The medication used at this point is usually all wrong if the headaches have gone beyond a few weeks. Initial mild head injury may respond to low dose anti-inflammatories, such as ibuprofen or naprosyn. Post traumatic headaches respond best to low doses of tri-cyclic anti-depressants such as Elavil or Pamelor. If severe in the acute phase, it can be given, and is definitely indicated if headaches have gone beyond 6 or 8 weeks.
Elavil (amitryptiline) is generally accepted as being the best headache medication for TBI, but most doctors make the mistake of using migraine doses (10-50mg). Unfortunately, post-traumatic headaches do not respond to this dose but most people do respond when the dose is slowly titrated up to 75-150 mg. Fortunately, this medication is also excellent for any associated neck pain and spasms!
The breakthrough migraines are treated just like that..like migraines. A small dose of an anti-seizure drug may also be necessary with triptans (Imitrex or Maxalt) for when the pain is bad.
Don't forget, like all other headache syndromes, lifestyle is very important. Regular sleep cycles, good diet and exercise as tolerated will all help the headaches get better. In this particular case, however, the vitamins and herbs used to successfully treat migraines do not have much of an effect on post traumatic headaches. None the less, many people do want to try them to help the migraine component.
The key to post traumatic headache syndrome and head concussion is to find a headache specialist and be patient. If the headaches are severe, chances are that it will take several months for any one treatment to have an effect. Most people are not aware of this fact in headache treatment, so they tend to start and stop treatments after a few days or weeks and become discouraged. The longer the brain has the treatments on board, the greater the chance it will heal.
Additional Head Concussion Treatment
If you have had side effects from Elavil (amitryptiline) then Pamelor (nortryptiline) or trazadone could be considered. They are in the same class of drug, but seem to have less side effects.
Side effects can include sedation (which is a benefit when trying to sleep), dry mouth, and to less extent, urinary retention and nightmares. Rarely, diarhhea or constipation may result.
More often than not, rest is the key to healing, especially when in the acute phase of a head concussion. Associated symptoms of nausea and vomiting usually settle down within a few days. If they don't this is a concern and neuroimaging should be performed. Vertigo and milder dysequilibrium (a sensation of feeling drunk) may also occur but usually take a little longer to go away, perhaps a few weeks.
Do I Need An MRI?Generally with head injury, a CT of the brain is done at the time of injury to rule out a bleed in the brain. If you have gone weeks or months with a continuing headache, then an MRI might be what your doctor would order next. One of the concerns about a head concussion is that a small bleed may occurr 2-3 days after the injury.
An MRI will get a better look at the structures of the brain and can pick up the changes seen in traumatic brain injury (TBI) or head concussion, that are not seen on a CT. This may be helpful for insurance purposes, however if the MRI is normal that does not mean that the headaches are not real!
Remember to take the symptoms of head concussion seriously and speak to your doctor, especially if you have had several head injuries previously as they are cumulative. In other words, each time you get a head injury, it can be worse than the last one until you finally move into post-concussive daily headaches.