Post-Traumatic Headache

Post-traumatic headache is one of the most common symptoms following a head injury, affecting up to 90% of people who experience traumatic brain injury. While most people recover within weeks, some continue to experience debilitating headaches for months or even years after the initial injury.

Table of contents

• What Is Post-Traumatic Headache?
• How Common Is It?
• Types and Symptoms
• Who Is At Risk?
• Diagnosis and Timing
• Treatment Options

What Is Post-Traumatic Headache?

Post-traumatic headache is a type of secondary headache that develops after a head injury or trauma, such as a concussion or whiplash. It is characterized by persistent head pain that may be accompanied by other symptoms including dizziness, nausea, and sensitivity to light or sound.^[1]

The condition can be divided into two main categories based on how long symptoms last. Acute post-traumatic headache resolves within three months after the injury. Persistent post-traumatic headache continues beyond three months and may become a chronic, debilitating condition.^[1]

Headache pain is the most common symptom after a traumatic brain injury (which means any sudden blow or jolt to the head that disrupts how the brain normally works), with up to 90% of patients experiencing this symptom for at least a few days after suffering a concussion.^[2]

How Common Is It?

Headache is the most common physical complaint following traumatic brain injury, with a prevalence ranging from 30% to 90%. Of those patients, 18% to 22% reported post-traumatic headaches after one year.^[1] The wide range in reported numbers may be because most traumatic brain injury cases are defined as mild, such as concussions, and patients may not seek immediate medical attention.^[1]

Interestingly, post-traumatic headache appears to be more frequent in patients recovering from mild traumatic brain injury than in those who experienced moderate to severe traumatic brain injury.^[1] However, patients with moderate to severe traumatic brain injury may be more likely to report persistent chronic post-traumatic headache.^[1]

Post-traumatic headache is more frequent in females than males, with a ratio of two to one.^[1] One study found that 35% of people who had traumatic brain injury were still experiencing post-traumatic headache five years after their concussion.^[3]

Types and Symptoms

When a person experiences post-traumatic headache, 95% are likely to have headache symptoms, and among those with headache, roughly two-thirds will have symptoms similar to migraine.^[3] The two most common types are headaches that feel like migraines and those that feel like tension-type headaches.^[1]

Post-traumatic headache that feels like a migraine can be moderate to severe in intensity and may include:^[4]

• Pain that pulses or throbs
• Nausea and vomiting
• Sensitivity to light and noise
• Dizziness
• Symptoms that worsen with regular activity

Post-traumatic headaches that feel like tension-type headaches typically have symptoms that are mild to moderate. The headache pain does not pulse, and you won’t have nausea or vomiting. You may be sensitive to light or sound.^[4]

People with post-traumatic headaches may also experience a wide range of other symptoms, including:^[2]

• Brain fog
• Mood swings or personality changes
• Memory problems
• Difficulty concentrating
• Insomnia
• Fatigue
• Depression or nervousness

Post-traumatic headaches can be constant or may happen only once in a while.^[4] When a symptom severity checklist for concussion is examined, it reads very much like the criteria for migraine, with headache, light sensitivity, sound sensitivity, nausea, and vomiting all appearing.^[3]

Who Is At Risk?

Several factors can increase the likelihood of developing post-traumatic headache. You are at higher risk if you already get headaches and migraines regularly. You are also more likely to get one if you have a family history of headaches.^[4]

Research has identified additional risk factors for persistent post-traumatic headache. These include a history of migraine, previous psychiatric history, positive CT scans (a type of imaging test), fewer years of formal education, younger age, and female sex.^[5] One study reported that 45% of patients with a past medical history of headaches are more likely to report post-traumatic headache.^[1]

Combat-related injuries deserve special mention. Military post-traumatic headache is a significant cause of disability in military personnel. Due to the immense physical and psychological toll compared to civilian trauma or injury, combat traumatic brain injury and the resulting problems require separate consideration. There is a considerable overlap between post-traumatic headache and post-traumatic stress disorder in military populations. Combat-related explosions are the most common causes of U.S. military personnel injury.^[1]

Diagnosis and Timing

According to the International Classification of Headache Disorders, post-traumatic headaches are defined as a secondary headache with onset within seven days following trauma or injury, within seven days after recovering consciousness, or within seven days after recovering the ability to sense and report pain.^[1]

However, this definition has been challenged recently, as some patients may report symptoms several months to one year after trauma or injury.^[1] If your headaches continue for more than three months after your concussion, your doctor may call it persistent post-traumatic headache.^[4]

It is important to see your doctor right away if you get a headache after a head injury.^[4] Your healthcare provider will ask about the characteristics of your headache, such as whether you have nausea, vomiting, light sensitivity, or sound sensitivity. They will also watch for warning signs that might indicate another form of headache requiring different treatment.^[3]

Treatment Options

Treating post-traumatic headache can be difficult because there are currently no specific, evidence-based medications designed specifically for this condition.^[3] At this particular moment, doctors use medications that work for the headache type it most closely resembles.^[3]

If you find that your post-traumatic headache is making it hard to work or do your everyday activities, there are ways to manage the symptoms. For headaches that happen in the first few weeks after a concussion, medication is usually the best choice. Your doctor may suggest you try:^[4]

• Anti-inflammatory drugs like aspirin, ibuprofen, or naproxen
• Pain medications, such as acetaminophen
• Drugs made specifically for migraines, such as triptans

Always talk to your doctor before taking pain medications for post-traumatic headache. Your doctor will want to watch for and help prevent side effects called rebound headaches, which can happen when you overuse pain medicine.^[4]

Your doctor may suggest medications that can help prevent complications or persistent post-traumatic headache. Some drugs that may help are:^[4]

• Antidepressants
• Blood pressure medicines
• Anti-seizure drugs

You also have options to manage your headache symptoms that don’t involve medication. Your doctor might recommend you try:^[4]

• Physical therapy
• Speech therapy
• Occupational therapy
• Relaxation therapy
• Nerve stimulation
• Cognitive behavioral therapy (a type of counseling that helps you change thoughts and behaviors)

Some case reports have indicated that cognitive behavioral therapy can help, though it is unclear whether it works as well for post-traumatic headache as it does for migraine.^[3]

A comprehensive approach is important for managing chronic post-traumatic headaches. A person with post-traumatic headache can experience a tension headache, migraine headache, and neck-related headache all at once. If you treat only the migraine and don’t address the tension or neck-related headache, you haven’t given complete and optimal resolution of the headache.^[13]

Recovery from post-traumatic headache means you can do your regular activities without experiencing symptoms. Recovery may be slower among older adults, young children, and people who have had a concussion or other traumatic brain injury in the past.^[18]