Post Traumatic Headache (PTH) is a common and often debilitating condition experienced by individuals who have sustained a traumatic brain injury or bodily trauma.
While many headaches frequently resolve quickly after an injury, some may persist for weeks, months, or even years after the initial onset.
Understanding the causes, symptoms, treatment options, and preventive measures for alleviating the symptoms of a post traumatic headache is crucial for improving the quality of life for those affected.
This article will serve as your guide to understanding your options and finding the care that you deserve.
What is a Post Traumatic Headache?
A post traumatic headache is a type of secondary headache, which means that it develops as a result of another underlying cause—in this case, head trauma. The headache typically manifests after a mild traumatic brain injury (TBI), such as a concussion, but it can also follow more severe head and body-based injuries.
Post traumatic headaches can present in various forms, often mimicking other types of headache disorders, such as migraines, cluster headaches, and tension-type headaches. This variation in symptoms usually makes diagnosis and treatment challenging, especially if you’re working with a provider who doesn’t see traumatic headaches often.
Research shows these headaches can last for days, weeks, and sometimes months. Sadly, we often see patients who have had post traumatic headaches lasting for months or even years after the initial injury.
Common Causes of Post Traumatic Headache
As previously stated, post traumatic headaches occur as a direct result of trauma to the head or neck. The exact mechanisms behind these headaches aren’t entirely understood, but several factors may contribute to their development:
Traumatic Brain Injury
Trauma can disrupt brain function, directly and indirectly affecting blood vessels, nerves, and central brain structures responsible for regulating pain. This disruption can lead to headaches that persist even after the brain appears to have healed.
Whiplash or Neck Strain
Many head injuries also involve neck strain or whiplash, which can cause cervicogenic headaches (headaches that originate from the neck) and structural damage. Sadly, providers often focus on structural issues, forgetting to investigate the neurological outcomes that also arise with whiplash and strain symptoms.
Inflammation
Following a traumatic injury, significant levels of inflammation in the brain and surrounding tissues can contribute to persistent headaches. Inflammation acts like pouring gasoline on a previously existing fire, causing further damage and breakdown of healthy tissue.
Vascular Changes
Trauma can cause changes in the blood flow to the brain, triggering vascular-type headaches that resemble migraines. Unfortunately, this also changes oxygen levels and concentrations within the brain, which presents additional issues for damaged areas. We can live for months without food and days without water, but we can only live for a few minutes without oxygen before brain tissue starts to die and cause long-term damage.
Psychological Factors
Mental health issues like emotional stress, anxiety, or depression that often follow head trauma can exacerbate or contribute to the persistence of headaches. We know that trauma to the brain will cause secondary damage via inflammation, which can affect mental health and psychological well being.
Symptoms of Post Traumatic Headache
Post traumatic headache symptoms can vary depending on the type of headache and the severity of the injury. Sadly, this condition has no one-size-fits-all approaches to treatment, but we know enough to lay the foundation.
Common symptoms associated with post traumatic headaches include:
Throbbing Pain
Similar to migraines, post traumatic headaches can cause intense, pulsating pain, often localized on one side of the head. These symptoms can also sit over the area where the trauma ensued.
Tension-like Headaches
Some individuals experience a dull, constant ache that can feel like a tight band around the head or base of the skull. These are usually consistent and can be alleviated with pressure over the temples and base of the skull.
Sensitivity to Light and Sound
Post traumatic headaches frequently bring heightened sensitivity to light (photophobia) and sound (phonophobia), akin to migraines. If the trauma is impactful enough, it will most likely cause a concussion, causing post-concussion symptoms.
Nausea and Vomiting
Severe headaches may trigger nausea and, in some cases, vomiting. While this is far less common, it’s still possible, especially if the person had symptoms before the injury.
Dizziness or Vertigo
Balance issues, dizziness, and vertigo often accompany these post traumatic headaches, especially with concussions. Concussions can cause trauma throughout the entire brain and impact various brain structures responsible for maintaining balance and stability.
Irritability and Fatigue
Chronic headaches can make people more irritable and contribute to feelings of tiredness or fatigue. As previously discussed, the psychological effects are real and can be a significant factor in the recovery process after a head injury.
