Living With Migraines

Head Trauma and Migraines

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Head Trauma and Migraines

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.

Migraine After Concussion: Is There a Connection?

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. 

Treating Migraine Following Concussion

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:

  • Triptans: Commonly used to manage migraine and post-traumatic headache, triptans interfere with the serotonin system to help prevent inflammation in the brain. The choice of triptan must be tailored to the individual, as some people who don’t respond well to one triptan may find success with another. To pinpoint the optimal treatment for you, consult your physician or consider a program that matches you with treatment tailored to your DNA.  
  • Calcitonin gene-related peptide (CGRP) ligand-receptor antagonists: CGRP antagonists, known to be an effective treatment for migraine, were likewise found effective and safe in treating patients with post-TBI headaches.

Staying “Ahead” of Post-TBI Migraine

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. 

Learn more about migraine treatment tailored to your DNA.

Not sure if your headaches are actually migraine pain? Take the Mable quiz

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  2. Journal of Neurosurgery (JNS). Estimating the global incidence of traumatic brain injury.
  3. Psychiatric Neuroimaging Laboratory (PNL). Mild Traumatic Brain Injury.
  4. NIH/National Library of Medicine. Persistent post-traumatic headache attributed to mild traumatic brain injury: Deep phenotyping and treatment patterns.
  5. The American Journal of Sport Medicine. Posttraumatic Migraine as a Predictor of Recovery and Cognitive Impairment After Sport-Related Concussion.
  6. NIH/National Library of Medicine. Hypersensitivity to Calcitonin Gene-Related Peptide in Post-Traumatic Headache.
  7. Mable. New Migraine Treatment: Anti-CGRP Therapy and How It Works.
  8. NIH/National Library of Medicine. Family History of Migraine is Associated with Posttraumatic Migraine Symptoms following Sport-related Concussion.
  9. NIH/National Library of Medicine. Post-traumatic headache: epidemiology and pathophysiological insights.
  10. Emergency Medicine Journal. Aspirin and the risk of intracranial complications following head injury.
  11. The Journal of Headache and Pain. Post-traumatic headache: facts and doubts.
  12. UpToDate. Acute treatment of migraine in adults.
  13. NIH/National Library of Medicine. Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials.
  14. Mable Website.
  15. NIH/National Library of Medicine. CGRP Inhibitors for Migraine.
  16. NIH/National Library of Medicine. Use of CGRP receptor blocker erenumab in the management of post-traumatic headache: a case series of 5 women.
  17. NIH/National Library of Medicine. Is Migraine Headache Associated with Concussion in Athletes? A Case-Control Study.
  18. Mable. DNA Quiz.

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Updated on
September 23, 2022
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