Headaches after a head injury

Many patients visiting the New York Headache Center with persistent post-traumatic headaches report having had a relatively mild head injury. The perception by neurologists has always been that milder injuries without loss of consciousness are more likely to cause headaches that severe ones. A research study just presented at the 54th Annual Scientific Meeting of the American Headache Society in Los Angeles confirms this old observation. Dr. Sylvia Lucas and her colleagues at the University of Washington in Seattle evaluated 220 patients with a mild traumatic brain injury (TBI) and a group of 378 individuals with moderate or severe brain injury. Both groups were evaluated within a week of the head injury and then again, by phone, 3, 6 and 12 months later. Both groups had similar demographics (age, sex, etc) and similar causes of injury (motor vehicle accidents was the most common cause). In the mild TBI group headaches were present in 63% after 3 months, 69% after 6, and 58% after 12 months. In the moderate and severe TBI group these numbers were 37%, 33%, and 34%. In both groups about 17% also had headaches prior to the injury. As far as the kind of headaches these individuals experienced, migraine was the most common type in both groups. It remains unclear why a milder injury should cause so many more headaches than a severe one. Treatment of post-traumatic headaches includes the usual approaches to the treatment of migraines – aerobic exercise, biofeedback and relaxation training, magnesium, butterbur, CoQ10, and other supplements, abortive medications, such as Migralex and triptans, prevention with Botox and other medications.