Headaches

These are the most common after a brain injury, but 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, paracetamol and aspirin. 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 disorders, resulting in what is often called a tension headache.

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. This can be achieved by avoiding activities that are triggering the migraine or taking appropriate medication.

Musculoskeletal headaches are common with traumatic brain injuries when there is an injury to the neck and/or structures in the head. An example of this is a whiplash injury. These headaches often worsen with stooping, bending or exertion. They 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 brain injury, it is important to report these to your doctor. It could be the symptom of a condition needing urgent treatment or a reaction to medication, in which case a new medication should be tried.

Before you try medications, there are basic lifestyle changes to try that could cut the chances of headaches occurring:

• sleep well
• regular exercise
• avoid caffeine and nicotine
• avoid certain foods that can trigger headaches e.g. red wine, certain cheeses
• minimise use of pain medications, unless they are prescribed.

Pain management in brain injury can be difficult, as some medications may work against recovery. Certain medications can also become a problem because of their potential for substance abuse and their impact on the ability to think clearly. Often over-the-counter analgesics like ibuprofen, paracetamol and aspirin are used.

Non-steroidal anti-inflammatory drugs (NSAIDs) which include asprin, ibuprofen (Nurofen), Voltaren, and other COX-2 inhibitors are appropriate for musculoskeletal pain. However, they can increase the risk of serious gastrointestinal complications (including ulcers) and may increase cardiovascular events in some people, so check with your doctors before taking them.

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.

Migrain and Headache Australia: www.headacheaustralia.org.au