or shooting sensations
- Severe pain at the back of the head
- Headaches that spread into the neck
Understanding the specific pattern helps the provider determine which nerves, muscles, or pain pathways may be involved.
What Is Cranial Neuralgia?
Cranial neuralgia occurs when a nerve around the head or face becomes irritated or unusually sensitive.
Dr. Mbeo discussed several nerves that may contribute to post-traumatic headaches.
The supraorbital and supratrochlear nerves serve areas above and around the eye. When irritated, they may cause sharp or stabbing pain that patients describe as feeling like an object is being pushed into the eye.
The auriculotemporal nerve may cause pain around the temple and side of the head.
The occipital nerves travel from the upper neck into the back of the scalp. Irritation can cause occipital neuralgia, which may affect one or both sides of the head.
A patient may have one sensitive nerve or several pain sources at the same time.
Traditional Medications Can Create Challenges
Doctors have historically used several medication classes for persistent headaches and nerve pain.
These may include:
- Tricyclic antidepressants
- Anti-seizure medications
- Nerve-stabilizing medications
- Migraine medications
- Anti-inflammatory drugs
Dr. Mbeo mentioned medications such as nortriptyline, gabapentin, and topiramate as examples that may be used in headache treatment.
These medications may help some patients, but they can also cause side effects.
That becomes especially concerning after a brain injury because patients may already be struggling with memory, fatigue, slowed thinking, or poor concentration. Adding a medication that causes drowsiness or cognitive difficulty may worsen those limitations.
This is one reason providers continue exploring targeted and medication-sparing treatments.
Botox Is More Than a Cosmetic Treatment
Botox is commonly associated with cosmetic procedures, but it is also used medically for certain chronic headaches.
Dr. Mbeo explained that Botox may be injected into established areas around the forehead, temples, back of the head, neck, and shoulders.
The treatment may help in more than one way.
Botox can relax tight muscles, but it may also reduce the transmission of pain signals through sensitized pathways.
Treatments are commonly repeated at scheduled intervals, often approximately every three months, depending on the patient and the clinical plan.
The goal is not to treat the appearance of the face. It is to reduce the frequency or severity of disabling headaches.
Nerve Blocks Can Identify the Pain Source
A nerve block involves placing a local anesthetic near a suspected pain-producing nerve.
The medication temporarily interrupts the nerve’s ability to transmit pain signals.
Dr. Mbeo compared this to restarting a malfunctioning computer. The nerve is temporarily quieted, giving the pain system an opportunity to reset.
A nerve block can also have diagnostic value.
When the patient experiences meaningful relief after a particular nerve is blocked, that response helps confirm that the nerve is likely contributing to the headaches.
The provider may then consider additional treatments aimed at that same location.
What Is Cryoablation?
A standard nerve block may provide temporary relief lasting hours or days.
Cryoablation, also called cryoneurolysis, is intended to quiet the nerve for a longer period.
The procedure uses carefully controlled cooling energy to temporarily disrupt the nerve’s ability to send abnormal pain signals.
Dr. Mbeo described this as placing the nerve into a longer hibernation period while it gradually regenerates.
Depending on the patient and the nerve being treated, relief may last for months and, in some cases, longer.
The procedure does not permanently remove the nerve. The goal is to interrupt the abnormal pain cycle while reducing the need for daily medication.
The Sphenopalatine Ganglion
Another treatment discussed during the episode targets the sphenopalatine ganglion.
A ganglion is a collection of nerve cells. The sphenopalatine ganglion sits deep within the facial and nasal region and is involved in certain headache and facial pain pathways.
For some patients with persistent or difficult-to-control headaches, this nerve center may become overactive.
The provider may use a specially designed catheter placed through the nostril to deliver a carefully measured local anesthetic near the ganglion.
This is known as a sphenopalatine ganglion block.
How a Sphenopalatine Ganglion Block Works
The procedure is designed to temporarily reduce activity in the nerve center contributing to the headache.
Dr. Mbeo again used the idea of resetting an overactive pain system.
The procedure is generally performed in an office or bedside setting and may take only a few minutes.
Because the medication is delivered through the nasal passage, the treatment does not require surgery.
Patients may experience brief discomfort, but the goal is to provide longer-lasting relief from headaches that have not responded well to other approaches.
As with every procedure, results vary, and patients should discuss the potential benefits, risks, and alternatives with a qualified provider.
Office-Based Treatment Can Improve Access
Dr. Mbeo explained that Botox, nerve blocks, cryoablation, and sphenopalatine ganglion blocks may all be performed in an office setting for appropriate patients.
This can reduce the need to travel to several different hospitals or treatment facilities.
Transportation is often a major challenge for brain injury survivors.
A patient may no longer have a working vehicle after a crash. Dizziness, visual problems, headaches, or anxiety may also make driving difficult.
Being able to receive evaluation and selected procedures in one location may make treatment more manageable.
Is It Too Late After One or Two Years?
Early diagnosis and treatment generally offer the best opportunity for improvement.
When symptoms continue for months or years, the brain and nervous system may reinforce abnormal pain patterns, making them more difficult to change.
However, Dr. Mbeo emphasized that delayed treatment does not mean all hope is lost.
A patient who does not return fully to their pre-injury condition may still benefit from targeted symptom relief.
Reducing one disabling symptom can make a significant difference.
For example, improving a persistent headache may help the patient sleep better, think more clearly, tolerate therapy, and participate more fully in family life.
Focus on the Most Treatable Problems
Dr. Mbeo described an approach based on identifying and treating one “low-hanging fruit” at a time.
A patient may be dealing with headaches, dizziness, anxiety, PTSD, cognitive fatigue, and sleep deprivation.
Trying to solve everything at once may be overwhelming.
Instead, the treatment team may begin with the symptom that is easiest to identify and most likely to respond.
That could involve:
- Blocking an irritated nerve
- Treating neck muscle tension
- Addressing migraine-like pain
- Beginning vestibular rehabilitation
- Improving sleep
- Treating anxiety or PTSD
Each improvement may create more capacity to address the next problem.
Neurology Is Moving Beyond Diagnosis
Dr. Mbeo described an older view of neurology as “diagnose and adios.”
Neurologists were often highly skilled at identifying complicated conditions but had fewer treatment options to offer.
That is changing.
New devices, targeted injections, rehabilitation techniques, and non-medication treatments are expanding what providers can do for people with traumatic brain injuries.
The challenge now is making sure patients and other healthcare professionals know these options exist.
Hope Does Not Require a Promise
No ethical provider should guarantee that a patient will return completely to the person they were before a brain injury.
Some symptoms may remain, and long-standing problems can be difficult to treat.
However, improvement does not have to mean a perfect recovery.
Fewer headaches, better sleep, improved balance, or reduced anxiety may dramatically improve a person’s quality of life.
Persistent post-traumatic headaches deserve a careful evaluation of the pain pattern, involved nerves, neck muscles, migraine features, and previous treatment response.
For selected patients, Botox, nerve blocks, cryoablation, and sphenopalatine ganglion blocks may provide additional options when standard medication has not been enough.
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