The timing of symptoms can inherently vary from person to person. Some headaches can start immediately after the injury or develop days or weeks later, while other symptoms may be immediate and improve over hours and days.
In some cases, post traumatic headaches last only a short time, while in others, they persist for months, becoming a chronic issue. Statistically, a headache is considered “chronic” if it lasts over three months.
Diagnosing Post Traumatic Headache
The diagnosis of post traumatic headaches often involves a thorough medical history and a detailed structural and neurological examination.
Since there are no definitive tests to confirm a post traumatic headache, doctors often rely on clinical criteria and the patient’s description of the injury and symptoms. A detailed history usually gives us 80% of the information we need to formulate a diagnosis, but an examination is essential for uncovering function and overall viability.
Medical History Review
A healthcare provider will review the patient’s history of head trauma, including the type and severity of the injury and the onset of headaches. Previous head trauma is a significant factor in how quickly an individual will progress after a recent injury and must be taken into consideration when providing a prognosis.
Symptom Description
The patient will be asked to describe the frequency, intensity, and type of headache pain they’re experiencing. Environmental triggers, stressors, and activities are also significant factors in understanding the impact of injuries and quality of life.
Diagnostic Imaging Tests
While most headaches do not require imaging, in cases of severe or worsening symptoms, doctors may recommend tests like MRI or CT scans to rule out other underlying causes, such as bleeding in the brain or structural damage.
While diagnostic tests are great at picking up overt trauma, bleeding, brain tumors, and venous malformations, they rarely show positive findings with concussions and mild traumatic brain injuries.
It’s essential to understand this point, as people are told “they’re fine” after having imaging performed with no findings, but they’re still dealing with symptoms.
Neurological and Orthopedic Examination
A bedside neurological and orthopedic evaluation helps assess any deficits in brain function related to the headaches. It will also address critical structural problems that need to be addressed, which can significantly impact the quality of life and treatment moving forward.
Treatment Options for Post Traumatic Headache
Treating post traumatic headaches requires a multifaceted approach because of the varied nature of the condition. The treatment plan and type of therapy will always depend on the type of headache, its frequency, and its severity.
Here are some of the most common treatments:
Medication/OTC Pain Relievers
- Pain Relievers: Over-the-counter medications like ibuprofen or acetaminophen are common choices to manage mild head pain. However, long-term use should be avoided due to the risk of medication-overuse headaches and the damage these medications can do to our organs.
- Prescription Medications: For more severe or chronic headaches, doctors may prescribe triptans (for migraines), muscle relaxants, or preventive medications such as beta-blockers or anti-seizure drugs. These medications can play a role in treatment, but often, they mask symptoms that are important markers for progress. Medications should be used to improve quality of life while rehabilitation and therapy are done simultaneously.
- Antidepressants: Certain antidepressants, like amitriptyline, can be effective in reducing headache frequency and intensity, especially when stress or depression is a contributing factor.
It’s important to note that these medications only mask the symptoms; they don’t treat the root cause.
Treating the root cause involves a thorough understanding of the brain and body. An individual’s structural, neurological, and nutritional needs are essential for improving healing time.
Cognitive Behavioral Therapy (CBT)
Psychological factors often play a role in the persistence of post traumatic headaches, which makes Cognitive Behavioral Therapy (CBT) a valuable tool in rehabilitation.
CBT focuses on helping patients manage stress, anxiety, and depression through the use of therapeutic techniques, which can reduce headache frequency and improve overall coping strategies.
These therapies can be performed in person or through an online platform/application. They help people reframe their thoughts and improve their ability to change behaviors over time.
Neurological Rehabilitation and Physical Therapy
Neurological rehabilitation and physical therapy can be incredibly beneficial when paired together for post traumatic headaches related to neck strain or whiplash.
Physical exercises to strengthen the neck and improve posture may alleviate cervicogenic headaches as long as patients are able to perform them both in and outside the clinic.
Physical rehabilitation specialists also offer manual therapy and myofascial release techniques to help relieve head, neck, and shoulder tension.
Neurofeedback and Relaxation Techniques
Neurofeedback therapy teaches patients to control physiological processes such as heart rate and muscle tension using feedback mechanisms. This feedback occurs via relaxation exercises, including deep breathing, meditation, and progressive muscle relaxation.
