Post-Traumatic Headache Information

Background

According to the Ontario Neurotrauma Foundation’s Concussion Guidelines, headache is the most common symptom following a mild traumatic brain injury (mTBI).  They say “Studies to date have documented that anywhere from 30-90% of individuals who sustain a mTBI develop post-traumatic headache. Several researchers have reported that post-traumatic headache is more common after mild TBI than after severe TBI.”

Guidelines

Ontario Neurotrauma’s Concussion Guidelines suggest during the first 24-48hrs giving acetaminophen or acetaminophen/codeine for headaches (e.g., Tylenol).  It’s important to note the vast majority of people with post-traumatic headache improve within days or weeks; however, for some individuals, headaches continue for months or years. Unfortunately there aren’t clear guidelines doctors can use to help guide their post traumatic patients who continue to experience this symptom.

Assessment

According to these same Concussion Guidelines there is a lack of research in this area so doctors are left to use their own experience and expertise. Their approach should include:

  1. Determining which type of headache the patient is experiencing (migraine, tension-type, neck referral or occipital nerve) and trying to identify possible root causes.
  2. Making suggestions for lifestyle changes and non-pharmaceutical approaches to reducing the severity and frequency of headaches (such as pacing and planning of activities and alternative strategies to relaxation – all subjects to be discussed in subsequent posts).
  3. Making suggestions/giving prescriptions for medication (a topic discussed in my next post).

Additional Sources of Information

In addition to reading the Ontario Neurotrauma Foundation’s Guidelines for Concussion/Mild Traumatic Brain Injury Modules Two (“Management of Concussion/mTBI”) and Six (“Post Traumatic Headache”) I also recommend:

  • Podcast by the Director of Brain Injury Programs, Northeast Center for Special Care titled “A Pain in the Brain – The Problem of Headache After Traumatic Brain Injury”
  • Webcast with Dr. Keith Sequira, Parkwoods Hospital titled “Dealing with Headaches and Pain Following ABI”.
  • I also found it helpful to meet with Michael Zitney, a Toronto doctor specializing in chronic headaches and chronic pain.

I will provide additional information about medications for post-traumatic headache in a subsequent post.

 Disclaimer: The information contained in this post and others like it is intended for information purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion I strongly recommend that you contact a qualified health professional for appropriate diagnosis and treatment. The collaborators have made responsible efforts to include accurate and timely information; however, the individuals and organizations listed on this website make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

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