More than one-third of individuals suffering a traumatic brain injury report headaches that continue to occur long after the original injury. While headaches are common after a brain injury, these people find themselves suffering for months afterward. After five years, about 20% of brain injury patients find themselves developing new headache symptoms or begin to experience worse headaches than before.

There isn’t any way to tell whether a specific person will develop migraines or other headache illnesses after the initial insult to the brain. However, we can still treat the headaches, no matter where they came from.

Post-Traumatic Brain Injury Headache: An Overview

The International Headache Society defines a post-traumatic headache as a headache that develops within seven days after the initial injury or after regaining consciousness. These headaches typically present like a migraine, with moderate to severe intensity, throbbing or pulsating pain that may be coupled with nausea, aura, light sensitivity, and other common symptoms of migraines.

Headaches occurring after brain injury are thought to occur due to surgery or small collections of blood or other fluid inside the skull. Sometimes the headaches come after healing occurs, and may be due to a change in the brain caused by the injury, tension and stress, neck and skull injuries that are not yet healed, or side effects from medication.

Another theory is that the pain is caused by chemical release, the swelling of the brain, or brain shrinkage.

Post-traumatic brain injury headaches can present as one of several types of head pain besides migraines:

• Tension headache
• Cervicogenic headaches
• Rebound headaches
• Vestibular headaches
• Cluster headaches

Migraines are diagnosed when the patient reports typical symptoms, including:

• Throbbing or dull sensations, often on one side of the head
• Nausea or vomiting
• Pain level rated moderate to severe
• Light and sound sensitivity
• Aura - seeing spots or bright lights just before the migraine strikes

Migraine with aura is less frequent in the general migraine population than migraine without aura. However, it may be the most likely type of migraine to develop after a traumatic brain injury. Brain injury during sports tends to be followed by a headache disorder in nearly half of patients. Only a quarter of people develop chronic but non-aura migraine.

Migraines can be differentiated from tension headaches by considering the symptoms. Tension headaches tend to have a tight, squeezing sensation all the way around the head or on both sides. The pain is reportedly mild to moderate and occurs later in the day.

Soldiers returning from deployment comprise one group exhibiting migraines after brain injury. Nearly a third of those with mild traumatic brain injury had migraines - as opposed to 12% without a head injury who reported migraines. These reports are particularly interesting because they come from a group that does not typically suffer migraines: young males.

Sometimes, brain-injury headaches change over the months or years. New symptoms can develop, the migraines may become chronic instead of episodic, and other changes can occur.

When to See a Physician about Your Trauma-Induced Migraine

Migraines are not usually dangerous. That being said, you may want to see your healthcare professional if you suffer the following:

• Nausea or vomiting, along with the head pain
• Worsening headaches
• Increasing sleepiness
• Weakness in your arms or legs
• Having problems with speech

The onset of these symptoms, particularly limb weakness or slurring speech, can indicate other problems than a migraine or other headache.

Testing

When a patient presents with a traumatic head injury, the physician typically orders a CT scan of the brain to make sure there is no bleeding. Once complete and the results analyzed, a brain scan or other test is not needed to diagnose the headache. 

Most headaches of any type are diagnosed according to your medical history and symptoms. You may be asked to keep a headache diary to track when the migraines occur, the severity and location of the pain, and how they responded to medication.

Treatment

Each patient and migraine responds differently to various treatments. Options include medication, lifestyle changes, and some types of exercise.

For immediate relief, patients can try one of several pain-killing medications:

• Over-the-counter pain medicines, such as acetaminophen or ibuprofen
• Prescription medications, such as sumatriptan
• Local injections of medication or steroids to muscles, nerves, or joints of the spine

Relief from pain may be found by relaxing in a dark, quiet room. Heat or cold applied to the head or neck may help. Some migraineurs have reduced their pain through biofeedback therapy or meditation. 

Stretching, self-massage, and acupuncture have also aided in combating the pain and fatigue of migraines.

If you suffer recurring migraines two or more times a week, long-term medication may be prescribed, such as:

• Anti-seizure medications like gabapentin
• Antidepressants
• Beta-blocker blood pressure medication
• Botox injections

Prevention

If you can prevent or avoid a migraine, so much the better. Prevention sometimes includes daily medication, but more usually, lifestyle changes do more good. 

• Get plenty of effective sleep - If you wake often and are tired upon arising, you may need assistance with a sleep disorder.
• Exercise every day - Walking and stretching are available to anyone. If any activity makes the pain worse, go to your doctor.
• Avoid foods known to trigger migraines - These include red wine, MSG (monosodium glutamate), and some types of cheese. You may have found a specific food that triggers your migraines.
• Don’t take medications daily - Unless the physician prescribes it, you could end up with a rebound headache worse than the one you were trying to treat.

Beyond lifestyle changes, you may find the need for counseling support. Psychological problems may trigger headaches and migraines like food-related triggers, bright lights, or other triggers.

Suffering a traumatic brain injury predisposes you to develop a headache disorder, including migraines. Whether it’s due to fluid in the skull or changes to the brain during healing, pain and other symptoms must be managed to help you live a productive life.

If you have had a head injury and find yourself suffering from frequent severe headaches, consult a healthcare provider to determine the type of headaches you suffer and refer you to a specialist if required.  

Treatment and relief are available through medications and lifestyle changes. It's also possible to learn how to avoid or prevent migraines in the future. Give Migraine Relief Center a call, and we will help you figure out the best way to help.