PAIN AFTER A HEAD INJURY: LONG-TERM HEADACHES AFTER INJURY

Wednesday, March 11, 2009 13:09

Posted in category Pain Relief-Muscle Relaxers

As well as damage from concussion, the brain can also be injured without receiving a blow. Internal damage can occur through pressure; for example, from a sub-arachnoid haemorrhage, from a stroke, from hydrocephalus, and tumours. The non-specific injury the brain receives from these can also cause post-traumatic headaches, a term which includes headaches both from direct concussion and from other forms of brain injury.

Assessing post-trauma headaches is not easy, if for no other reason than the fact that any blow to the skull almost certainly strains the neck as well. For example, a car crash which knocks out the driver will probably cause a whiplash accident as well. So is the post-trauma headache due to the head injury or the neck injury? Other than neck problems, true post-concussion headache is by far the most common continuing symptom after a severe head injury. Interestingly, the degree of headache depends on what the patient was doing when they had their injury -head injuries sustained during recreation seem to cause far fewer post-concussion headaches than do injuries sustained at work. Obviously there must be some psychological element in the degree of pain experienced.

One interesting aspect of post-traumatic headaches is that they sometimes don’t start until six months after the original injury. These ‘late acquired’ headaches may be related to depression, especially if the patient has lost their job as a result of their injuries.

Type of headache

Most post-traumatic headaches are over the whole of the head, and are usually accompanied by poor concentration and dizziness. Just occasionally a head injury can start off migraine-type headaches, but this is very rare.

What else could it be?

It’s not always easy to disentangle headaches caused by direct brain damage (concussion), and those arising from injury to the neck.

Don’t forget that it’s quite possible for other types of headaches to occur coincidentally, unrelated to the injury. Unfortunately, the idea that the two things are unrelated is often very difficult for the patient to comprehend. After all, he thinks, / injured my head and then six months later I start getting migraines. Surely the two are related? They may be, but then again, they may not.

Orthodox treatment

Post-concussion headache sometimes responds to mild analgesics, including the non-steroidal anti-inflammatory drugs (NSAIDs). These are drugs that are commonly used for rheumatism; for example, ibuprofen (also known as Brufen or Nurofen), diclofenac (Voltarol), and indomethacin (Indocid). There are many others. In addition, a small dose of the beta-blocker propranolol may help. This drug is principally used in treating blood pressure and angina, though it can also be useful in cases of migraine. It relaxes the muscle lining of blood vessels in the brain, which may be the way that its anti-headache effects occur.