A post-traumatic headache (PTH) is a headache that occurs in the days after a head injury, or after regaining consciousness. It is a common complication of traumatic brain injury (TBI), occurring in between 30–90% of cases.
This statistic comes from a
Scientists do not fully understand how PTH develops. In some people, the condition goes away on its own within 3 months. In some cases, though, PTH can lead to chronic pain that lasts longer.
In this article, we will explain what PTH is, its symptoms, and whether it is dangerous. We will also explore diagnosis, treatment, and recovery.
There are two types of PTH. Acute PTH lasts for
PTH, in itself,
It is for this reason that a person who has developed a headache after any type of head injury, even if mild, should get an evaluation from a doctor.
Dial 911 if a person has:
- a headache that gets
increasingly worseand does not improve
- repeated vomiting
- slurred speech
- decreased coordination
- weakness or numbness
- seizures or convulsions
- confusion, such as difficulty recognizing people or places
- restlessness or agitation
- one pupil that is bigger than the other
- unusual behavior
- in children, inconsolable crying or a refusal to eat or nurse
If a person does have PTH, it can have a significant impact on their quality of life. People may have difficulty carrying out daily activities.
The main symptom of PTH is head pain, which can manifest in different ways. Most often, though, the pain resembles migraine or tension-type headache.
Migraine-like symptoms include:
- moderate-to-severe head pain
- pulsating or throbbing pain
- nausea and vomiting
- light or sound sensitivity
Tension-type headaches involve:
- mild-to-moderate head pain
- light or sound sensitivity
- no pulsating sensation
- no nausea or vomiting
Some people also get cervicogenic headaches, which occur due to pain or structural problems in the neck. In this type of headache, pain may start in the neck and then radiate to the head, and may worsen when a person moves or positions the neck in specific ways.
PTH can also occur as part of a group of symptoms known as post-concussive syndrome. If a person has this condition, they
Concussion is a mild form of TBI. It can occur after a person receives a knock or blow to the head, or as a result of whiplash.
PTH is a complication of brain injuries, including concussion. As such, a person can experience PTH and concussion together, as a result of one injury.
The absence of headaches does not necessarily mean a person does not have concussion, or that they will not develop PTH later on. It can develop at any time in the first week following an injury.
There is no test that can confirm PTH. People with PTH often have no structural changes in the brain, so medical scans are typically not useful. Doctors will usually base a diagnosis on a person’s symptoms, and whether they show signs of TBI.
A doctor may order additional medical tests if a person has a history of TBI, or other neurological conditions, to rule out other causes for the pain. This may involve CT scans to rule out brain hemorrhage, and MRI scans to rule out ischemic infarction and masses.
Treating PTH often involves a combination of approaches to manage pain and improve quality of life. It may involve:
Doctors may recommend various types of pain medication, depending on the symptoms a person has and how long they have had them. Options include:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- triptans, which are a migraine drug
If moderate or severe pain persists, doctors may recommend the use of preventive treatments. These include:
- certain antidepressants that can relieve pain, such as amitriptyline
- nerve blocks, which can block pain signals from the neck
People with PTH may find physical therapy helpful, particularly if they have cervicogenic headaches. A
- physical therapy for the neck
- physical therapy for the temporomandibular region
- manipulation and mobilization of the spine
- massage therapy or myofascial release
- stretching exercises
It is worth noting that spinal manipulation has some risks. A person should speak with a professional for advice on trying these techniques.
Education and behavioral therapy
PTH is a complex condition, and can get worse or better in response to many things. Education about PTH can help a person understand their symptoms better, and find ways of managing them by identifying and avoiding triggers.
For example, emotional distress may trigger symptoms, which in turn, can cause more distress. Getting support in reducing this cycle may reduce symptoms.
People may benefit from therapies that support mental health and the connection between the mind and body, such as:
- biofeedback, which teaches a person how to control bodily functions that are usually unconscious
- progressive muscle relaxation, which involves inducing a state of deep relaxation
- cognitive behavioral therapy (CBT), which can help a person manage their thoughts and feelings
For people whose pain originates in specific nerves, such as a nerve in the neck, some medical procedures
- radiofrequency ablation
- transcutaneous magnetic stimulation
For most people, PTH resolves on its own in the
- older age
- a history of headaches and migraine
- presence of headache in the emergency room
- being female, although scientists are not sure why this increases the risk
A person cannot change these risk factors, but they may be able to control other factors that can contribute to acute headaches becoming chronic. After the head injury, try to:
- rest according to a doctor’s instructions
- get enough sleep
- reduce stress
- seek support for anxiety or other mental health conditions
- avoid the use of substances such as caffeine and alcohol
- avoid the overuse of pain medication, as this can lead to rebound headaches, or medication overuse headache
- gradually resume daily activities, such as work
People with PTH may be more likely to use caffeine, alcohol, opioids, and illegal drugs to cope with symptoms. However, this may interfere with recovery. If a person is using substances and is struggling to stop, they should speak with a doctor.
PTH can develop after a head injury, or after regaining consciousness following a blow to the head. It can occur after a mild or severe TBIs, such as concussions.
People may experience symptoms similar to migraine, tension-type headaches, or cervicogenic headaches. Treatment can involve a combination of pain medications, behavioral therapies, and physical therapies.
Most people will recover from PTH in