Post-Traumatic Headache

Post-Traumatic Headache (PTH): Symptoms, Causes and Treatment

Post-traumatic headache (PTH) is characterized by persistent headaches occurring within seven days of an event that has caused altered consciousness. The most common symptom following a traumatic brain injury is a posttraumatic headache. Most people with PTH experience headaches of either the migraine or tension type.

Chronic conditions like this may be disabling. It is common for the treatment to include at-home approaches, medication and other approaches. This article gives you a quick overview of post-traumatic headaches, including what causes it, how it’s diagnosed, and the treatment options available.

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Post-traumatic headache symptoms

Symptoms of PTH usually develop within seven days after a traumatic brain injury (TBI), which causes significant damage to the brain and sometimes causes loss of consciousness.

Most people with this condition have similar symptoms to migraines or tension headaches, but this condition can take many forms. In absence of other medical conditions, these are the two most common types of primary headache disorders.

There are several symptoms that resemble tension headaches:

  • Headache that is dull to moderate
  • Squeezing headache
  • Headache that affects both sides
  • Sound or light sensitivity

There are several PTH causes that are similar to migraines:

  • Headache that throbs and pulses
  • Moderately to severely intense
  • Sensory sensitivity (heightened responses to light, sound, or other stimuli)
  • Vomiting and nausea

PTH may co-occur with the following symptoms as well as traumatic brain injury:

Read: Sinus Headache

Acute vs. chronic PTH

Chronic PTH is defined as persistent and/or recurrent symptoms over a period of two months. Patients with acute symptoms are considered to have this condition.

Causes

Traumatic brain injuries are the primary cause of post-traumatic headaches. Mild traumatic brain injuries (concussions) to more serious ones can all result in these types of injuries. Traumatic brain injuries, such as whiplash, typically occur when brain tissues strike the sides of the skull. There are two main causes of TBI:

  • Falls
  • Automobile accidents
  • Sports injuries
  • Impacts to the head caused by objects
  • Domestic or interpersonal violence
  • Blast injuries

Post-traumatic headaches aren’t completely understood by researchers yet. Several potential explanations have been suggested for PTH by neuroimaging and other types of studies:

  • Inflammation: When the skull (brain) is struck by an object, neurogenic inflammation (within the nervous system) occurs. Chemicals released in the body cause the brain to respond in a way that elevates temperature causes swelling, and causes discomfort and pain. Hyperexcitation of nerve cells linked to pain perception causes headaches to recur.
  • Spinal damage: Traumatic brain injuries typically damage the spinothalamic pathways (wiring between the spinal cord and brain) and the thalamocortical pathways, which control pain and sensory perception. When nerve pathways are more sensitive as a result of inflammation, headaches result.
  • Dysfunction of pain inhibition: The physiology of PTH is also thought to be caused by dysfunction and damage to the pain pathways in the nervous system. The TBI reduces the function of the nerves responsible for easing and stopping pain, which can lead to headaches and other complications.

Read: Chronic Tension Headache

Diagnosis

If headaches manifest within seven days after a traumatic brain injury, a diagnosis of post-traumatic headache is considered. The fact that PTH may present in many different ways, and since there are many headache disorders, makes it necessary for healthcare providers to examine the causes of the symptoms. The causes typically include:

  • Symptom assessment: You will be evaluated by your medical provider, including a neurologist (a doctor specializing in disorders of the brain and nervous system). Your healthcare provider will take a history of your health and evaluate your symptoms for signs of neurological symptoms. It is most important to do this within 72 hours after the TBI.
  • Neuropsychological testing: This may include cognitive testing and memory tests. In addition to repetition, you’ll be assessed for mood disorders, screened for speech patterns, and asked to perform reasoning problems.
  • Vestibular testing: The purpose of this test is to determine whether you have any dizziness, balance problems, or problems with eye coordination. The use of a variety of methods, such as an electromyography (ENG) test or a rotary chair test can verify eye movements, balance and coordination.
  • Neuro-ophthalmologic tests: Your eyes will be assessed to determine if they can move properly and how well they work. Additionally, other neurological tests may be performed, such as those for coordination, movement, sensation and strength.
  • Imaging: MRI and computed tomography (CT) scans, along with the above-mentioned treatment options, are often necessary in cases requiring more severe treatment. Neurologists can utilize these to identify bleeding in the brain, or a medical emergency.

