Headaches After Concussion
What is a post-traumatic headache?
A post-traumatic headache (PTH) is a recurring headache attributed to a concussion or traumatic injury to the brain. It is a predominant symptom in Persistent Symptoms After Concussion. Subtypes of PTH include migraine, tension, cervicogenic (pain stemming from the neck), neuritic/neuralgic (stabbing pain from nerves), and TMJ. Migraines are the most common, followed by tension headaches. However, suffering from multiple types of headaches simultaneously is common. You may also experience referred pain, which is pain originating in one area but felt in another area. A medical professional can evaluate your symptoms and help you determine the causes of your symptoms and appropriate treatments.
Elizabeth Sandel, MD, Medical Director for Paradigm and author of Shaken Brain, reviewed this page for content accuracy.
Table of Contents
Here are a few very important reminders if you have or suspect you may have a post-traumatic headache:
See a doctor as soon as possible.
If you are taking as-needed medications such as acetaminophen, ibuprofen, or naproxen more than 10 times per month, consult your doctor. See our medication page for more information.
Frequent use of medications can cause medication overuse headaches.
Avoid using opiates and barbiturates since they are highly addictive and they only treat symptoms rather than helping the root cause of the pain.
Tell your medical provider if you are using CBD oil.
This page is only intended as a starting point and should not be substituted for a medical diagnosis or prescription.
Self-management
There are several things you can do to combat the symptoms of post-traumatic headache. Your first “line of defense” should not be medication. It is important to get enough sleep and to sleep consistently at regular hours. Having regular meals and appropriate hydration is also essential. Regular exercise, fresh air, mindfulness, a peaceful environment, deep breathing and other self-care exercises can also help minimize headache symptoms. Drinking fewer caffeinated beverages may help decrease the frequency and intensity of headaches, but if symptoms don’t improve, you can resume drinking caffeinated beverages. Physical therapy may also provide helpful exercises or stretches to alleviate pain.
Managing Medication
Medication-based approaches should be used with the recommendation of a medical professional.
It is important to recognize that headache medications and supplements help manage concussion symptoms, but they do not treat the concussion itself. This is because concussions are trauma to the neurons (read more here). Medications do not heal neurons, but they do alleviate pain.
As-needed, non-prescription medications such as acetaminophen, ibuprofen, or naproxen can be effective, but they should not be used more than 10 days per month, or they could cause a medication overuse headache, also called a rebound headache. Additionally, there is some research that supports the use of CBD oil for pain.
Prophylactic (preventative) care such as exercise, relaxation therapy, and stress management can reduce the symptoms of chronic headaches. Prophylactic medications such as tizanidine (prescription needed) can also help. Vitamin B2 (riboflavin), high-dose magnesium, and coenzyme Q-10 have prophylactic effect for migraine headaches.
Abortive (urgent relief) medications can stop a headache while it is occurring. For example, triptan medications such as rizatriptan (prescription needed) can be used to stop a severe migraine.
Migraine
Symptoms can include:
Head-throbbing pain
Pain on one side of the head
Hypersensitivity to light and sound
Nausea
Dizziness
Pain worsens with activity
Vomiting (uncommon)
Treatments can include:
Regular Exercise
Relaxation therapy
NSAIDs (aspirin, ibuprofen, etc.)
Melatonin, Vitamin B12, Magnesium, Coenzyme Q-10 supplements
Prescribed oral or intranasal triptans (serotonin stimulators that alleviate headaches)
Antidepressants such as amitriptyline
Anticonvulsant (anti-seizure) drugs
Botox injections
Tension “Stress” headache
Symptoms can include:
Usually mild to moderate pain
Band-like pressure around the head or forehead
Joints in the jaw may be irritated, cramped or aching (could also be TMJ headache)
Usually NO nausea
Usually NO hypersensitivity to stimuli
Treatments can include:
Exercise
Relaxation therapy
Acupuncture
NSAIDs (aspirin, ibuprofen, etc.)
Muscle trigger point therapies
Cervicogenic headache
Symptoms can include:
Neck pain
Pain around the eye
Dizziness
Blurred vision
Balance problems
Poor concentration or memory
Treatments can include:
Physical therapy, primarily working on muscles in the neck
Cervical (neck area) spine rehabilitation
If eye or head movements trigger dizziness, blurred vision, or balance problems, you may consider vestibular therapy and/or vision therapy
Steroid injection
Neuritic and neuralgic headache
Symptoms can include:
Sharp, intense stabbing pain around craniocervical junction (where back of the head connects with the neck)
Tenderness or numbness upon touching occipital region (back of the head)
Pain behind the eyes
Neck pain
Treatments can include:
NSAIDs (aspirin, ibuprofen, etc.)
Topical pain medications
Antidepressants
Cryoneurolysis (nerve block)
Steroid injection
Anticonvulsants
TMJ Headache
Symptoms can include:
Jaw pain
Restricted jaw movement
Clicking when jaw opens
Tight facial or jaw muscles
Earache
Treatments can include:
Avoid chewing hard foods
Bite plate/night guard
TMJ trigger point massage
NSAIDs (aspirin, ibuprofen, etc.)
Ultrasound therapy
Psychological treatments
Having chronic headaches can contribute to anxiety, depression, and post-traumatic stress disorder, which can proliferate or worsen future headaches. Luckily, there is ample evidence supporting the effectiveness of psychological treatment for chronic pain, including headaches. Cognitive-behavioral therapy (CBT), mindfulness, acceptance and commitment therapy, and biofeedback analysis have been shown to reduce different types of pain, including headache pain.
In addition to medical treatments, individualized psychological and behavioral treatments can help reduce pain and speed up the process of recovery. Psychological and behavioral treatments should be directed at improving the symptoms of sleep disturbance, emotional distress, anxiety, and depression while also helping to manage chronic symptoms and alleviate pain.
For more information, see our pages on Mental Health and Emotional Wellness.
Healthcare Providers
It is important to see a medical professional for post-traumatic headaches as soon as possible. Whoever evaluates you and prescribes treatments should be an expert in brain injury. They should first take an in-depth medical history with an emphasis on your history of headaches and then conduct a physical examination.
Treating post-traumatic headache, particularly if chronic, often requires the involvement of multiple specialists depending on the type of headache. Ideally, your primary care provider would recommend you to a physiatrist who specializes in brain injury medicine. Physiatrists provide a physical examination of nerves and muscles throughout the body as well as cognitive and neurologic examinations. This approach allows the physiatrist to differentiate between different types of headaches and recommend specific treatment accordingly. If your primary care provider does not make this recommendation, you may have to advocate for it yourself. Many brain injury medicine physiatrists work through outpatient rehabilitation medicine clinics - you can advocate for a referral to one of these clinics.
You may also want to see a neurologist at a headache clinic with a sub-specialty in headache treatment. Physical therapists are also very useful for treating potential causes for post-traumatic headache. These causes include balance disorders which disrupt your body’s natural sense of balance and vision problems that interfere with the brain’s ability to integrate visual stimuli. Vestibular rehabilitation and vision therapy can help alleviate these problems. You can read more about finding a healthcare practitioner here.
Additional Information
The resources we used to find our information can be found here.
For more in-depth information about concussion-related headaches, please visit our advanced page.
Related Blog Posts
Some people recover quickly from headache after concussion, but others take much longer. How do we know as soon as possible what will be the case for someone who has had a concussion? A recent study in Cephalalgia by Marbil and colleagues tracked the progression of headaches over time in children after a new concussion. They found that post-concussion headaches were common and were more severe in those with a history of headache prior to concussion.