Headache-Adviser.com

Post Traumatic Headache

by Wendy
(Dixon)

Traumatic Brain Injury

Traumatic Brain Injury

I have a friend that had a car accident a month later headaches started and she was feeling weak loss of appetite and weakness and she was even blacking out.
But she doesn't know what it can be. She says its a throbbing pain in her head and she feels like she is going to die when she has the headaches. what kind of headache you think it may be?

Wendy

Answer:

Hi Wendy,

Although traumatic brain injury can be one of the causes of migraine headaches the symptoms you describe are a bit more worrisome.

We begin to be concerned about a patient with traumatic brain injuries when they start having symptoms days or weeks after the initial injury. You do not mention or may not know if she has had previous head injuries. Head injuries are cumulative and eventually the brain has had enough!

The symptoms you describe necessitate that she see a doctor right away as she may be having seizures due to the injury. Seizures can present with severe headaches, weakness and other "odd" symptoms including loss of consciousness. This requires further testing such as an MRI and an EEG but the doctor can decide once he or she examines your friend.

Good luck!
Mary Kay Betz MS RPA-C



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Post-Traumatic Headaches

by Ally
(Canada)

I am a 39-year old female who has been having chronic daily post-concussive headaches from a mild TBI (traumatic brain injury) for five years after a freak accident where I struck my head (right parietal area; closed head injury).

The main additional symptom of the TBI is vestibular issues (e.g., eye tracking, balance) which trigger headaches.

I have tried various medications and am currently on Trazedone, Lyrica, Topiramate, and most recently Cymbalta. While I have had great success initally from both Lyrica and Cymbalta, within a few months my pain is high again. I have also tried acupuncture, massage, homeopathy, chiropractor, and osteopathy but to no avail. I have currently stopped working due to the disabling headaches. Do you have any further suggestions for treatment?

Ally

Answer:

Hi Ally,

Without more information about the frequency and quality of the headaches it is a bit difficult to say what would help. Most people with TBI who have post traumatic headaches have a daily headache that is global and diffuse. Then on regular occasions they will have a breakthrough migraine. When that one happens many of my patients tell me it is like having a poker behind the eye that goes out the back of the head.

Although you are on trazadone, which is a TCA, I usually use amitriptyline which works a bit better. Generally the dosing is higher than for migraine (10-50mg)..for TBI headache it is 50-150mg. Topiramate (Topamax) is a good choice as was Cymbalta.

We have had some success with severe cases by combining low dose Seroquel, taken at night with the topiramate. You would have to get rid of the trazadone or amitryptiline to do this.

Any migraine like headaches should be treated like a migraine with a triptan such as Imitrex combined with naprosyn at the onset of the headache.

I don't know where you live in Canada but there are headache specialists in many areas. Ask your doctor because if you are not seeing an actual specialist you should consider going to one.

Good luck,
Mary Kay Betz MS RPA-C

Comments:

know your pain...i suffered the simular thing but mine was i fell out of bed and hit my head on the window seal. i remember hitting my head and waking up in the hospital but there is a week i don't remeber. they told me that i had a complex migrane brought on by the hit to the head. i suffer from bad migranes before this but when i got the complex migrane it shut me down i couldn't talk and had trouble walking. i was given antivan at a low dose and it has worked for me now i can function and speake and it has only been 8 days since i woke up from being in a hospital but everyone is different. research migranes they are caused by stress and every test they did on me came back negative.

nicole


I AM HAVING SPORADIC HEADACHES, AFTER A CAR WRECK A YEAR AGO. I HAD A INJURY TO THE HEAD MRI AND CT SCAN WERE NEGATIVE. I STILL HAVE A SLIGHT BUMP ABOVE MY LEFT EYE AND THE HEADACHES OCCUR OVER THIS LEFT EYE. I HAVE BEEN TAKING ASPIRIN AND IT SEEMS TO HELP,BUT I AM AFRAID THAT I WILL BE TAKING ASPIRIN FOR THIS HEADACHE FOR THE REST OF MY LIFE. WILL THIS STOP EVENTUALLY OR DO I NEED TO GET ANOTHER MRI.

