Headaches are one of the most common symptoms following a concussion or traumatic brain injury. However, not every post-injury headache is the same.
Some resemble migraines. Others feel like tension headaches. In certain cases, a sudden or unusually severe headache may signal a more dangerous condition that requires immediate medical attention.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Gilbert Mabeo of the Brain Spine and Pain Institute about post-traumatic headaches, treatment challenges, medication concerns, and the warning signs survivors should never ignore.
What Is a Post-Traumatic Headache?
A post-traumatic headache is a headache that develops after an injury to the head or brain.
These headaches can appear in different ways. Some patients experience one-sided, throbbing pain accompanied by sensitivity to light and sound. This presentation may resemble a migraine.
Others experience pressure or tightness similar to a tension-type headache.
Because post-traumatic headaches do not follow one consistent pattern, understanding the location, intensity, frequency, triggers, and related symptoms is essential when developing a treatment plan.
Acute Versus Persistent Headaches
Post-traumatic headaches are generally classified as acute or persistent.
An acute post-traumatic headache begins within seven days of the injury and resolves within three months.
A persistent post-traumatic headache continues for more than three months. These longer-lasting headaches are commonly seen in concussion clinics and can significantly interfere with work, sleep, concentration, and daily activities.
The migraine-like form is one of the most common presentations. Symptoms may include throbbing pain on one side of the head, nausea, and sensitivity to light or noise.
Why Treatment Can Be Difficult
There is no single treatment that works for every post-traumatic headache.
One patient may experience occasional headaches triggered by bright lights. Another may have daily pain made worse by poor sleep, physical activity, or stress.
Treatment requires a detailed history that examines:
- When the headaches began
- Where the pain is located
- How often the headaches occur
- How severe the pain becomes
- What triggers or worsens the symptoms
- Whether nausea, dizziness, or vision problems are present
- Which medications and supplements the patient uses
This information helps the medical provider understand the headache pattern and choose an appropriate approach.
Sleep, Anxiety, and Depression Matter
Post-traumatic headaches rarely occur in isolation.
Many brain injury survivors also experience disrupted sleep, anxiety, depression, cognitive changes, or emotional distress. These conditions can worsen headaches and make treatment more complicated.
Poor sleep may increase pain sensitivity and reduce the brain’s ability to recover. Anxiety can make someone more alert to symptoms, while ongoing headaches may create additional fear and emotional stress.
A treatment plan should consider the entire person rather than focusing only on pain.
For example, a physician may choose a medication that addresses both headaches and sleep problems or avoids one that could worsen an existing condition.
The Risks of Medication Overuse
People experiencing frequent headaches may begin taking over-the-counter or prescription medication more often than recommended.
This can lead to medication-overuse headaches, in which the medicine intended to relieve pain begins contributing to recurring headaches.
Managing several medications can also create problems. A brain injury survivor may be taking prescriptions for pain, sleep, anxiety, depression, or other medical conditions.
These medications can interact, cause side effects, or place additional strain on the body.
Patients should provide their doctors with a complete list of everything they take and should not increase dosages without medical guidance.
Supplements Should Be Included Too
Patients may not think of vitamins, herbs, and dietary supplements as medications, but they can still affect treatment.
Some supplements may change how the body processes prescription drugs. Others may influence blood vessels in the brain or contribute to headache symptoms.
A complete medication history should include:
- Prescription medications
- Over-the-counter pain relievers
- Vitamins
- Herbal products
- Energy supplements
- Sleep aids
- Other wellness products
Including these details can help the medical provider identify possible interactions or headache triggers.
A Headache Should Be Evaluated by Its Pattern
Dr. Mabeo described a phenotypic approach to treatment. This means identifying what type of headache the patient appears to have and treating it according to its specific characteristics.
In the acute phase, treatment may include nonsteroidal anti-inflammatory drugs or migraine medications such as triptans, depending on the patient’s symptoms and medical history.
However, the first priority is determining whether the headache may be caused by something more serious.
Headache Warning Signs You Should Never Ignore
Certain symptoms may indicate a brain bleed or another medical emergency rather than an ordinary post-traumatic headache.
Important warning signs include:
- A sudden and severe headache
- The worst headache of your life
- New weakness or numbness
- Difficulty speaking
- Facial drooping
- Confusion or unusual behavior
- Loss of consciousness
- Seizures
- Significant vision changes
- Worsening balance or coordination
- Repeated vomiting
These symptoms may be associated with conditions such as a subdural hematoma or bleeding within the brain.
Anyone experiencing stroke-like symptoms or a sudden, extreme headache after a head injury should seek immediate emergency medical care.
Do Not Assume Every Headache Is Normal
Headaches may be common after a concussion, but that does not mean they should be ignored.
A medical provider should evaluate the headache’s onset, pattern, severity, related symptoms, and response to treatment. Persistent headaches may require ongoing management, while sudden neurological changes may require emergency testing.
Brain injury survivors should also be honest about their sleep, emotional health, medications, supplements, and any changes in symptoms.
The more complete the medical picture, the better the provider can distinguish between a common post-traumatic headache and something potentially life-threatening.
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