Head injuries come in all varieties, from mild bumps and bruises to the more serious traumatic brain injury (TBI). And TBIs are rising dramatically, with some estimates ranging as high as 69 million incidents globally each year.
Common causes of head injury include falls, sports-related impact, assaults, blast and combat injuries in military personnel, and motor vehicle accidents. Groups most at risk are adolescents between the ages of 16-19 and those over 65.
In milder cases of TBI, an injured person may not even lose consciousness or may be unconscious for under 30 minutes. While most people improve in a few days, a smaller percentage may continue to experience symptoms such as migraine and other head pain, foggy thinking, balance issues, mood disorders, or sleep difficulties. The length and severity of head trauma may increase depending on how long the injured person was unconscious and/or that person’s degree of amnesia post-injury.
A recent study indicates that 61% of people experience post-traumatic migraine-like symptoms, after even a mild TBI. These symptoms can include nausea, phono- and/or photo-sensitivity, and deep, pulsing pain on one side of the head.
One study shows that patients with these symptoms may be 7 times likelier to experience a longer recovery and greater cognitive defects. People with post-TBI headaches, but no prior history of migraine, were also shown to be hypersensitive to CGRP, a molecule known to be elevated in migraine. And a new study suggests that people with a family history of migraine are more likely — more genetically vulnerable — to experience migraine symptoms after traumatic brain injury.
If you experience a head or brain concussion, you may have post-trauma symptoms typical of migraine headaches, such as unilateral head pain, nausea, light or sound sensitivity, and aura. Other post-concussion symptoms may include dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory, or ringing in the ears.
How should post-concussive migraine be treated? Many experts agree that a post-TBI headache should be treated “according to the class of headache its characteristics most closely resemble.” In other words, treatment of post-concussive migraine headaches can typically follow a standard migraine protocol. However, it’s important to consult a physician, in case other symptoms may influence your treatment plan as well.
Treatment after traumatic brain injury can be complex and timing of medication critical, as some drugs like aspirin could cause complications like intracranial bleeding if taken immediately after concussion occurs. Certain medications or their overuse, such as opioids, may exacerbate pain and headache following a traumatic brain injury. It is vital to consult your neurologist about medication after a TBI (certain associated complications may require a form of treatment not included in the Mable program).
To relieve post-TBI migraine-like pain, your doctor may recommend an over-the-counter (OTC) medication, including non-steroidal anti-inflammatory drugs (aspirin and ibuprofen), acetaminophen (paracetamol), and naproxen, all of which may include caffeine as an ingredient. These drugs are shown to have some efficacy in improving migraine and pain symptoms.
Antiemetics (metoclopramide or prochlorperazine) that reduce dopamine signaling in the brain can be taken to treat nausea that accompanies the headache.
If OTC medications are not effective in relieving post-traumatic migraine, other potential options include:
The best way to prevent a post-TBI headache or migraine is to prevent injury to begin with — particularly if you’re a person who already experiences migraines, which may place you at greater risk of concussion. Concussion prevention means: always use a seatbelt in a motor vehicle, wear a helmet for cycling, skateboarding, and other dangerous activities, and avoid playing through head injuries in contact sports.
Most importantly, seek medical attention for migraine-like or other post-concussive symptoms after a head injury. A physician will determine the right treatment plan for you.
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