These exercises can also aid in stress management and reduce headache triggers.
Neurofeedback doesn’t need fancy equipment or medical devices to be effective. By simply closing the eyes and focusing on one’s heart rate, patients can use these tools in their homes to improve their brain and body’s responses to stress.
Nerve Blocks and Injections
In cases of severe, intractable headaches, doctors may recommend nerve blocks or injections of anesthetic agents directly into the affected area of the head, neck, and shoulders.
These treatments can provide temporary and significant relief for those suffering from chronic post traumatic headaches, but they don’t treat the root cause of the issues.
These should be reserved for the worst of the worst, as they can be expensive for the patient.
Preventing Post Traumatic Headache
Very few headaches following a head injury are preventable. Regardless, there are ways to reduce the likelihood of developing chronic post traumatic headaches.
One thing to note is that the brain, body, and metabolic capacity one has before an injury will significantly affect one’s ability to heal and recover after the injury.
Significant amounts of inflammation, preexisting comorbidities, and chronic pain change clinical outcomes. These patients will do far worse after a traumatic event compared to someone who is far healthier.
Here are a few ways to prevent significant issues from developing after a traumatic event:
Proper Care After Injury
Seeking immediate medical attention after any head injury is critical. Prompt treatment and rest can reduce the risk of long-term headaches.
It’s best to treat the injury like a concussion to ensure proper structural and neurological treatment and prevent long-term problems down the road.
Rest and Recovery
Allowing the brain to heal is vital in the days and weeks following a head injury. And voiding strenuous physical and cognitive activities can help prevent the worsening of symptoms, to a point.
The literature shows that the quicker one can get back to low-grade cardiovascular activity, the faster one will recover from a concussion or mild traumatic brain injury. Movement is a significant factor in recovery.
Hydration and Nutrition
Staying hydrated and maintaining a balanced diet can prevent dehydration-induced headaches and improve overall recovery. Since a traumatic event causes inflammation, diet and nutrition play a fundamental role in recovery.
Poor dietary choices and behaviors can delay healing, worsening symptoms.
Stress Management
Chronic and acute stressors can exacerbate post traumatic headaches. Practicing stress management techniques like mindfulness, yoga, or relaxation exercises can help mitigate these triggers.
Posture and Ergonomics
Maintaining good posture and ergonomic habits is key for maintaining function. Individuals who work at desks that require prolonged sitting need good posture to reduce neck strain and prevent cervicogenic headaches.
While posture is important, it’s also essential to get movement throughout the day. It’s also imperative to reinforce postural health with functional therapies to stabilize structural instabilities.
Optimize Sleep
Optimizing sleep is a crucial factor for recovery, as sleep is restorative and helps the body and brain recover after an injury. Sleep is a critical factor for healing; without it, people will struggle to overcome their symptoms.
When to See a Doctor
It’s essential to seek medical advice if post traumatic headaches become frequent, severe, or persistent.
In some cases, there may be signs of a more serious condition that requires medical attention. Conditions like severe post-concussion syndrome, intracranial bleeding, or structural damage to the brain need quick interventions.
Symptoms that warrant immediate medical attention include:
- Sudden, severe headache that is the worst headache you’ve ever felt
- Confusion or memory loss
- Seizures
- Weakness or numbness in the limbs
- Vision changes
- Facial drooping
- Altered speech
- Inability to raise the arms over the head
Post Traumatic Headaches Are Treatable
Post traumatic headaches are a common but complex consequence of head injuries, affecting many individuals long after the initial trauma has healed. With proper diagnosis, treatment, and preventive care, most people can find relief and improve their quality of life.
The key to managing post traumatic headaches lies in understanding the underlying causes. It’s essential to receive tailored treatment to your individual needs to optimize recovery. You must take proactive steps to prevent your symptoms from becoming chronic.
It’s imperative to address the physical, neurological, and psychological aspects of post traumatic headaches. When done properly, individuals can better navigate their recovery journey and minimize the impact of this debilitating condition on their daily lives.
Our team at The Neural Connection has spent the last decade working with post traumatic headaches, concussions, and brain injuries.
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*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients are advised to consult their medical provider or primary care physician before trying any remedies or therapies at home.
