Concussions, a common form of mild traumatic brain injury, result from a blow to the head or a rapid back-and-forth movement that causes the brain to shift inside the skull. While often temporary, the effects can be significant and varied, impacting physical, cognitive, and emotional well-being. Migraines are a complex neurological disorder characterized by severe headaches, often accompanied by light and sound sensitivity.
The Concussion-Migraine Connection
Concussions can lead to migraines that emerge or persist long after the initial injury. This phenomenon is recognized as “post-traumatic headache” (PTH), with migraine-like headaches being a frequent presentation and neurological consequence of head trauma. While some headaches appear immediately, others can develop or become chronic months or years later, indicating a lasting impact on brain pain pathways.
Headaches are common and persistent symptoms after a concussion, with 30% to 90% of individuals experiencing post-traumatic headaches for a year or more. This indicates the brain’s response to trauma can have prolonged effects beyond the acute recovery phase.
Understanding Post-Traumatic Migraines
Post-traumatic migraines share characteristics with typical migraines. Symptoms include throbbing pain, often moderate to severe and felt on one side of the head. Individuals report heightened sensitivity to light (photophobia) and sound (phonophobia), nausea, or vomiting. Physical activity often worsens the pain.
Some individuals experience an aura, involving visual disturbances like spots or bright lights before the headache. While symptoms resemble pre-existing migraines, their onset links directly to the head injury. Diagnosis relies on specific criteria, including the temporal relationship between trauma and headache development. Headaches typically arise within seven days of injury or regaining consciousness, though delayed onset can occur.
How Concussions Can Lead to Migraines
Concussions can trigger biological and neurological changes that predispose individuals to chronic migraines. Neuroinflammation is one mechanism, where the brain’s immune response activates glial cells and releases inflammatory molecules. This environment sensitizes pain pathways, increasing susceptibility to headache triggers.
Brain chemistry changes also play a role, particularly altered neurotransmitter levels. Serotonin, involved in mood, sleep, and pain regulation, can be affected by head trauma. Imbalances in serotonin are implicated in migraine development, and concussions can disrupt this balance. Calcitonin gene-related peptide (CGRP), released during migraine attacks, contributes to pain signaling. Concussions can upregulate CGRP, contributing to migraine-like headaches.
Concussions can cause structural and functional brain changes. Microscopic damage to neural networks, white matter tracts, or pain processing regions like the thalamus and brainstem can occur, even if not visible on standard imaging. This damage can lead to lasting dysfunction in pain processing pathways.
The brain’s pain system can become hypersensitive, known as sensitization. This involves an overreactive response to minor stimuli, lowering the pain threshold. This heightened sensitivity can manifest as allodynia, where non-painful sensations are perceived as painful. These mechanisms contribute to migraines years after the concussion.
Managing Post-Concussion Migraines
Diagnosis of post-concussion migraines begins with a thorough medical history, including head injury details and headache symptom evolution. A neurological examination assesses brain function. Imaging studies like MRI or CT scans may rule out other causes or identify structural issues, though scans often appear normal after a mild concussion.
Treatment involves acute and preventive strategies. Acute treatments, or abortive medications, are taken at migraine onset to alleviate symptoms. These include over-the-counter pain relievers like acetaminophen, or prescription triptans. NSAIDs may be used, though caution is advised immediately post-injury due to bleeding risks.
Preventive treatments reduce migraine frequency and severity. These include anti-seizure medications, beta-blockers, or antidepressants, which stabilize brain activity and pain pathways. Newer options, such as CGRP inhibitors, target the CGRP molecule implicated in migraine. Non-pharmacological therapies include physical therapy for neck issues, cognitive behavioral therapy for pain and stress reduction, and lifestyle modifications like adequate sleep and a healthy diet.
Consult a healthcare professional, such as a neurologist or headache/concussion specialist, if headaches develop or persist after a concussion. They can provide an accurate diagnosis and tailor a treatment plan. Early intervention and a comprehensive approach improve outcomes and help manage these headaches.