What Medication is Best for Post-Traumatic Headache After The First 48 Hours?

In order to best treat or prescribe the most appropriate medication for a headache, doctors need to know what types of headaches you’re having and the root cause. A previous post provides general information on the types of post-traumatic headache and recommended medication for the first 24-48 hours. This post provides Ontario Neurotrauma Foundation’s recommended approach to medication for post-traumatic headaches after that initial 48 hours, the risks of using too much medication and the importance of maintaining a headache journal.

Ontario Neurotrauma’s Concussion Guidelines’ Recommended Approach to Medications

The Guidelines provide the following medication suggestions for post-traumatic headaches:

  1. For certain headaches consideration may be given to using acute headache medications, limited to <15 days per month:-Over-the-counter or prescription NSAIDs (e.g., Tylenol);
    -Acetylsalicylic acid;
    -Acetaminophen; and
    Combination analgesics (with codeine or caffeine).
  2. For migraine headaches, migraine-specific triptan class medications may be effective to abort the headaches but should be limited to <10 days per month.
  3. Narcotics should be avoided or restricted to “rescue therapy” for acute attacks when other first- and second-line therapies fail or are contraindicated.
  4. Medications that work prophylactically (i.e. prevent headaches) should be considered if headaches are occurring too frequently or are too disabling, or if acute headache medications are contraindicated, poorly tolerated, or being used too frequently.

These Guidelines also indicate “post-traumatic headaches may be unresponsive to conventional treatments. If headaches remain inadequately controlled, referral to a neurologist, pain management specialist, or traumatic brain injury clinic is recommended”.

The Problem with Overuse of Pain Medication

Patients suffering from post-traumatic headache may over-use pain medication (known as analgesics). Doctors are aware that this over-use can perpetuate the problem and become the cause of the headaches. Even an over-the-counter medication like Tylenol if over-used can start to cause headaches when it wears off. This is known as “The Rebound Effect”. Doctors need to provide their patients with clear guidance as to the maximum number of days in a month they can take any medication that falls into this category. The Ontario Neurotrauma’s Concussion Guidelines indicate the medications that fall into this category should be used no more than 10 days per month to avoid rebound headaches.

The Importance of a Headache Journal

It is important to maintain a daily headache journal in order to accurately know how many days you are using headache medication. This will help you provide your doctor with all the necessary information for him/her to accurately diagnose and treat the headaches. See the Concussion Guidelines mentioned above for details to include in this journal and suggested places to keep it in order to remember to complete it daily.


In Conclusion

It’s clear that medication for post traumatic headache is a complicated subject. It will take considerable effort by you and your doctor to develop a treatment plan that works best for you. A later post describes the many medications I have personally tried.


 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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