What are the typical types of headaches experienced after traumatic brain injury? How can you effectively manage and relieve these headaches? Find the answers to these and more questions in this comprehensive guide.

Understanding Headaches After Traumatic Brain Injury

Headache is one of the most common symptoms reported by individuals who have experienced a traumatic brain injury (TBI). Over 30% of people with moderate to severe TBI and an even larger percentage of those with mild TBI report experiencing persistent headaches long after the initial injury.

Why do headaches occur after a brain injury? In the immediate aftermath of a severe TBI, headaches may be caused by the surgical procedures performed on the skull or the presence of small collections of blood or fluid within the skull. However, headaches can also develop after mild to moderate injuries or in the later stages of recovery from severe TBI. These headaches can be attributed to various factors, including changes in the brain due to the injury, ongoing neck and skull injuries, tension and stress, or side effects of medication.

Types of Headaches After TBI

There are several common types of headaches that can occur following a traumatic brain injury:

Migraine Headaches

Migraine headaches are caused by an area of the brain becoming hypersensitive, triggering a pain signal that spreads to other parts of the brain. These headaches are typically characterized by a dull, throbbing sensation, usually on one side of the head, accompanied by nausea, vomiting, light and sound sensitivity, and a pain level ranging from moderate to severe. Some individuals may experience an aura, or warning sign, before the onset of a migraine.

Tension-Type Headaches

Tension-type headaches are associated with muscle tension or spasms and stress. They typically involve a tight, squeezing sensation around the entire head or on both sides, with a pain level ranging from mild to moderate, and often occur later in the day.

Cervicogenic Headaches

Cervicogenic headaches are caused by injury to the muscles and soft tissues in the neck and back of the head. These headaches usually start in the neck, shoulders, and back of the head, and can sometimes travel over the top of the head. Neck movement or positioning can exacerbate the pain, and these headaches can range from mild to severe, but are not usually associated with nausea.

Rebound or Medication Overuse Headaches

Certain medications used to treat headaches can, in some cases, actually cause headaches if taken too frequently. This is known as a rebound or medication overuse headache. Sudden decreases in caffeine intake can also trigger this type of headache.

Seeking Medical Attention

Most headaches after a TBI are not dangerous, but it’s important to seek medical attention if certain symptoms occur, such as:

• Worsening headaches
• Nausea and/or vomiting with a headache
• Arm or leg weakness or problems speaking along with a headache
• Increasing sleepiness with a headache

In the first few days after a head injury, a healthcare provider may order a CT scan of the brain to rule out any internal bleeding or other serious issues. After the initial period, further testing is usually not necessary, as the healthcare provider will rely on the patient’s history and symptoms to diagnose the type of headache and determine the appropriate treatment.

Treating Headaches After TBI

The treatment for headaches following a traumatic brain injury will depend on the individual case and the type of headache experienced. It’s important to work closely with your healthcare provider to discuss your headaches and the various treatment options available, which may include:

Medications

Over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen, may be used to manage mild to moderate headaches. Prescription medications, including migraine-specific drugs, anti-seizure medications, and antidepressants, may be necessary for more severe or persistent headaches.

Lifestyle Modifications

Making changes to your daily routine and habits can also help alleviate headaches. This may include getting enough sleep, managing stress, staying hydrated, and avoiding potential triggers, such as certain foods or bright lights.

Physical Therapy and Other Therapies

Physical therapy, massage, and other complementary therapies may be beneficial for managing tension-type and cervicogenic headaches by addressing muscle tension and imbalances in the neck and shoulders.

Preventing Headaches After TBI

While it may not be possible to completely prevent headaches after a traumatic brain injury, there are steps you can take to reduce the frequency and severity of these headaches:

• Follow your healthcare provider’s treatment plan, including taking medications as prescribed
• Engage in regular physical activity and exercise to maintain muscle strength and flexibility
• Practice stress management techniques, such as meditation, yoga, or deep breathing exercises
• Maintain a consistent sleep schedule and ensure you’re getting enough rest
• Stay hydrated and eat a healthy, balanced diet
• Avoid potential triggers, such as bright lights, loud noises, and certain foods

Conclusion

Headaches are a common and often persistent symptom for individuals who have experienced a traumatic brain injury. By understanding the different types of headaches, seeking prompt medical attention, and implementing a comprehensive treatment plan, you can effectively manage and reduce the impact of these headaches on your daily life. Remember to work closely with your healthcare provider to find the most appropriate and effective approach for your individual needs.

