You have hit your head. It hurts. Maybe it swells. No matter what, the first step is to see a doctor, and time is of the essence. If any swelling is present, or your sight or hearing is compromised in any way, the emergency room is recommended. The head is a precious beast. It is tough, but it is vulnerable, and internal injuries may or may not be visible to the naked eye. Of course, your injury may result in nothing more than a bruise or a red spot, but you have to rule out embolisms, clots, internal bleeding, and many other life-threatening problems.
Okay. You have taken all the correct steps. But you have developed a headache. Could it be a migraine, even if you have no history of experiencing migraines? And can it be stopped?
After an injury, especially if the injury is defined as Traumatic Brain Injury (which may be mild or severe), it is possible to develop what is called a “post-traumatic headache,” or PTH. Typically, these will develop fairly soon after an injury—even if the injury did not result in the need for medical intervention—but on occasion these injuries can develop slowly. These headaches are highly variable, but often they resemble post-concussion headaches, which can include dizziness and unsteadiness, poor concentration, sleep disturbance, and even increased irritability or other personality changes.
The nature of the pain often closely resembles tension-type headaches, meaning the pain may feel like something is squeezing on your head or pressing out from the inside. The pain can travel to or from your neck. However, the pain can also form on one side of your head and stay there for hours.
Yes, PTH can resemble a migraine. It’s the old problem in headache medicine: classification. So many headaches resemble each other, and the one with the most visceral experience—you!—is the one with the headache.
One way medical professionals differentiate between PTH and migraines is by noting the duration. In one study, 30% of PTH patients reported that their headaches went away about one year after their injury. 1 That is a pretty clear indicator that what they were suffering was not chronic migraine, or at least had an abnormally short life-cycle.
What about the other 70%?
Coming up with a definition of post-traumatic headache is not too difficult: at the risk of stating the obvious, a person who develops headaches after a head injury has it! Narrowing that definition to the more precise—and potentially more reimbursable—definition of “migraine” may be trickier. Quite a few researchers and policy makers have attempted to come up with meaningful classifications and tests to standardize those classifications, but arriving at a definition of migraine is probably still quite physician-specific, meaning two very fine physicians may not agree that your PTH is or is not a migraine.2 While “shopping around” to get the diagnosis you want is not necessarily desirable, it is good to know which diagnoses are controversial or murky.
Two things do seem to be fairly well-agreed upon, however: the condition of having chronic migraines lasts longer than the condition of having non-migraine PTH, and people with post-traumatic migraine are less adequately diagnosed and treated than people whose migraines are not due to injury.
Several studies claim that post-traumatic migraines are inadequately treated. One of these studies, a 2014 paper in the journal Headache, reports that only 8% of brain injury patients who developed a migraine are treated with triptans.3 While triptans certainly do not work in every case, they are more effective than drugs like ibuprofen, which causes some to worry: if you are seeking relief of your migraine with ibuprofen, how much ibuprofen are you taking? Too much, is the likely answer, and this can lead both to liver problems and dependence.
The larger point is that if you have had a traumatic head injury—even if it is minor—you are at risk of developing chronic migraine and are at further risk of not treating it.
Do not make the mistake of thinking your injury-induced headache will go away in time or is just something you have to live with. See a physician: there may be a way.
- Chong S. Post-traumatic-headache – 2012. The Migraine Trust: February 2012. http://www.migrainetrust.org/research-article-post-traumatic-headache-2012-15133
- Anderson K et al. Detecting migraine in patients with mild traumatic brain injury using three different headache measures. Behav Neurol. 2015; 2015:693925
- DiTommaso C et al. Medication usage patterns for headache treatment after mild traumatic brain injury. 2014 Mar;54(3):511-9.