Post-Traumatic Headaches: When to See a Neurologist

Q: Post-Traumatic Headaches: When to See a Neurologist

Hello： It is recommended that you schedule an appointment with the neurology department for further examination. <br>If the neurology evaluation shows no issues, you may then consider an appointment with the psychiatry department.

Occipital pain

I was accidentally hit on the head by a classmate during physical education class.
That night, I went to a clinic for a cold treatment, which resolved, but my headache persisted.
At the moment of impact, I only felt mild pain, so I didn't seek any treatment and continued playing badminton.
Later, I experienced ongoing headaches and nausea, though I didn't actually vomit.
About a week later, due to severe headaches and dizziness with a feeling of nausea, I rushed to the emergency department at Fu Jen Catholic University.
While at the hospital, I underwent a CT scan of my brain, which showed no issues.
The emergency physician referred me to neurosurgery.
Despite receiving an injection, my condition did not improve, so I waited for the doctor.
Eventually, I took the initiative to find a doctor, but the original physician had already left for the day.
The subsequent doctor quickly referred me to neurology and ordered another brain CT scan, which also showed no problems.
I received a prescription and went home, but my headaches continued.
The day after my visit, I began to experience a burning smell, but since I have mild schizophrenia, I was unsure if this was a symptom of my condition or something related to my brain, so I did not return to the emergency department or follow up with neurology at Fu Jen.
Additionally, I have mild intellectual disability and was a low-birth-weight premature infant weighing 800 grams.
I experienced mild developmental delays as a child and attended early intervention classes at a center in Taipei.
I made significant progress, and my pediatrician, Dr.
Hsu Ching-Hsin, played a crucial role in my recovery.
Due to changes in my condition, I no longer hold a developmental delay disability certificate.
I had two instances of intracranial hemorrhage shortly after birth and spent several months in an incubator.
Since childhood, I have received physical, occupational, and speech therapy, with speech therapy ceasing in junior high school, while physical and occupational therapy continues.
Before the head injury, I frequently experienced headaches, but they have not improved since the incident.
Sometimes, when it is windy, my head shakes and the pain worsens.
I have undergone three EEGs, one MRI of the brain, and one CT scan, all of which were normal, with the CT scan performed on the day of the emergency visit.
There was no bleeding or swelling, but I still have headaches.
I went to the emergency department on January 21, after being hit on the head with a basketball during the last period of physical education class the previous Friday.
Prior to the injury, I often found myself daydreaming and had poor balance, along with flat feet and hallux valgus.
During junior high, I frequently sprained my ankle, but I hadn't been injured in a long time.
Since the head injury, my balance has worsened, and I find myself daydreaming more often.
I have always had poor memory, but it has deteriorated further since the injury.
Due to my schizophrenia, I have always had sleep issues, and I have returned to the worst sleep patterns I experienced in junior high, often feeling unrested.
I have had vivid dreams and experienced insomnia, and I have struggled with depression since elementary school, being bullied and having no friends.
I attended resource classes due to learning disabilities, and after being diagnosed with schizophrenia in ninth grade, I was classified as having mild intellectual disability.
I switched to a special education program and am currently a senior at Taishan High School in a comprehensive vocational program.
My questions are: Should I see a neurologist or a neurosurgeon? Can you recommend any neurologists or neurosurgeons at National Taiwan University? Is it possible that my brain has calcification due to my schizophrenia and the head injury? Do my symptoms indicate brain calcification? I am currently seeing Dr.
Tsai Wen-Che at the National Taiwan University Children's Hospital in the pediatric psychiatry department.
I am taking the following medications: Depakine 500 mg, Seroquel XR 200 mg, Seroquel IR 50 mg, Mirtazapine 50 mg, and Melatonin 50 mg, all taken before bed.
My previous follow-up for prematurity indicated that my brain only had bleeding without significant issues.
I also have no memory of that now.
My eyes underwent laser treatment at birth due to my prematurity, and I am now severely myopic.
After being hit, I have not experienced any visual abnormalities, only headaches and occasional head shaking, but no full-body shaking.
Thank you for your response, doctor.

Lian Xiumin, 10~19 year old female. Ask Date: 2021/02/05

Dr. Wu Zongying reply Family Medicine

Hello: It is recommended that you schedule an appointment with the neurology department for further examination.
If the neurology evaluation shows no issues, you may then consider an appointment with the psychiatry department.

Reply Date: 2021/02/05

More Info

Post-traumatic headaches are a common issue that can arise after a head injury, even if the injury seems minor at first. Based on your description, it appears that you experienced a head trauma during a physical education class when you were struck by a basketball. Following this incident, you have been experiencing persistent headaches, nausea, and other symptoms that have raised concerns about your neurological health.

Headaches that occur after a head injury can be classified into several categories, including tension-type headaches, migraines, and post-traumatic headaches. Post-traumatic headaches can develop immediately after the injury or may appear days or weeks later. They can be caused by various factors, including changes in brain chemistry, muscle tension, and psychological stress.

Given your history of head trauma and the ongoing symptoms you are experiencing, it is essential to seek further evaluation from a neurologist. A neurologist specializes in diagnosing and treating conditions related to the nervous system, including headaches, and can provide a comprehensive assessment of your symptoms. They may recommend additional imaging studies, such as an MRI or CT scan, to rule out any structural issues in the brain that could be contributing to your headaches.

Your mention of experiencing a burning smell and increased forgetfulness raises additional concerns. These symptoms could be related to your underlying mental health conditions, such as your history of psychotic disorders and cognitive challenges. It is crucial to communicate all your symptoms to the neurologist, as they can help determine whether these issues are related to your head injury or if they stem from your existing conditions.

In terms of treatment, managing post-traumatic headaches often involves a multi-faceted approach. This may include:
1. Medication: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may help alleviate headache pain. However, since you mentioned that you are not currently taking pain medication, it would be advisable to discuss this with your doctor. They may also prescribe medications specifically for migraine or tension-type headaches.

2. Physical Therapy: If muscle tension is contributing to your headaches, physical therapy may help. A physical therapist can teach you exercises to improve posture and strengthen neck muscles, which may alleviate some of the pain.

3. Cognitive Behavioral Therapy (CBT): Given your history of mental health issues, CBT may be beneficial in managing stress and anxiety, which can exacerbate headache symptoms.

4. Lifestyle Modifications: Maintaining a regular sleep schedule, staying hydrated, and managing stress through relaxation techniques can also help reduce the frequency and severity of headaches.

5. Follow-Up Care: Regular follow-ups with your neurologist are essential to monitor your symptoms and adjust treatment as necessary.

Regarding your question about calcium deposits in the brain, it is important to clarify that calcification typically refers to the accumulation of calcium salts in body tissue, which can occur for various reasons, including aging or certain medical conditions. However, it is not a direct result of head trauma. Your neurologist can provide more insight into this if it becomes a concern based on your imaging results.

In summary, it is advisable to see a neurologist for a thorough evaluation of your headaches and related symptoms. They can help determine the best course of action for your specific situation and provide you with the necessary support and treatment options. If you have any further questions or concerns, do not hesitate to reach out to your healthcare provider for guidance.

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