At Mind Matters, we’re constantly exploring the evolving landscape of brain injury care. In our latest episode, Legal Nurse Consultant Kiley Como with Shane Smith Law sat down once again with Dr. Gilbert Mbeo of the Brain and Spine Institute to dive deep into one of the most frustrating and persistent complications of traumatic brain injuries (TBI): post-traumatic headaches (PTH).
Abortive vs. Preventative: Two Paths to Relief
Dr. Mbeo began by distinguishing between two primary treatment strategies: abortive and preventative. Abortive medications, like triptans, are taken at the onset of a headache to stop it in its tracks.
But in recent years, a revolutionary class of drugs known as CGRP inhibitors (calcitonin gene-related peptide blockers) has expanded the options for both abortive and preventative care.
Brand names like Ubrelvy, Nurtec, and Ajovy are gaining traction as CGRP medications show promising results in halting migraine-type headaches and reducing their frequency when used daily or monthly.
These medications come in various forms—oral pills, nasal sprays, injectables, and even infusions—offering flexibility for patients with different preferences and tolerances.
Off-Label but Effective
A striking point from Dr. Mbeo’s insight: most medications used for post-traumatic headaches are technically off-label. That means they weren’t originally approved by the FDA specifically for treating headaches related to brain injuries.
However, don’t let that term mislead you—these treatments have decades of clinical use and data supporting their effectiveness in migraine-type headache cases, which often mirror PTH.
Medications like propranolol (a beta-blocker for blood pressure) and nortriptyline (a tricyclic antidepressant) are prime examples of drugs repurposed to prevent chronic headaches. The key, as Dr. Mbeo emphasized, lies in proper phenotyping—understanding the specific characteristics and patterns of a patient’s headaches to match them with the right therapeutic tools.
Beyond Pills: Interventional Pain Management
What happens when medication isn’t enough? Dr. Mbeo walked us through an array of interventional procedures that are transforming how we treat stubborn headaches:
- Botox Injections: No longer just for wrinkles, Botox is now a frontline treatment for chronic migraines. Injected in specific head and neck muscles, it blocks pain-signaling neurotransmitters and helps reduce muscle tension.
- Sphenopalatine Ganglion (SPG) Block: This involves inserting a soft-tipped catheter through the nose to apply local anesthetic to a key nerve cluster. Think of it as a neurological “reset button”—an innovative and well-tolerated procedure that can bring powerful relief.
- Occipital Nerve Blocks: Many headache sufferers report pain radiating from the back of the head. Targeting the occipital nerves with anesthetic can help calm the storm. If the effects are short-lived, more permanent solutions like radiofrequency ablation or cryotherapy (e.g., with the iovera device) can extend relief for six months or more.
Non-Invasive Option: Transcranial Magnetic Stimulation (TMS)
For patients hesitant about medications or injections, TMS offers a non-invasive alternative. Using gentle magnetic pulses, this FDA-approved therapy calms overactive neurons involved in headache pathways.
Sessions last about 30–45 minutes and are typically delivered over a multi-week period. It’s a promising option, especially for patients with medication sensitivities or needle anxiety.
The FDA Challenge and the Road Ahead
So why aren’t more of these treatments FDA-approved specifically for PTH? According to Dr. Mbeo, the diversity of TBI presentations and the complexity of the neurometabolic cascade make standardization difficult.
Add to that the massive cost and time involved in running clinical trials, and it’s no surprise that much of the progress in this field has occurred without formal FDA labeling.
But the tide is turning. As awareness grows, particularly around so-called “mild” TBIs that cause very real and lasting symptoms, the push for targeted research and approval is gaining momentum.
Final Thoughts: A Call to Hope and Action
This episode was a powerful reminder: you don’t have to suffer in silence. From cutting-edge medications to innovative procedures and brain-stimulating therapies, treatment for post-traumatic headaches is more personalized and promising than ever.
As Dr. Mbeo wisely noted, the first step is to speak with a neurologist who understands TBI and its many complications. With the right guidance and persistence, relief is within reach.
If you or a loved one are living with the aftereffects of a brain injury and are in pain—call Shane at 980-999-9999. We’re here to help.
Subscribe to Mind Matters for more expert insights and inspiring survivor stories. Leave us a comment and let us know what treatments you’ve tried—or what you’d like to learn more about in future episodes!