Headaches After Traumatic Brain Injury

Headache is one of the most common symptoms after traumatic brain injury (often called “post-traumatic headache”). Over 30% of people with moderate to severe TBI report having headaches which continue long after injury. An even larger percentage people with mild TBI complain of headache.

Why are headaches a problem after brain injury?

Headaches after TBI can be long-lasting, coming and going even past one year. Headaches can make it hard for you to carry out daily activities or can cause you to have more difficulty thinking and remembering things.

Why do headaches happen after brain injury?

Right after a severe TBI, people may have headaches because of the surgery on their skulls or because they have small collections of blood or fluid inside the skull.

Headaches can also occur after mild to moderate injury or, in the case of severe TBI, after the initial healing has taken place. These headaches can be caused by a variety of conditions, including a change in the brain caused by the injury, neck and skull injuries that have not yet fully healed, tension and stress, or side effects from medication.

What are some typical kinds of headaches after TBI?

Migraine headaches

These kinds of headaches happen because an area of the brain becomes hypersensitive and can trigger a pain signal that spreads out to other parts of the brain (like the ripples that spread out after you drop a pebble in water). These headaches typically have the following features:

• Dull, throbbing sensation, usually on one side of the head.
• Nausea or vomiting.
• Light and sound sensitivity.
• Pain level rated as moderate to severe.
• You might get a warning signal that a migraine is coming on, such as seeing spots or bright lights. This is called an aura.

Tension-type headaches

These headaches are associated with muscle tension or muscle spasms and stress. They usually have the following features:

• Tight, squeezing sensation, often around the entire head or on both sides.
• Pain level rated as mild to moderate.
• Occur later in the day.

Cervicogenic headaches

This type of headache can occur when there has been some injury to the muscles and soft tissues in the neck and the back of the head. Many nerves that are located in the tissues and bones of the neck have branches that travel to the skull and scalp and can result in head pain. This type of headache usually has these features:

• Often start in the neck, shoulders and back of the head, and sometimes travel over the top of the head.
• Neck movement or positioning can make the pain worse.
• These headaches are not usually associated with nausea and can range from mild to severe.

Rebound or medication overuse headaches

Sometimes the very medicines used to treat headaches can actually cause headaches. If some over the counter pain medications for headaches or certain prescribed medications are taken every day, they can actually lead to worsening headaches overall. Speak with your provider about which medications can cause overuse headaches.

Rebound headaches can occur if a person suddenly decreases the amount of caffeine they use. For example, if a person normally drinks a lot of coffee, tea or energy drinks and then doesn’t get their usual amount, they may get a headache. In addition, missing one or two doses of certain medications can result in a headache.

Other facts about headaches

Although there are many other types of headaches, these are the most frequent. It is not unusual for someone to have more than one type of headache or for pre-existing headaches to get worse after brain injury. For certain headaches like migraine, a family history is common. It is possible for certain problems associated with brain injury to trigger or worsen headaches (like vision problems or sleep apnea).

Should I worry about having a headache?

Most headaches are not dangerous. In the first few days after a concussion or head injury, a person should see a health care professional experienced in treating persons with brain injuries IF the following occurs:

• Headaches get worse.
• There is nausea and/or vomiting with a headache.
• Arm or leg weakness or problems speaking develop along with a headache.
• Increasing sleepiness occurs with headache.

Do I need special tests to diagnose a headache?

In the first few days after a head injury, doctors will often order a CT scan of your brain to make sure there is no bleeding in your head. After that, a brain scan or other test is rarely needed in order to diagnose a headache accurately.