ANONYMOUS

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Fogginess Around Eyes

by Chris
(oklahoma)

I have experienced this foggy feeling around eyes and head for about 4 months. its not pain, its more pressure and just feels uncomfortable and not normal. I did suffer and concussion around four months ago and was diagnosed with acute concussion syndrome. I also take vyvanse for ADHD. Could this be linked to this feeling?

Its really frustrating me cause the symptoms are really hard to explain. when i exercise consistently it seems like it goes away?

Thanks,
Chris

Answer:

Hi Chris,

The symptoms may be consistent with post-concussive headache, especially the pressure like sensation. Post traumatic headaches do not always have to be severe.

Can Vyvanse make it worse? Interesting question, as yes it is possible, however your symptoms are not severe enough to stop the medication without discussing it with your doctor. Treatment of multiple conditions is always a risk/balance decision and without more information about your history, it is difficult to say if the Vyvanse is really making the headache worse.

If you have not yet had an MRI of the brain, I would recommend that you speak to your doctor about this and consider seeing a neurologist for further treatment. You are still somewhat in the acute phase of this, but if you get beyond six months after the injury you run the risk of this becoming chronic. Be sure to tell your doctor if you have had any other head injuries.

Good luck!
Mary Kay Betz MS RPA-C

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Bad Headaches After Car Accident

by Kristina
(Denver, CO- USA)

Does this seem like something to be terrified over? I am a 29 year old female. I have not smoked cigarettes since I was 18.

In 2009, I was in a car accident and was thrown into my windshield. I ended up with about 40 stitches in the front of my face/forehead and a concussion. I recall having a CT scan done at the time of the accident and have not had it checked since. Although, I can't remember chunks of my life and my memory seems to be getting worse.

About a year ago, I started getting headaches for the first time in my life. The headaches always center around where I smashed into the windshield and in that eye. I should mention that my eye was not harmed, but I did get stitches in my eyelid.

About 2 months ago, I started feeling pressure in my head, like the pressure of a sinus headache, but still centered where I hit my head. I found myself always opening my eyes as much as I could, like a pug dog. I guess to feel some sort of relief, I am not sure. For about the past 2 weeks, the pressure will not go away. It is constant, but not always painful. When I stretch, laugh, cough, sneeze, etc.. I really feel it kick in. Sometimes, my head starts throbbing out of the blue and will last for hours, other times, it last for 5 min., then leaves and may or may not come back.

My headaches get pretty painful and the feeling of pressure is always there. I find myself getting a bit freaked out when I do something as simple as stretch my body, and I feel like my head is going to suddenly pop. I have not tried any treatment other than aspirin, tylenol, and ib profin. They are only temporary patches, so I keep them at a minimum- if any and drink lots of water. Any advice? Thanks so much for your time, Kristina.

Answer

Hi Kristina,

You do sound like a case of post concussive headache syndrome and perhaps even TBI (traumatic brain injury). I mention the TBI as memory loss and possible cognitive difficulties occur with this. During a head injury, the brain has no where to go but hit the skull...and the skull is pretty hard! The brain is rather soft and can be damaged easily.

Head injuries are cumulative, so if you have had ANY other injuries, this would compound the problem.

Typically, post concussive patients will have headaches that can be global with breakthrough migraines.

Since you have started having headaches, I would recommend that you see a neurologist and ask for an MRI of the brain. There is a special type of imaging that can be done called SWI (suceptability weighted imaging) which can show post traumatic changes in the brain if there are any. These will show up even if the accident was a long time ago. The neurologist can also place you on the appropriate medication for this, including medications for possible migraine.

Unfortunately, over the counter meds do not work well for this and may even make the problem worse by causing analgesic rebound headaches.

Good luck!
Mary Kay Betz MS RPA-C

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Post Concussion

by Joe
(OK)

I was rear ended several month ago while at a complete stop, other vehicle was traveling over 50mph. After impact i was forced into a car in front me (Shaking my head all over the place)
I have Post Concussion Syndrome along with a list of others injury's.

