Post-Accident Head Pain: When to Seek Neurological Evaluation?

Car accident, head injury, experiencing headaches 4 months later?

Hello doctor, I was in a car accident four months ago and lost consciousness upon impact.
My helmet flew off, and my head hit the ground.
I woke up in the hospital while the nurse was stitching my head, and I received ten stitches.
I was completely unaware that I had been in an accident and had a fractured bone.
I was monitored for 72 hours for brain observation before undergoing surgery for the fracture.
Now, more than four months have passed since the accident.
Initially, the only pain I experienced was from the stitched wound on my head, which has since healed.
However, in the past few days, I have been feeling pain around the stitching area, and occasionally, I experience sharp pains in my head.
When I touch my hair, there is also a slight pain, but the stitched wound has long since healed.
Doctor, should I go for a check-up? Could I be experiencing chronic bleeding? Should I see a neurosurgeon or a neurologist?

A BOb, 20~29 year old female. Ask Date: 2018/03/17

Dr. Zhang Junwei reply Neurosurgery

It is normal to feel some pain after a wound has been sutured.

Reply Date: 2018/03/17

More Info

After experiencing a significant head injury, such as the one you described from your car accident, it is crucial to monitor your symptoms closely. The fact that you lost consciousness and required stitches indicates that you sustained a serious injury, and it is understandable to have concerns about ongoing pain and discomfort in the area of the injury.

In general, post-traumatic headaches can occur after head injuries, and they may manifest in various forms, including tension-type headaches, migraines, or even more complex forms of pain related to nerve damage or other complications. Given that you are experiencing pain around the area where you were stitched, it is essential to consider several factors:
1. Nature of the Pain: You mentioned that the pain is localized around the stitched area and that it has been intermittent. This could be a sign of several things, including nerve irritation, muscle tension, or even scar tissue formation. If the pain feels sharp or like an electric shock, it may indicate nerve involvement.

2. Duration and Changes in Symptoms: Since it has been over four months since your injury, and you are now experiencing new or worsening symptoms, it is advisable to seek medical evaluation. Chronic pain or changes in the nature of your pain can sometimes indicate complications such as post-traumatic headaches, post-concussion syndrome, or even the possibility of a chronic subdural hematoma, especially if there was any bleeding at the time of the injury.

3. Neurological Evaluation: Given your history of loss of consciousness and the current symptoms, it would be prudent to consult a neurologist. They can perform a thorough evaluation, which may include a neurological examination and possibly imaging studies (like a CT scan or MRI) to rule out any complications that may have developed since your injury.

4. Choosing the Right Specialist: In your case, since the symptoms are primarily neurological in nature, it would be best to see a neurologist rather than a neurosurgeon initially. The neurologist can assess your symptoms and determine if further intervention or imaging is necessary. If they find any structural issues that require surgical intervention, they can refer you to a neurosurgeon.

5. Self-Care and Monitoring: In the meantime, keep track of your symptoms. Note any triggers that exacerbate the pain, such as physical activity, stress, or changes in posture. Over-the-counter pain relief (if not contraindicated) and rest may help manage your discomfort, but they should not replace professional medical advice.

In summary, it is essential to seek a neurological evaluation given your history of a significant head injury and the new symptoms you are experiencing. Early intervention can help prevent further complications and improve your quality of life. Remember, your health is paramount, and it is always better to err on the side of caution when it comes to head injuries.

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