A post-traumatic headache (PTH) develops after a head injury, such as a concussion or mild traumatic brain injury (TBI). The headache typically begins within seven days of the trauma or after regaining consciousness. While most people experience relief within weeks, for others, the headaches can persist for months or even years. Effectively managing PTH involves a comprehensive approach that targets both immediate pain and underlying contributing factors.
Identifying Post-Traumatic Headache
The head pain in post-traumatic headache often mimics other common headache types. Many individuals report a pain pattern similar to a tension-type headache: a mild-to-moderate, non-pulsing, squeezing sensation affecting both sides of the head. Others experience headaches with migrainous features, including moderate-to-severe throbbing pain, sensitivity to light (photophobia) and sound (phonophobia), and sometimes nausea or vomiting.
The key factor distinguishing PTH is its clear temporal relationship to a head or neck injury. PTH is frequently accompanied by a cluster of other symptoms that affect daily life, including dizziness, difficulty concentrating, memory problems, fatigue, and irritability. These symptoms often link PTH to the broader post-concussion syndrome. Neck pain or stiffness from the injury can also contribute to the head pain, suggesting a cervicogenic component.
Consulting a Healthcare Professional
Seeking a professional evaluation is necessary after any head injury and subsequent headache development. An initial medical assessment rules out serious underlying issues, such as bleeding or a blood clot, which require immediate intervention. Physicians may order a CT scan or MRI in the acute phase to ensure there is no structural damage, though the diagnosis of PTH is ultimately clinical, based on symptoms and history.
Specialists such as neurologists, headache specialists, or physiatrists are often involved in managing persistent PTH. They rely on a detailed history, including a thorough neurological and musculoskeletal examination of the head and neck. Keeping a detailed headache diary is helpful, as it provides specific information on the frequency, duration, severity, and type of pain, which guides treatment decisions. The goal of this assessment is to establish the specific headache phenotype (e.g., migraine-like or tension-type) to tailor the most effective treatment plan.
Medication Approaches for Management
Pharmacological treatment for post-traumatic headache is divided into two primary categories: acute treatments for stopping a headache attack once it has begun, and preventive treatments taken regularly to reduce the frequency and severity of attacks. The choice of medication is tailored to the specific characteristics of the individual’s headache.
For acute pain relief, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and acetaminophen are often the first-line options. If the headache has strong migraine features, migraine-specific medications such as triptans or calcitonin gene-related peptide (CGRP) antagonists may be prescribed. Limiting the use of these acute medications is important, as taking them too frequently can lead to medication overuse headache (MOH). Over-the-counter analgesics should be used no more than 15 days per month, while triptans and combination analgesics should be limited to 10 days per month to avoid MOH.
Preventive medications are taken daily to dampen the nervous system’s hypersensitivity and decrease headache frequency and severity. These treatments may include certain anti-seizure medications (such as topiramate or valproate) or specific classes of antidepressants (like tricyclic antidepressants). Beta-blockers are another common preventive option, especially when headaches are frequent and disabling. These drugs are often used for headache prophylaxis even if they were originally approved for another condition. Preventive therapy can take weeks to months to show a noticeable benefit, and treatment is considered successful if headache frequency is reduced by at least 50%.
Non-Pharmacological Treatments and Lifestyle Changes
Non-pharmacological strategies are integral to the long-term management of post-traumatic headache and can reduce reliance on medications. These interventions often address the related symptoms that complicate the pain experience, such as neck stiffness, dizziness, and stress.
Physical therapy and manual treatment of the neck and spine are frequently recommended, especially when headaches are linked to muscle tension or whiplash-type injuries from the trauma. Targeted exercises can improve neck range of motion and strength, while vestibular rehabilitation helps address dizziness and balance issues that often accompany PTH. Oculomotor vision therapy may also be beneficial for patients whose headaches are triggered or worsened by visual strain or problems with eye tracking.
Behavioral therapies are effective in managing pain perception and associated psychological effects. Cognitive Behavioral Therapy (CBT) teaches patients strategies for coping with pain, improving sleep, and addressing comorbid symptoms like anxiety or depression. Biofeedback is another technique that trains a person to control certain physiological responses, such as muscle tension, which can help mitigate headache severity.
Implementing consistent lifestyle adjustments further supports recovery and headache reduction. Maintaining a strict sleep schedule (sleep hygiene) is important because sleep disturbances are a common headache trigger. Identifying and avoiding dietary triggers, such as caffeine or processed foods, can also help stabilize the system. Integrating controlled physical activity and stress reduction techniques, including mindfulness, can improve overall resilience and reduce the frequency and intensity of post-traumatic headaches.