I had a CT (day of) and MRI of my brain (2weeks after), all came out clean but the MRI showed I have several sinus cysts.
I had sinus bleeding for about 6 weeks after accident. the doctor I seen for the head injury never told me about the cysts, I found out from the MRI report couple months after.

My Question:
Can a hard impact of this kind cause a sinus cysts to form? I still server headaches and ear ringing since accident (8months ago)

Sorry about my poor sentences, I might have mtbi. Test are scheduled

Joe

Answer:

Hi Joe,

I sincerely doubt that the accident caused the cysts. Cysts take a little time to form so most probably they were there before the accident.

The main reason they were not mentioned is that on an MRI of the brain, sinus cysts were considered an incidental finding.

Post-concussive syndrome can be associated with tinnitus (ringing in the ears) which may or may not improve. For the headaches, low dose amitryptiline is the drug of choice, start at 10mg and work the dose up to 50mg. Your neurologist can do this for you.

Good luck!
Mary Kay Betz MS RPA-C

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8 weeks post concussion

by Sara
(PA)

I am a 30 year old female. I got a concussion from a horseback riding accident in November 2011. At that time I lost five days of memory including the accident itself. I have since remembered more details of the days prior to the accident, but I don’t even remember going to the barn the day of the accident. I was hospitalized overnight due to hours of continued confusion. I didn’t know what day it was, where I was or that I had even been in an accident.

I have had complete body CT's and brain MRI. There is "one area of intensity" noted from the MRI on my left frontal lobe. No bleeding or swelling was evident on any of the tests. I am currently taking Amantadine. Not sure how much it is helping with the headache or nausea, but I feel a lot less foggy then I was, so I believe it has helped in that department.

The headaches, nausea, insomnia, vision/balance issues and restlessness continue to plague me. I was taking Vicodin for about the first 7 weeks for headache, neck and back pain. I feel that was helping me with sleep and definitely with pain. Now my doctors don’t even want me taking Ibuprofen every day.

I am currently participating in vestibular rehab for balance, vision, and extreme car sickness. I feel like I am in continual misery, the headache being the worst of my symptoms. I read a small article about Amitriptyline and human growth hormones for post concussion syndrome. I would like to get your opinion on these types of therapies and any other information on medications or therapies that may help me get relief.

Thank you for your time,
Sara

Answer:

Hi Sara,

So sorry you are still having post concussion symptoms. Typically when we see this, the patient has daily headache that is global with regular breakthrough migraines. The migraine part can be severe, behind or around the eye (s) pain and throbbing with nausea and vomiting. It sounds like you had a Grade III concussion with loss of conciousness and amnesia of greater than 24 hours associated with the incident.

I am glad that you had imaging done. The results of the MRI sound like you had a small area of T2 hyperintensisty which could have been the result of the head injury judging by the location. This not really anything to worry about and it is not causing your headache.

Brain trauma results in microscopic shearing injuries to the brain. The headache, memory loss and vertigo or dyseqilibrium are consistent with the injury. You may have trouble for some time (months) with activities that "jostle" the brain. Examples are car rides over one hour, amusment park rides, jogging, etc.

At the present time, with a patient case such as yours, we would do IV infusions for 2 days in a row of steroid, then the patient would be on oral steroid for a week or two to break the cycle of pain. The drug of choice to treat this syndrome is elavil or amitryptiline. I start at low doses of 10mg 2 hours before bed and work it up to 50mg which is the dose for treating this. It is a good choice as it calms the brainstem and will thus treat the vertigo in addition to the headaches. It also treats spasms and back pain.

For the migraines, a triptan such as Imitrex is indicated unless there is a reason why you cannot take it. Coronary artery disease or pregnancy are common contraindications.

You can read more about head concussions and treatments.

Finally, if not seeing a headache specialist I would recommend this. In PA, there is the Jefferson Headache Center and the Pittsburgh Headache Center which is part of UPMC. General neurologists who are not board certified in headache, may not be able to offer you the up to date treatments you need. The good news is that you are still in the acute phase of this head injury and if treated agressively most probably will improve.

Good luck!
Mary Kay Betz MS RPA-C

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