What are headaches and migraines?

A headache is a pain in any region in the head. It may be sharp, dull, located in one area or all across the head. Primary headaches are when the headache is the only source of pain. A secondary headache is when the headache is the secondary issue resulting from a primary problem such as sinus irritation, whiplash or a TBI.

A migraine is headache that is generally located at one location within the head. It can be with or without an aura, and once it begins the person’s head may throb and it may hurt to see bright lights. An aura may be present in 20 – 30% of migraine cases.3 Migraines are more likely if there is a family history of migraines and can be exacerbated by a TBI. They are caused by an irregular flow of blood to the brain and may also be accompanied by seeing bright lights or spots, and nausea or vomiting.

Headaches or Migraines following TBI

Following a TBI, headaches and migraines are a common problem, with 30 – 90% of patients reporting the symptom post-TBI. After one year, up to 22% of people with TBI still suffer from post-traumatic headaches.1

Following a mild TBI headaches occur as the brain heals. With more moderate to severe TBI, headaches may be on-going as the brain and body recover from the trauma, from any post-traumatic surgery, and from collections of blood, fluid or swelling within the brain.4 Ongoing changes in the brain may also result in chronic headaches. Treatments are available for headaches and migraines. Ask your doctor for advice or a referral if this symptom is a problem for you.

Types of headaches after TBI

There are a number of types of headaches that a patient may suffer following a TBI. These include:

  • Post Traumatic Headache
  • Vestibular Migraine
  • Chronic Migraine
  • Tension Headache
  • Cluster Headache
  • Cerviogenic Headache

Post Traumatic Headache
A post traumatic headache occurs following trauma, and can replicate the pain which occurs during a migraine or tension headache. These are the most common types of post TBI headaches.2

Vestibular Migraine
A vestibular migraine occurs in people who have suffered migraines for many years, and who then develop symptoms including dizziness, imbalance and often motion sickness at the time of their migraine.3

Chronic Migraine
A migraine is a debilitating, localised headache which can cause severe pain. A person with a chronic migraine suffers headaches at least 15 days of the month, with 8 of those being a migraine. A TBI may cause these migraines to become worse in severity.3

Tension Headache
A tension headache, also known as a musculoskeletal headache, feels like there is a dull pain across the head. It can generally be associated with tightness across the neck or scalp. Tension headaches can be caused by stress or depression, both of which can occur as symptoms of a TBI.3

Cluster Headache
Cluster headaches tend to occur during the night and can cause people to wake from their sleep. They can last from 15 minutes to three hours, and can cause deep, intense pain behind the eyes or in the temples.3

Cervicogenic Headache
A cervicogenic type headache can feel similar to a migraine, however the pain comes from injury to the cervical spine or base or the skull.1 These headaches are a secondary injury to the TBI and can be associated with other symptoms such as stress, fatigue and eyestrain or sensitivity to light.

Reducing the chance of headache or migraine

Headaches and migraines are an unpleasant experience, so there are some things you can do to try and reduce their severity.3

  • Avoid triggers such as bright lights, poor posture, stress and anxiety, as well as overuse of medication.
  • Make sure you have good sleep patterns. If you suffer from sleep disturbances following your TBI you may need help to get into a normal routine for sleep and rest to reduce the severity of tension headaches.
  • Refrain from or eliminate caffeine and alcohol intake completely.
  • Introduce healthy habits such as regular exercise if that is possible for you.

Diagnosis

Post Traumatic headaches need to be clinically diagnosed. If you believe you are suffering from post-traumatic headaches or migraines it’s important to see your medical practitioner for diagnosis and individual medical advice.

 

References

  1. Tessler J, Horn LJ. Post-Traumatic Headache. [Updated 2020 Mar 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556134/
  2. Labastida-Ramírez, A., Benemei, S., Albanese, M. et al. Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence. J Headache Pain 21, 55 (2020). https://doi.org/10.1186/s10194-020-01122-5
  3. https://headacheaustralia.org.au
  4. Headaches after Traumatic Brain Injury  by Kathleen R. Bell, MD, Jeanne Hoffman, PhD, and Thomas Watanabe, MD, in collaboration with the Model Systems Knowledge Translation Center.

 

What is an Aura in Migraines?

An Aura is a visual disturbance which accompanies a migraine with symptoms of an aura including visual disturbances such as flashing lights, trouble focussing, blind spots or bright zigzag lines. An aura can affect one or both eyes and can last up to an hour.1

Reference
1. https://headacheaustralia.org.au