Usually, the health care provider will rely on your history and symptoms to sort out what kind of headache you are having and how to treat it.

What can be used to treat a headache after TBI?

This will depend on each individual case. It’s important to discuss your headaches with your doctor and to keep track of headaches and your response to treatment. Many people use a headache diary to help them do this.

Lifestyle changes to help prevent headaches

The first steps in treating any type of headache don’t involve drugs or other therapy. Many times, lifestyle factors can trigger headaches or make headaches worse. Making simple changes can often make a big difference in whether or not headaches occur. Try to:

• Get enough sleep.
• Get daily exercise. Aerobic exercise such as walking and good stretching often help to prevent headaches by improving sleep and decreasing triggers. If a headache is worsened by any particular exercise, check with your health care provider.
• Avoid caffeine.
• Avoid certain foods that may trigger a headache, like red wine, monosodium glutamate (MSG, a common food additive) or certain cheeses.
• Avoid taking pain medicines on a daily basis unless your health care provider prescribes it.

Common types of treatment for occasional headaches include:

• Over-the-counter pain medicines like acetaminophen (Tylenol®) or ibuprofen.
• Prescription medicines for migraine headache like sumatriptan (Imitrex®).
• Relaxation therapy/meditation.
• Stretching and self-massage.
  • Therapeutic massage.
  • Heat or ice packs.

Treatments for recurrent headaches that happen more than twice a week

Headaches that occur frequently may require treatment such as therapy, a procedure, or a prescription from your health care provider. The following may help:

• Antidepressants.
• Therapeutic massage.
• Physical therapy for the neck and upper back.
• Local injections (numbing medication or steroids) to muscles, nerves, or joints of the cervical spine.
• Nerve stimulators such as a transcutaneous electrical nerve stimulation device (known as Cefaly device)
• Cognitive behavioral therapy

These medications may be used to help prevent or decrease headaches following TBI:

• Tricyclic antidepressants (like amitriptyline, also called Elavil®).
• Antiseizure medicines (like topiramate, also called Topamax^® or Trokendi^®).
• Certain blood pressure medication called beta-blockers (like propranolol).
• Botulinum toxin (Botox^®) injections.
• CGRP inhibitors (calcitonin gene-related peptide blockers) such as erenumab (Aimovig®) or galcanezumab (Embality^®).

While headaches after TBI can make it hard to manage activities, fortunately there are many treatment options that exist to prevent headaches from becoming chronic. Speak with your health care provider about an effective treatment strategy.

References

• Hoffman J, Lucas S, Dikmen S, et al. Natural History of Headache Following Traumatic Brain Injury. Journal of Neurotrauma. 2011;28:1-8.
• Lucas S, Hoffman J, Bell K, Dikmen S. Natural history of headache in the first year after mild traumatic brain injury. American Academy of Neurology; 2012; New Orleans, LA.
• Lucas S, Hoffman JM, Bell KR, Walker W, Dikmen S. Characterization of headache after traumatic brain injury. Cephalalgia. 2012;32(8):600-606.
• Brown AW, Watanabe TK, Hoffman JM, Bell KR, Lucas S, Dikmen S. Headache after traumatic brain injury: a national survey of clinical practices and treatment approaches. PM R. 2015;7(1):3-8.
• Stacey A, Lucas S, Dikmen S, et al. Natural History of Headache Five Years after Traumatic Brain Injury. J Neurotrauma. 2017
• Howard L, Schwedt TJ. Posttraumatic headache: recent progress. Curr Opin Neurol. 2020 Jun;33(3):316-322. doi: 10.1097/WCO.0000000000000815. PMID: 32304441.

Authorship

Headaches after Traumatic Brain Injury was developed by Kathleen R. Bell, MD, Jeanne Hoffman, PhD, and Thomas Watanabe, MD, in collaboration with the University of Washington Model Systems Knowledge Translation Center

Factsheet Update

Headaches after Traumatic Brain Injury was reviewed and updated by Kathleen R. Bell, MD, Jeanne Hoffman, PhD, and Thomas Watanabe, MD. The review and update was supported by the American Institutes for Research Model Systems Knowledge Translation Center.

