Post-traumatic headache
Post-traumatic headache (PTH) is a type of headache that most often occurs in connection with a concussion, but can also be related to other accidents.
The headache can be caused by both direct blows to the head, and indirect trauma such as forceful movements of the head.
Although some people experience this headache briefly, for others it can last for over three months.
Post-traumatic headache is described as the headache it resembles (phenotype), where migraine is most common with symptoms such as pulsating pain, nausea, and sensitivity to light, followed by tension headache (with a tight band around the head) and cervicogenic headache (neck pain and unilateral headache). Many believe the treatment should be similar to the phenotype, but it often takes a multidisciplinary approach to get a good result. Much of the rehabilitation focus is on gradually increasing mental and physical load.
1
Post-traumatic headache is a common condition after concussion, with symptoms similar to migraine and tension headaches.
2
Accurate diagnosis requires thorough clinical assessment and exclusion of other headache diagnoses.
3
The prognosis is best with early assessment and good advice, where function and load management both mentally and physically are in focus.
Occurrence
Approximately 5 out of 100 men and 2 out of 100 women will experience PTH in their lifetime. A significant proportion of concussion patients experience persistent symptoms. Around 40% have symptoms one month later, 43% after three months, 34% after six months, and 5-20% after twelve months.
Different subgroups:
Post-traumatic headache is classified as acute, where it starts within 7 days of the trauma, and prolonged if it continues after 3 months. There are also three categories:
- Post-traumatic headache due to head injury, where mild injuries such as concussion are most common.
- Headaches related to whiplash.
- Headache related to surgical intervention in the brain or skull.
Typical symptoms:
The symptoms of PTH can vary, but they are often similar to migraine or tension-type headaches. Common symptoms include:
- Throbbing or pulsating pain in the head
- Tenderness in the scalp
- Pressure sensation in the head
- Stinging or tingling sensation in the scalp
- Burning pain in the scalp
In many cases, PTH can also be accompanied by other symptoms, such as:
- Neck pain
- Dizziness
- Tinnitus (ringing in the ears)
- Vision problems
- Nausea and vomiting
- Light and sound sensitivity
- Concentration difficulties
- Memory problems
- Fatigue
- Mood swings
Recommended surveys
A thorough clinical examination is very important after a trauma. Red flags and dangerous causes must be ruled out. If you or someone you know has just been exposed to a trauma, visit the emergency room. The earlier you are examined and given the right advice, the better the prognosis. The examination should include observation, palpation, neurological and orthopaedic tests and, in some cases, MRI, CT or X-ray. Co-vision tests and treadmill tests are also recommended. Seek out healthcare professionals with expertise in concussion and headaches.
Mechanisms
The mechanisms behind PTH are complex and involve both physiological and psychological factors, including neuroinflammation and changes in brain blood flow following traumatic injury.
Duration of seizures
Attacks of PTH can last from a few hours to several days. Symptoms can be persistent or episodic.
Exacerbating factors
Stress, fatigue, physical activity and certain sensory stimuli can worsen PTH symptoms
Mitigating factors
Rest, dark rooms and relaxation techniques can help, but are primarily important in the early stages. After a few days, you should try to gradually return to normal activity. A slight increase in symptoms is okay, but it's a good idea to get some rest after exposure. Adapted advice can be given by qualified healthcare professionals.
How are you diagnosed?
The diagnosis of PTH is made based on clinical criteria and a history of concussion, neck injury or surgery. The diagnosis is confirmed if the headache begins within seven days of the injury.
Preventive measures
The use of protective equipment during activities with a high risk of head injury and early treatment of concussion can help reduce the risk of PTH.
Treatment
Medical treatment:
Medical treatments for PTH include painkillers, anti-inflammatory/anti-inflammatory drugs, triptans, and preventive medications such as beta-blockers, antidepressants and anti-epileptics.
However, keep in mind that medications do not always have the same effect on post-thrombotic headaches as other headaches, even if the headaches are similar.
Medication should not be taken on your own initiative, but in consultation with a doctor.
Medication can mask what the body actually needs from physical or mental stress.
It is recommended to try interdisciplinary follow-up, where non-medical rehabilitation is emphasized.
Non-medical treatment:
Non-medical treatments for PTH include cognitive-behavioral therapy, mental and physical gradual load increase, graded cardio training, vestibular training, optometric co-vision training, manual treatment of the neck and back, and psychological treatment.
An interdisciplinary coordinated rehabilitation effort is recommended.
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