Post-traumatic headache (PTH) is pain that develops following a mechanical injury to the head or neck. It is one of the most common symptoms reported after a traumatic brain injury (TBI), particularly after a mild TBI or concussion. For a formal diagnosis, the headache must begin within seven days of the traumatic incident, regaining consciousness, or discontinuing masking medications. The headache characteristics can resemble other primary headache disorders, such as tension-type headaches or migraines.
The Critical Distinction: Acute vs. Persistent Headaches
Clinicians use a time-based classification system, outlined by the International Classification of Headache Disorders (ICHD-3), to classify PTH duration. The initial phase is the Acute Post-Traumatic Headache, defined as pain lasting less than three months after onset. This category applies to the vast majority of individuals who experience PTH.
If the headache persists for 90 days or longer, it is reclassified as a Persistent Post-Traumatic Headache, replacing the older “chronic” designation. This three-month threshold signals a change in the expected course of recovery, suggesting a need for more comprehensive management strategies, regardless of the original injury severity.
Typical Recovery Timelines and Prognosis
The outlook for individuals with an acute post-traumatic headache is generally favorable, with most experiencing resolution within the initial recovery window. Studies indicate that a large percentage of patients, often ranging from 50% to 90%, see their headaches resolve spontaneously within the first three months after the injury. For those whose headaches transition into the persistent category, the recovery path becomes slower and more complex.
While the majority of acute headaches resolve, approximately 15% to 20% of individuals who sustain a concussion will continue to experience persistent post-traumatic headache at one year post-injury. The incidence of persistent headache is paradoxically higher following a mild TBI (concussion) compared to a moderate or severe TBI. Headaches that have characteristics similar to migraines tend to be associated with a slower recovery time. Even when the headache is persistent, ongoing improvement remains possible, though it typically requires specialized intervention.
Factors That Influence Duration
The high variability in PTH duration is attributed to several biological and psychological factors present before or immediately following the head injury. A significant risk marker for prolonged duration is a pre-existing history of primary headaches, such as migraines or tension-type headaches. Individuals with this history are more likely to develop a persistent form of PTH.
Demographic characteristics correlating with longer symptoms include being female and being younger. The presence of co-occurring post-concussion symptoms is strongly linked to headache chronicity, including dizziness, sleep disturbances, and vertigo.
Psychological factors, such as anxiety, depression, and post-traumatic stress disorder (PTSD), also increase the likelihood of the headache persisting past the three-month threshold.
When to Seek Specialized Care
While most post-traumatic headaches improve with rest and basic pain management, specific situations necessitate prompt medical attention. Immediate specialized care should be sought if the headache abruptly worsens, becomes severe, or is accompanied by concerning neurological symptoms. These warning signs include repeated vomiting, confusion, difficulty walking, slurred speech, or vision changes. These symptoms could indicate a more serious underlying issue that requires immediate evaluation.
If the headache persists despite initial management and approaches the three-month mark, a consultation with a headache specialist or neurologist is advisable. Reaching the persistent classification threshold suggests that a more targeted, multidisciplinary treatment approach may be necessary.