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Post-traumatic headache treatment

The treatment for PTH depends on how the condition presents itself, and there is no prescribed treatment. Patients with migraine-like PTH are treated as migraines, and those with tension headache PTH are treated as headaches. Since each person’s situation is different, strategies for treatment and management need to be mixed and matched.

Acute medications

Acute or preventive medication is available for headache disorders. These treatments manage symptoms after PTH has developed. It is recommended that some classes of acute drugs are available over-the-counter (OTC) or by prescription, but excessive use may lead to side effects:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs reduce inflammation as well as pain. They are available over-the-counter and in prescription strength versions. OTC options such as Aleve (naproxen), Motrin, and Advil (ibuprofen) are commonly available. DayPro (oxaprozin) and Celebrex (celecoxib) are prescription options.
  • Acetaminophen: Acetaminophen (Tylenol) can relieve pain, but not inflammation. These drugs can be obtained over the counter as well as by prescription.
  • Combination drugs. There are also medications that combine aspirin, caffeine, and acetaminophen in order to treat tension, migraines and posttraumatic headaches. These medications include Excedrin, Cafergot and Midrin.
  • Opioids: Percocet and Vicodin (oxycodone/paracetamol), as well as Oxycontin (oxycodone), are all prescription painkillers in the opioid class. Their use is carefully monitored and limited since they can cause side effects and can be addictive. Alternative options are usually considered first.
  • Triptans: The triptans Imitrex (sumatriptan) and Zomig (zolmitriptan) are often prescribed for migraines. These drugs stimulate two types of serotonin receptors in the brain, which are associated with mood and feelings of well-being.

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Preventive medications

The use of medications to prevent posttraumatic headaches may also be prescribed in cases of chronic post-traumatic headache-in which headaches recur and return after two months. Some of the most common migraine medications include:

  • Tricyclic antidepressants: Elavil (amitriptyline) and Pamelor (nortriptyline) are two tricyclic antidepressants used to treat depression and other mood disorders. PTH is often treated with moderate to low doses, while mood disorders usually require higher doses.
  • Anticonvulsants: Neurontin (gabapentin), Lyrica (pregabalin), Topamax (topiramate), and Depakene (sodium valproate) are medications used predominantly for epilepsy; however, they have been shown to effectively prevent migraines as well. They’re used to treat migraines and chronic PTH, as well.  
  • Beta-blockers: Chronic headaches can often be prevented with drugs such as Indraral (propranolol) and Levatol (penbutolol). Additionally, these drugs can treat heart problems and blood circulation issues.

Counseling and therapy

It has been shown that a variety of therapeutic methods are effective for managing chronic pain problems, like chronic PTH. Cognitive behavioral therapy (CBT) is one of these approaches that aim to increase patients’ control over their pain. Psychologists can assist you in coping with tension, relaxation, and pain by providing you with strategies.  

Many chronic headache patients also experience mental health issues, such as anxiety and depression. Therapy can prove helpful in dealing with these issues.

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Biofeedback and relaxation training

The use of biofeedback and relaxation techniques may also help chronic headaches, such as persistent PTH. Wearable devices track physiological signs of stress as well as temperature and muscle tension, which can exacerbate pain or trigger attacks. Users can use this information to detect and prevent issues when they arise.

Relaxation exercises, such as breathing exercises, can be taught through these techniques. It has been shown that this can decrease headache frequency and intensity.

Lifestyle modifications

Lifestyle changes can be beneficial in conjunction with pharmaceutical management in chronic PTH. The following strategies are often recommended:

  • Sleeping well
  • Getting up and going to bed at the same time every day
  • Eating healthy and staying hydrated
  • Getting exercise
  • Exercises that trigger TBI symptoms, such as PTH, should be stopped immediately

Headache diaries

Especially if you experience migraine symptoms, chronic PTH patients should keep track of their headaches. In other words, chart when and how long your PTH attacks last, as well as any foods or beverages that trigger them, as well as what medications you take.

