Headaches and migraines are one of the most commonly experienced, yet misunderstood, symptoms of post-traumatic brain injury that can continue to impact people years after their injury.
Recently, The American Headache Society compared 300 patients who were admitted to inpatient rehabilitation with mostly moderate to severe traumatic brain injuries against a pre-injury group. Their study showed a higher prevalence of new or worse headaches among the inpatient group as compared to the pre-injury group (American Headache Society). The study considered prior headache history, headache prevalence, frequency, classification, pain rating, and impact, and they recorded symptoms three, six, twelve, and sixty months post-injury. While only 17% of the patients had experienced headaches before migraines and headaches, most had a brand new or worse headache after their traumatic brain injury.
It is estimated that about 50% of people who had a concussion, or a TBI, had head pain that persisted for more than two months. This is labeled as post-concussion syndrome, which is a topic for another blog, but the headache associated with the injury is called a Chronic Post Traumatic Headache (CPTHA). CPTHA is poorly understood and can affect the overall quality of life for people living with traumatic migraines and headaches (Hope Therapy, 2014).
What is a CPTHA?
CPTHA is the most prevalent type of pain after a mild TBI. It occurs in 47-95% of mild TBI cases, and 20-38% of cases with moderate to severe TBIs (Journal of Manual and Manipulative Therapy, 2014). Despite the high prevalence of CPTHA, a precise list of symptoms that would allow for easy identification of CPTHA does not exist. CPTHA headaches can take many forms, with the most common being a tension headache. 82% of individuals with CPTHA reported that their temple area was the most painful, followed by the forehead, neck, back of the head, eyes, and vertex region. Headaches/migraines can appear daily, or weekly, and for years if left untreated (Journal of Manual and Manipulative Therapy, 2014).
Types of Headache and Migraine Disorders:
There are five types of post-TBI headache disorders:
- Persistent post-traumatic headache: directly attributable to brain injury
- Migraine with or without aura: sensory symptoms that result in head pain (i.e. light, sound, nausea, odor, etc)
- Vestibular migraine: dizziness, vertigo, or motion-induced sickness
- Cluster headache: blinding pain usually behind one eye
- Chronic tension-type headache: chronic headaches that impact both sides of the head and may be enhanced by light or sound (TheraSpecs)
These headaches or migraines are thought to be the result of damage to structures, inflammation, hyper-reactivity, dysfunction of pain-inhibition pathways, PTSD, and more (Journal of Manual and Manipulative Therapy, 2014). Some other types of headaches include cervicogenic, dealing with an injury to the tissues and muscles in the neck, and rebound headache, or headache as a result of medication.
Why does this matter and what does this mean for TBI patients?
“Headaches after traumatic brain injury should not be written off. This study sheds light on education needed among primary care providers and other practitioners caring for those suffering from traumatic brain injury” says Sylvia Lucas, M.D., Ph.D., clinical professor at the University of Washington Medical Center and lead author of the study (American Headache Society).
Headaches in TBI patients should not be taken lightly. They are not of some normal occurrence, but the result of a traumatic incident. This does not mean that they should last forever, and more research needs to be done on the frequency and severity of these headaches so that they can be better treated and those suffering from traumatic brain injuries can experience a better quality of life.
How can Power of Patients help you?
We know that TBIs look differently for everyone and recovery is an individual process, so migraines and headaches must be managed by not a one-size-fits-all approach. At Power of Patients, we seek to empower people and caregivers by giving them a platform to advocate for themselves and their recovery. Our TBI dashboard can help you track any headache or migraine symptoms and/or triggers so you can identify what the headache feels like, how it starts, where it hurts, how long it lasts, and what makes it better or worse.
Join us as we work to address your concerns. Register for our dashboard here and our newsletter here, and get one step closer to managing your condition by having a tangible tracking platform to share with your doctors and other practitioners.