Source: The content is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute of Disability, Independent Living, and Rehabilitation Research, as well as experts from the Polytrauma Rehabilitation Centers (PRC), funded by the U.S. Department of Veterans Affairs.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. This factsheet was produced under a grant from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education (grant number h233A060070). It was updated under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DP0082 and 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, HHS, Department of Education, and you should not assume endorsement by the Federal Government.

Recommended Citation: Bell, K. R., Hoffman, J., & Watanabe, T. (2021). Headaches after traumatic brain injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/tbi/factsheets/headaches-after-traumatic-brain-injury.

Copyright © 2021 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.

Managing tension headaches at home: MedlinePlus Medical Encyclopedia

A tension headache is pain or discomfort in your head, scalp, or neck. Tension headache is a common type of headache. It can occur at any age, but it is most common in teens and adults.

A tension headache occurs when neck and scalp muscles become tense or contract. The muscle contractions can be a response to stress, depression, a head injury, or anxiety.

Hot or cold showers or baths may relieve a headache for some people. You may also want to rest in a quiet room with a cool cloth on your forehead.

Gently massaging your head and neck muscles may provide relief.

If your headaches are due to stress or anxiety, you may want to learn ways to relax.

Over-the-counter pain medicine, such as aspirin, ibuprofen, or acetaminophen, may relieve pain. If you are planning to take part in an activity that you know will trigger a headache, taking pain medicine beforehand may help.

Avoid smoking and drinking alcohol.

Follow your health care provider’s instructions about how to take your medicines. Rebound headaches are headaches that keep coming back. They can occur from overuse of pain medicine. If you take pain medicine more than 3 days a week on a regular basis, you can develop rebound headaches.

Be aware that aspirin and ibuprofen (Advil, Motrin) can irritate your stomach. If you take acetaminophen (Tylenol), DO NOT take more than a total of 4,000 mg (4 grams) of regular strength or 3,000 mg (3 grams) of extra strength a day to avoid liver damage.

Knowing your headache triggers can help you avoid situations that cause your headaches. A headache diary can help. When you get a headache, write down the following:

• Day and time the pain began
• What you ate and drank over the past 24 hours
• How much you slept
• What you were doing and where you were right before the pain started
• How long the headache lasted and what made it stop

Review your diary with your provider to identify triggers or a pattern to your headaches. This can help you and your provider create a treatment plan. Knowing your triggers can help you avoid them.

Lifestyle changes that may help include:

• Use a different pillow or change sleeping positions.
• Practice good posture when reading, working, or doing other activities.
• Exercise and stretch your back, neck, and shoulders often when typing, working on computers, or doing other close-up work.
• Get more vigorous exercise. This is an exercise that gets your heart beating fast. (Check with your provider about what kind of exercise is best for you.)
• Have your eyes checked. If you have glasses, use them.
• Learn and practice stress management. Some people find relaxation exercises or meditation helpful.

If your provider prescribes medicines to prevent headaches or help with stress, follow instructions exactly on how to take them. Tell your provider about any side effects.

Call 911 or the local emergency number if:

• You are experiencing “the worst headache of your life.”
• You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a headache before.
• You have a fever with your headache.
• A headache starts suddenly.

Schedule an appointment or call your provider if:

• Your headache pattern or pain changes.
• Treatments that once worked no longer help.
• You have side effects from your medicine.
• You are pregnant or could become pregnant. Some medicines should not be taken during pregnancy.
• You need to take pain medicines more than 3 days a week.
• Your headaches are more severe when lying down.

Tension-type headache – self-care; Muscle contraction headache – self-care; Headache – benign – self-care; Headache – tension- self-care; Chronic headaches – tension – self-care; Rebound headaches – tension – self-care

• Tension-type headache
• Headache
• CT scan of the brain
• Migraine headache

Garza I, Whealy MA, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley’s and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 102.