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Alternative approaches

There are a variety of medical approaches available to treat chronic headaches that have become difficult to manage (refractory):

  • Botox injections: Many people with chronic headaches benefit from injections of botulinum toxin A (Botox) into specific areas of their temples, necks, and heads. During Botox treatments, nerves that control pain are temporarily slowed.
  • Nerve block: Nerve block treatments are common for painful tendinitis. Anesthetic injections can interfere with nerve function and prevent headaches by stopping pain-related nerves from functioning.
  • Trigger-point injections: A trigger-point injection works by targeting specific points of tension on the face or neck to relieve tension headaches, such as TMJ (temporomandibular joint) headaches. Some evidence suggests this may be helpful as a preventative measure.
  • Transcranial stimulation: The wearable devices target specific brain regions with electromagnetic or electronic waves. Scrambling pain messages basically calms headaches or even resolves them.
  • Decompression surgery: This procedure is often reserved for patients with the most severe cases of PTH. It relies on releasing pressure on the peripheral nerves of the head that cause headaches. The bone and tissue surrounding these nerves are removed through very small incisions on the head and neck. 
  • Physical activity: Chronic migraines and headaches are often treated with physical therapy, massage and acupuncture. It has been shown that these treatments have reduced medication use when used along with other treatments.

Read: Difference Between Sadness and Depression

Coping with post-traumatic headache

Especially in more severe cases, headache disorders can be extremely challenging to deal with. PTH treatment often includes psychiatric examination and therapy. What other options are there for dealing with the disease? APA recommends taking several steps to battle depression, including:

  • Take on stress: Ensure that you get enough sleep, maintain good fitness habits, and eat right to reduce your stress. You could also go for a walk, garden, or practice yoga to relax.
  • Be connected: People with chronic pain often feel isolated and alone. The study showed that those with stronger social connections and support fared better. Engage with your community and relatives by reaching out to them.
  • Find social support: A person with chronic pain can also benefit from sharing experiences and finding support from others. Consult your medical team for information about local or online support groups. Social media groups and advocacy organizations that support chronic pain and headache sufferers can be valuable resources.
  • Seek professional help: PTH can be difficult psychologically and emotionally. Your doctor may suggest therapy to alleviate this burden. It provides strategies for coping with these feelings in a healthy way.

Prognosis

People who suffer a traumatic brain injury are very likely to develop post-traumatic headaches. Concussions or mild TBI, on the other hand, usually heal within days or weeks.

Chronic cases present particular challenges because they tend to resolve within three months. Chronic PTH can aggravate depression and anxiety, as well as impair sleep. In turn, insomnia can aggravate headaches.

Read: What is Self-harm

Summary

The term “post-traumatic headache (PTH)” usually refers to a headache resulting from traumatic brain injury within seven days. Some suffer from milder headache symptoms like tension headaches, whereas others are dealing with more severe headache symptoms such as migraines or rare headache syndromes.

There are several treatments available for this condition, which include drugs and lifestyle modifications, as well as biofeedback and relaxation techniques. If the condition is more severe, transcranial stimulators or decompression surgery may be necessary.

Taking note of your ability to remain active is important if your headache worsens with activity. The procedure is often performed under a neurologist’s or physical therapist’s guidance.

Chronic PTH, especially when persistent, can significantly impact mental health and morale, even though mild PTH usually passes within a few weeks. You can combat chronic pain by taking care of your stress, reaching out to family, friends, or fellow chronic pain sufferers, or seeking counseling.

Bottom line

Post-traumatic headache is among the most common effects of traumatic brain injury, and it can be extremely debilitating. Living with chronic pain can be very challenging. PTH is still poorly understood by doctors, but the good news is that we are learning more and more about the condition.

The extensive list of therapies for this disorder will be expanded, providing better outcomes for patients. The best way to manage your condition is to learn about it, develop strategies to manage it, and not be afraid to ask for help when you need it.

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