Headaches & brain injury
Headaches are a common
and often persistent problem after acquiring a brain
Headaches can arise after damage to different structures both
inside and outside the head, but a very common cause of headaches
is due to the microscopic damage to nerve pathways in the brain
after a traumatic brain injury and other types of brain disorder,
resulting in what is often called a tension headache.
Major types of headaches
We'll cover some of those that can be common after a brain
injury. Please note that how headaches are named and
classified changes from country to country.
Tension headaches often feel like a
diffuse vice-like pressure throughout the head, lasting from 30
minutes to a week. They usually respond well to over-the-counter
analgesics like ibuprofen, paracetemol and aspirin.
Migraines are moderate to
severe headaches, recurrent and pulsating in nature and often only
affecting one half of the head. Other symptoms may include vomiting
and sensitivity to light, sound or smell. They can last from four
hours to three days in length. Sometimes the person sees an 'aura'
before the migraine starts and can avoid the onset by avoiding
activities that are triggering the migraine, or taking appropriate
Musculoskeletal headache is common with
traumatic brain injuries when there is injury to the neck and/or
structures in the head such as a whip lash injury. These headaches
often worsen with stooping, bending or exertion and may be
associated with dizziness, sensitivity to light, sensitivity to
sound and even imbalance. These headaches often disappear when the
underlying problem is resolved.
Cluster headaches are typically short (15
minutes to three hours) of severe pain that usually is located
around one eye. Other symptoms include nasal congestion, tearing
and a red eye.
If you are experiencing headaches after a traumatic brain injury
it is important to report these to your doctor as it could be the
symptom of a condition needing urgent treatment. Headaches can also
result as a reaction to medication in which case a new medication
should be tried.
Healthy habits to reduce headaches
Before trying medications, there are basic changes to one's
lifestyle that are worth trying to minimize the chances of
- Sleep well
- Regular exercise
- Avoid caffeine and nicotine
- Avoid certain foods that can trigger headaches e.g. red wine,
monosodium glutamate, certain cheeses
- Minimize use of pain medications unless they are
Treatment of headaches
As already mentioned, the tension headache is the most common
one after a brain injury, and usually responds well
to ibuprofen, paracetemol and aspirin.
Pain management in brain injury is often difficult as some
medications may work against recovery. Certain medications can also
become a problem because of their potential for substance abuse and
their negative side effect on the ability to think clearly.
Anti-inflammatory agents are appropriate for musculoskeletal
pain, though doctors must stay alert for possible gastric problems.
Patients with brain injury and spinal cord injury tend to have high
acid content in the stomach and are susceptible to stomach ulcers
which can be increased by these agents.
Antidepressants can be effective in controlling headache and
nerve pain. These are not sedating except in high doses, and don't
depress the respiratory cycle.
Most headaches following brain injury do not require surgical
treatment. In some cases, particularly severe brain injury,
surgical intervention may be required for conditions such as
communicating hydrocephalus, carotid cavernous fistulas tension,
pneumocephalus, brain abscesses and subdural hematomas. Appropriate
clinical examination and diagnostic tests are needed to assess the
form of treatment required.
Where to get help
There are support groups and medical facilities set up to help
people cope with chronic pain. Contact your local doctor or Brain
Injury Association to get the contact details in your State.
References and further information