Jensen RH. Tension-type headache – the normal and most prevalent headache. Headache. 2018;58(2):339-345. PMID: 28295304 pubmed.ncbi.nlm.nih.gov/28295304/.

Rozental JM. Tension-type headache, chronic tension-type headache, and other chronic headache types. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 20.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Browse the Encyclopedia

Self-care: Self-care: Lenta.ru

Doctor Anna Protasova advised self-massage to get rid of headaches

Photo: Ulrich Niehoff / imagebroker.net / Globallookpress.com

I am sure the doctor, founder of the University of Integrative Psychology Anna Protasova. In an interview with Lenta.ru, she named other unusual ways to help herself.

Light body practices can help beat a headache, and they do not require special equipment, and you can do them even in the office, says Protasova.

Self-massage

You need to rub your hands together until a feeling of warmth appears, the doctor advised. After that, the palms should be placed on the back of the head so that the thumbs are in the area between the neck and the head, then a light massage should be done in circular motions. “After that, gather a few strands of hair into a fist, gradually and gently pull them in different directions. Pull strands in different directions – one to the left, the other to the right. This should not cause very uncomfortable sensations, only a pleasant relaxation of the scalp, ”said Protasova.

Relaxation of the neck

The doctor explained that one of the common causes of headaches (in the absence of pathologies) is difficult blood circulation due to overexertion of the neck muscles due to incorrect position while working at the computer. Relaxing the neck will help correct the situation.

Slowly tilt your head back, take a few deep breaths in and out. Do not overdo it, do not throw your neck back too much. To relax the muscles in the jaw area, open your mouth. To improve the effect, lightly massage the front of the neck with your hands. Two minutes after the first sensations of relaxation, you need to slowly, without sudden movements, return your head to its previous position

Anna Handshake Therapist

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Light Shoulder Stretch

In order to relax the muscles of the upper body, Protasova advises to lock your fingers in front of you so that your palms are facing up. Without separating your hands, you need to slowly raise your palms up above your head. It is necessary to maintain the position for 10-15 seconds.

Then you need to relax the back muscles by crossing your arms in front of your chest and clasping your shoulders. Then gently raise your arms up, trying to bring your elbows closer to the middle of your back. You need to stay in this position for 20 seconds. The triceps are stretched by raising the right arm above the head and bending it at the elbow joint behind the back, resting on the left shoulder. With your left hand, lightly press your right elbow. It is necessary to maintain the pose for half a minute, the interlocutor of Lenta.ru noted. Then repeat the exercise with the left hand.

“Be attentive to how you feel: none of the exercises should cause pain. You should feel only a pleasant stretch and relaxation. Regular headaches can be a symptom of a number of serious diseases, so you should not postpone a visit to the doctor, ”summed up Protasova.

Earlier, orthopedic doctor Mikhail Ignatov named a replacement for training in the gym. He noted that if it is not possible to go to a fitness center, you can do gymnastics at home for 30 minutes.

Headache in newborns and children under 4 years old osteopathic treatment in Yekaterinburg

• Consequences of birth injuries
• Krivoshey
• Hypertension-hydrocephalic syndrome
• Pyramidal and extrapyramidal insufficiency
• Hip dysplasia
• Flat valgus stop
• Delayed psychomotor and speech development
• Headache in newborns and children under 4 years old

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If the child can speak, he may complain of pain or discomfort by pointing with a pen to the place that brings the most suffering. If we are talking about children under one year old, then signs of a headache can be:

• pronounced crying,
• breast rejection,
• pulling legs to the tummy,
• violation of day and night sleep.

These signs are often confused with intestinal colic, the difference lies in the fact that the stomach is swollen and tense during colic, gas is difficult to pass.

Such symptoms must be treated with care. Normally, a child’s head should not hurt. The causes of headache in newborns are vascular problems – mainly venous congestion, changes in the meninges, the onset of infectious diseases, less often – reflected pain from internal organs transmitted through irritated nerves.

Still, most often these children have the following diagnoses:

and other neurological diagnoses.