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Stabbing headaches traumatic brain injury

by richard
(england)

in the year 2000, when i was 15yrs old i was assulted which resulted in a traumatic brain injury. i was in hospital for 6 months, the first 3 months i was in a coma following brain surgery. the damage is to the left side of my brain which has left me with poor short term memory, behavioural issues and permanent double vision. In 2008 i was diagnosed with bipolar disorder & in 2009 I was diagnosed with epilepsy ( complex secondary focal seizures).
Ever since my injury in 2000 i suffer with horrid head pains, even now after 10 years the headaches ruin my quality of life.
The headaches can just come from no where, last a few seconds to a few minutes & the headache could happen once per day or many times off & on per day. It is a huge stabbing pain to my head that really hurts, reduces me to tears as the pain is unbearable and sometimes i have passed out.
I was referred to a headache specialist who said it was a phenomina and prescribed a anti imflamitary med that was no good. I am currently prescribed co codamol which is also no good, by the time these tablets kick in my headache is usually gone, should i have a tablet i still have the headache anyway.
I have full time care because of my head injury & epilepsy.
I am a male and now 27yrs old, i do smoke cigarettes, approx 15 per day.
My carer wants to ask my doctor for a referal to again ask for help for the headaches but they don't seem to understand, but i am sure there must be a proper medication or treatment for this type of headache

Richard

Answer

Hi Richard,

You do not say where you are in England but I will assume that you can travel a bit. There is a headache center in London and it is worth going there if you haven't been already.

If the doctor gave you an anti-inflammatory, you may have a rare type of headache known as paroxsysmal hemicrania. Usually the cause is not known, but I do have one patient with this who has a history of head injury and traumatic brain injury (TBI). Treatment of choice is indomethacin as this headache responds only to this medication. In that way it is also diagnostic.

We have had some success with TBI with Seroquel when combined with Topamax(topiramate). The real medication of choice is amitryptiline but you have to be on doses of 50-150mg at night. It is titrated up slowly.

Most of all you must quit smoking. Nicotine irritates and hyperactivates brain tissue. Your brain is already that way because of headaches so the nicotine makes it worse.

Good Luck!
Mary Kay Betz MS RPA-C

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Daughter with Post concussion Headaches

by Beth F.
(Colorado Springs, CO)

Teen Headache

Teen Headache

I have a 16 year old daughter who had a MTBI on 1/20/2012. She is a cheerleader and was knocked to the mat with a whiplash type injury. No LOC or signs of concussion at the time.

Headaches and typical concussion symptoms began on the 1/23. She still has daily headaches. She describes them as mostly mild, often on her forehead, but sometimes on top of her head. All her other symptoms have gone away. She has passed her impact test and is functioning well in school. She does not smoke.

Her dad has occular Migraines and she had one about a year ago herself. We have an brain/head MRI scheduled for this afternoon. She has been on Magnesium 500mg twice a day, Vitamin B2 100mg once a day, and was on Amitryptiline 30 mg for about 4 weeks, we went up to 50mg for about 10 days but it didn't seem to take away her headaches,just made her more tired, so she went back to 30mg.

Has tried Aleve and Ibuprofen off and on since this started. One Doctor had her take tylenol 4x day for about a week in hopes of knocking out the headaches. Neurologist started to wean her off the Amitryptiline a week ago (last dose was 5/9) she started Gabapentin 100mg at night a week ago and CoQ10 60mg. She is feeling worse the last 4 days, headaches off/on almost all day. She also felt nauseous on Sunday. He told us she could go up on the Gabapentin if she thought it was helping. Should we still consider titrating even if it's not helping?

How quickly would the gababpentin help? How often should it be titrated up? Should we consider the Amitryptiline again and work up to a higher dose for a longer time?

We are seeing a headache specialist in about a month, but she still needs to get through another two weeks of school. She also would like to return to cheer, but hasn't been cleared for contact. At what point is she healed from her concussion when she seems to be facing a daily chronic headache situation? She has been given permission to exercise.

Beth

Answer

Hi Beth,

It does sound as if she is having post-concussion headache syndrome. The drug of choice is amitryptiline but the dose usually is higher than 30mg. Treatment of head concussion is multi-factorial. The vitamins are a good idea.

If she is having migrainous symptoms then she might benefit from a triptan such as Imitrex.

Also, headache across the forehead and at the top of the head may be coming from the neck. With a cheerleading injury, usually there is whiplash and the neck is in spasm. Amitryptiline is still a good choice here as it is an anti-spasmotic. Physical therapy would also help.

Talk to the neurologist about going back on a TCA such as amitryptiline, nortryptiline or trazadone.

The headache specialist will address the neck issues and will discuss the MRI. MRIs for TBI should include a special type of imaging called susceptibility weighted imaging or SWI. This can only be done on a newer machine with a 3t magnet. Open MRIs are not great and the really closed ones have only a 1.5t magnet and are not capable of doing this type of imaging. SWI will show changes in the brain specific to TBI.

At this point in the school year I would say she probably cannot return to cheerleading (I know..she will hate to hear this!) but the brain needs to rest. TBI involves shearing injuries at a microscopic level, known as axonal injury. She is young and her brain is still growing which means she will heal in a few months not a few years like adults. It is good that she has improved a bit already. Give it the summer. Also, avoid any activities this summer that would "shake" the brain a lot such as carnival rides or long car rides. Being in the car is OK, but take a break every hour if traveling.

Good luck!

Mary Kay Betz MS RPA-C

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