Managing Post-Trauma Headaches: Causes and Treatment Options

Headaches are common after a car accident?

Hello Dr.
Jiang! My name is Nick.
I had a severe car accident 10 years ago, resulting in a brain hemorrhage and subarachnoid hemorrhage.
I was in a coma for about a day before waking up.
After my recovery, I started experiencing headaches that are triggered by seasonal changes, before typhoons, and during periods of high work and life stress.
I often have migraines and pain on the top of my head that can last for 2 to 3 days.
Sometimes, the headaches are accompanied by discomfort in my eyes, rapid pulsation of the blood vessels in my temples, and even feelings of drowsiness and dizziness.
Dr.
Jiang, can my symptoms be improved, prevented, and treated?

Nick, 30~39 year old female. Ask Date: 2023/02/02

Dr. Jiang Junyi reply Neurology

Hello Mr.
Nick,
You mentioned experiencing "migraine and tension headaches that often recur for 2 to 3 days, sometimes accompanied by discomfort in the eyes and rapid pulsation of the temporal artery." This may indicate a vascular headache issue, particularly cluster headaches.
These headaches are typically concentrated around one eye or the temporal region, most commonly occurring behind one eye, and are associated with symptoms such as conjunctival injection, nasal congestion, tearing, forehead and facial swelling, facial sweating, miosis, and ptosis on the same side.
Some patients may exhibit restlessness, pacing, and find that resting may exacerbate the pain, which distinguishes it from migraines.
During a cluster headache episode, the pain tends to occur at the same time each day.
Cluster headaches are more prevalent in males.

For "acute treatment" during headache episodes, medications such as pure oxygen, ergotamine, and sumatriptan can be used.
It is advisable to avoid vasodilators, flying, and climbing as potential triggers during an episode.
Maintaining a regular sleep schedule is crucial; irregular sleep patterns can trigger cluster headaches, so please ensure consistent sleep during episodes.
Additionally, abstaining from alcohol during an episode is important, as alcohol consumption may provoke cluster headaches.
Thank you for your inquiry.
If you have further questions, feel free to discuss them.
Wishing you good health and peace.
Dr.
Jiang Junyi, Neurology, Taoyuan Hospital

Reply Date: 2023/02/02

More Info

Managing post-trauma headaches can be a complex issue, especially for individuals like Nick, who have a history of significant head trauma, such as a severe car accident resulting in subarachnoid hemorrhage. Understanding the underlying causes and exploring treatment options is crucial for effective management.

Causes of Post-Trauma Headaches
1. Post-Concussion Syndrome: After a traumatic brain injury (TBI), individuals may experience a range of symptoms, including headaches, dizziness, and cognitive difficulties. Post-concussion syndrome can manifest weeks or even months after the injury, and headaches are a common complaint.

2. Tension-Type Headaches: Stress and tension can lead to muscle tightness in the neck and scalp, resulting in tension-type headaches. These headaches often feel like a tight band around the head and can be exacerbated by stress, fatigue, or poor posture.

3. Migraine: Individuals with a history of head trauma may also experience migraines, which can be triggered by various factors, including hormonal changes, stress, and environmental factors like weather changes. Migraines are characterized by throbbing pain, often on one side of the head, and may be accompanied by nausea, sensitivity to light, and visual disturbances.

4. Cervicogenic Headaches: These headaches originate from issues in the cervical spine (neck) and can be a result of muscle strain or injury from the trauma. Symptoms may include pain that radiates from the neck to the head, often accompanied by neck stiffness.

5. Chronic Daily Headaches: Some individuals may develop chronic daily headaches following a TBI, which can be a combination of tension-type headaches and migraines.

Treatment Options
1. Medication: Depending on the type of headache, various medications may be prescribed. For tension-type headaches, over-the-counter pain relievers like ibuprofen or acetaminophen can be effective. For migraines, triptans or preventive medications such as beta-blockers, antidepressants, or anticonvulsants may be recommended.

2. Physical Therapy: Engaging in physical therapy can help address any musculoskeletal issues resulting from the trauma. A physical therapist can provide exercises to improve neck strength and flexibility, which may alleviate headache symptoms.

3. Cognitive Behavioral Therapy (CBT): Since stress and anxiety can exacerbate headaches, CBT can be beneficial in managing stress and developing coping strategies.

4. Lifestyle Modifications: Maintaining a regular sleep schedule, staying hydrated, and avoiding known headache triggers (such as certain foods, alcohol, or excessive screen time) can help reduce the frequency and severity of headaches.

5. Alternative Therapies: Some individuals find relief through alternative therapies such as acupuncture, chiropractic care, or massage therapy. These approaches can help alleviate muscle tension and improve overall well-being.

6. Regular Follow-Up: Given Nick's history of severe head trauma, regular follow-up with a neurologist or headache specialist is essential. They can monitor symptoms, adjust treatment plans, and conduct further evaluations if necessary.

Conclusion
In summary, managing post-trauma headaches involves a comprehensive approach that includes identifying the type of headache, exploring various treatment options, and making lifestyle changes. Given the complexity of Nick's symptoms and history, it is crucial to work closely with healthcare professionals to develop a tailored management plan. Regular monitoring and adjustments to the treatment strategy will be key to improving his quality of life and reducing the impact of headaches on daily activities.

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