Brain Injury Headache

By Gordon S. Johnson, Jr.

Brain injury headache may be the first symptom to come about after head injury. Brain injury headache is often the condition that draws care to the truth that the brain was hurt. Brain injury headache can persist after brain injury, magnifying other disabilities because of its ability to make stress and attention problems worse. Brain injury headache can also formulate as a migraine headache, which is likely severe and can be really hard to treat.

That someone’s head might hurt after brain injury may seem like a no-brainer, but the origin of the pain often is not. Post-traumatic headache comes in many forms, some of which are independent of brain damage. Other post-traumatic headaches occur because of physical damage to brain structures and cranial nerves. Others are directly related to disruption of cerebral tissue.

When I first started doing brain injury talks, I asked audiences of brain injury survivors, about the most significant problems they had after injury. I expected to hear about cognitive and behavioral issues and fatigue. Rather, the most frequent answer was headache.

As stated by Marc Hines, M.D. in The Evaluation and Treatment of Mild Brain Injury, ©1999, Lawrence Erlbaum and Associates, at page 375 and 376:

“It has been repeatedly demonstrated that post traumatic headache is most common and often the most severe in patients with the least injury.”

The problem with brain injury headache is pinpointing its cause and type. Headaches are such a common complaint, that headache’s appearance as a symptom often is not even taken into account in the diagnosis of the patient’s problems.

Thus, it is ironic that brain injury headache is one symptom for which effective treatment often exists. The right treatment of brain injury headache can often lessen the appearance of other cognitive complaints. In one study less than 25% of patients got treatment for headaches. Out of the patients who got no treatment for brain injury headache, only 14 percent returned to work. In contrast, those who got treatment for brain injury headaches returned to work 83 percent of the time. See The Evaluation and Treatment of Mild Brain Injury, page 382-383.

Because of the challenges in figuring out the cause and the type of headache, headaches are most accurately called “post-traumatic headaches” as opposed to brain injury headaches. Dr. Hines organizes headaches into complex and multiple types. He insists that the physician “treats whatever is treatable.” What good brain injury clinician could not follow such a mandate?

Different from so much of what we see in TBI treatments, neurologists do in fact have the experience to treat migraines. Treating a migraine is something neurologists do far more than treating brain injury. Thus, if the brain injury survivor gives the right description in meeting with a neurologist that person might get specific effective care for the migraine. Neurologists are used to patients who complain of auras, visual disturbances, extreme sensitivity to sensory sensations, nausea, vomiting, dizziness, and tingling or numbness. If neurologists hear these complaints, they know just what to do in terms of effective treatment. But traumatic pathology is uncertain, making the brain injury headaches less specific than they are in a non-traumatic population.

Those with brain injury headache must ensure that their treating doctors address the migraine. Migraines can be both treated and controlled. Without treatment migraines will make all other deficits worse and derail consistent efforts towards rehabilitation and recovery.



Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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