A concussion is a type of mild traumatic brain injury resulting from a bump, blow, or jolt to the head, or a hit to the body that causes the head and brain to move rapidly. This movement can stretch and injure brain cells and blood vessels, leading to temporary changes in brain function. Migraine is a neurological condition characterized by recurrent attacks of moderate to severe head pain, often accompanied by other symptoms that can significantly impact daily life.
The Link Between Concussion and Migraine
Concussions frequently lead to a specific type of headache known as post-traumatic headache (PTH), and many of these headaches exhibit characteristics similar to migraines. Studies suggest that up to 95% of individuals experience headaches following a concussion, with approximately two-thirds displaying migraine-like features. This indicates a strong and recognized medical connection between head trauma and the onset of migraine-like symptoms.
The International Headache Society (ICHD-3) defines PTH as a headache developing within seven days of the head trauma or after regaining consciousness. If these headaches persist for more than three months, they are classified as persistent post-traumatic headaches. The high prevalence and specific classification highlight that concussions can indeed trigger headaches that resemble or are diagnostically categorized as migraines. Individuals with a pre-existing history of migraines may also be at an increased risk for developing persistent post-concussion symptoms, including chronic headaches.
Understanding Post-Traumatic Migraines
Post-traumatic migraines present with distinct features that align closely with traditional migraine symptoms. These often include a dull, throbbing, or pulsating pain, typically felt on one side of the head, and ranging from moderate to severe. Individuals frequently experience heightened sensitivity to light (photophobia) and sound (phonophobia), alongside nausea and sometimes vomiting. Physical activity can worsen the pain.
These headaches can begin immediately after the injury or emerge hours, days, or even weeks later. While many concussions resolve within a few weeks, post-traumatic headaches can persist for months or even years, becoming chronic. Beyond the headache itself, accompanying symptoms often include dizziness, balance problems, and a feeling of cognitive fogginess. Some individuals may also experience visual disturbances, such as seeing spots or flashing lights, known as an aura, before the headache starts.
Mechanisms of Post-Traumatic Migraines
The development of post-traumatic migraines after a concussion involves several complex biological processes within the brain. One significant factor is neuroinflammation, where the brain’s immune response to the injury can lead to prolonged inflammation. This inflammatory state can alter neuronal excitability and disrupt neural networks, contributing to pain signaling and migraine-like symptoms. Changes in neurotransmitter levels, such as serotonin, also play a role in migraine pathophysiology and can be affected by head trauma.
Another mechanism involves the calcitonin gene-related peptide (CGRP), a neuropeptide that has a known role in migraine. Following a concussion, CGRP levels can become elevated, and this increase is linked to the development and persistence of post-traumatic headaches. Studies have shown that CGRP can induce migraine-like headaches in individuals with persistent post-traumatic headache. The brain’s overall excitability can also be disrupted by the injury, making it more susceptible to pain signals and triggers that can initiate a migraine attack.
Managing Post-Traumatic Migraines
Managing post-traumatic migraines involves a comprehensive approach, often starting with seeking medical attention if a new headache develops after a head injury, especially if it worsens or is accompanied by other concerning symptoms. A medical professional may conduct a neurological exam and potentially order imaging like a CT scan or MRI to rule out other issues. The diagnostic process often involves assessing the headache’s characteristics, timing, and any associated symptoms to differentiate it from other headache types.
Treatment strategies typically include rest and gradual reintroduction of light physical activity, as prolonged complete rest might worsen symptoms for some. Over-the-counter pain relievers like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can be used, though NSAIDs are generally advised after the initial 48 hours post-injury. For more severe or persistent cases, healthcare providers may consider specific migraine medications, such as triptans, or preventative medications.
Non-pharmacological interventions like physical therapy can help address neck pain and improve balance, while cognitive behavioral therapy (CBT) can assist in managing pain, stress, and associated emotional challenges. Lifestyle adjustments, including adequate hydration, regular sleep, and stress management, also contribute significantly to recovery.