Headaches after traumatic brain injury – Northumberland Head Injury Service patient information leaflet

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  • Introduction

    This leaflet provides you with information about headaches after traumatic brain injury. We hope you will find it useful.

    Headache is one of the most common symptoms after traumatic brain injury, occurring in up to 90% of people. These headaches are often referred to as “post-traumatic headaches”.

    Headaches can make it more difficult for you to carry out your daily activities or to think and remember things, impacting on your ability to go to work or school, as well as affecting quality of life.

  • How long will my headaches last?

    Most people with post-traumatic headaches improve within days or a few weeks, whilst others may take up to three months to recover. Occasionally, the headaches can last longer and are referred to as “persistent” but this does not mean that they will never get better.

  • Are my headaches anything to worry about?

    Post-traumatic headaches are rarely a sign of a serious underlying problem.

    In the first few days after a concussion or brain injury, you should contact a healthcare professional (GP, NHS 111 service, Urgent Care service or Accident and Emergency) if the following occur:

    • Your headaches get worse.
    • You have nausea and/or vomiting with a headache.
    • You develop arm or leg weakness or problems speaking with a headache.
    • You have increasing sleepiness with a headache.
  • What causes headaches after brain injury?

    Headaches can occur after all types of traumatic brain injury. Several studies have shown that headaches may actually be more common after mild injuries than severe injuries.

    We do not really know why headaches occur after concussion or mild brain injury, but factors might include injury to the skull or neck, tension and stress, or side effects from medication.

    Headaches after a severe brain injury can be caused by a variety of problems, including skull fractures, the effects of surgery on the skull, bleeding or bruising to the brain, as well as tension and stress or medication side effects.

  • How will my headaches be diagnosed?

    People with post-traumatic headaches can have different symptoms. Some people experience very brief stabbing headaches; some headaches can feel like migraine whilst others can feel like a tension-type headache. Headaches can also be caused by taking too much medication. This is referred to as medication overuse or rebound headaches.

    Your doctor will ask questions to work out what type of headaches you have. They may also need to examine you. Some people will have already had a brain scan in the first few days after their injury but further scans or other tests are rarely needed.

  • What can be done to treat post-traumatic headaches?

    This will depend on each individual case. It is important to discuss your headaches with your doctor and it is helpful to keep a record of your headaches and your response to treatment by keeping a headache diary.

  • Lifestyle changes to help prevent headaches

    Lifestyle factors can trigger headaches or make headaches worse. Making simple changes can often make a big difference.

    • Try to go to bed and wake up at the same time every day. If you have difficulty falling or staying asleep it would be helpful to read our Sleep information leaflet for further tips.
    • Stay hydrated – most people should aim to drink enough during the day so their pee is a clear pale yellow colour.
    • Avoid caffeine in coffee, tea or fizzy drinks.
    • Eat regular meals. Try not to skip meals.
    • Avoid foods that may trigger a headache, like red wine, monosodium glutamate (MSG, a common food additive) or cheese.
    • Try to exercise every day. Aerobic exercise such as walking or swimming may help to prevent headaches by improving sleep and decreasing triggers. Start slowly and build up your effort gradually. If exercise triggers a headache, reduce your effort or try a different activity. Consult your GP if you have any concerns.
    • Try to manage fatigue as best you can. Helpful information can be found in our information leaflet on managing fatigue.
    • Try to avoid spending long periods looking at your mobile phone or computer screen.
  • Managing headaches without medication

    Here are some things you can try:

    • Go to a quiet place
    • Lie down
    • Apply a cold or hot pack to your neck or head
    • Relaxation / meditation / mindfulness exercises
    • Stretching and self-massage
    • Therapeutic massage
    • Acupuncture
  • Medication

    In the early days after a brain injury you may need to take simple painkillers which can be bought over the counter or prescribed by your GP.

    • Examples include Paracetamol and Ibuprofen.
    • Do not take more than the recommended maximum dose.
    • Try not to take painkillers every day unless necessary.
    • Try to avoid medication which contains Codeine, Caffeine or Morphine as these are more likely to cause medication overuse headache. If you need to take these, just take them when absolutely necessary.

    If your headaches are not settling or if they are very frequent, you may be prescribed medication to prevent headaches. These medications do not cure headaches but they can reduce their frequency or intensity.

    • This type of medication needs to be taken every day.
    • The medication may take a few weeks to start working.
    • Examples include
      • Antidepressants such as Amitriptyline, Nortriptyline or Duloxetine
      • Anti-seizure medicines such as Gabapentin or Pregabalin.
      • Blood pressure medicines such as Propranolol or Candesartan.

    If your headaches still don’t settle, we may need to refer you to a specialist headache service.

  • Further information

    Your GP will probably be able to manage your headaches but, if further advice is required, your Community Practitioner will be able to refer you to the Neurorehabilitation Consultant at Northumberland Head Injury Service. Telephone: 01670 394 150

  • Useful resources

    Headway Headache Factsheet
    Produced by Headway, the UK-wide charity, to improve life after brain injury by providing support and information.

  • References

    • Benemei, S. et al., 2020. Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence. The Journal of Headache and Pain, 21(55), pp. 1-15.
    • Defrin, R., 2014. Chronic post-traumatic headache: clinical findings and possible mechanisms. Journal of Manual and Manipulative Therapy, 22(1), pp. 36-43.
    • Larsen, E. L. et al., 2019. Acute and preventive pharmacological treatment of post-traumatic headache: a systematic review. The journal of Headache and Pain, 20(98), pp. 1-9.
    • Lee, M. J., Zhou, Y. & Greenwald, B. D., 2022. Update on Non-Pharmalogical Interventions for Treatment of Post-Traumatic Headache. Brain Sciences, 12(1357), pp. 1-16.
    • Lucas, S., Hoffman, J. M., Bell, K. R. & Dikmen, S., 2014. A prospective study of prevalence and characterisation of headache following mild traumatic brain injury. Cephalalgia, 34(2), pp. 93-102.
    • NICE guideline, 2023. Head injury: assessment and early management. [Online].
    • Schwedt, T. J. et al., 2021. Headache characteristics and burden from chronic migraine with medication overuse headache: Cross-sectional observations from the Medication Overuse Treatment Strategy trial. Headache, Volume 61, pp. 351-362.
  • What if I have a comment, suggestion, compliment or complaint about the service?

    If you want to make a comment, suggestion, compliment or complaint you can:

    We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention. You can provide feedback in the following ways:

    • the quickest way for you to do this is to complete our short online survey at www.cntw.nhs.uk/poy
    • complete a Points of You survey, available on wards, reception areas or from staff
    • other options for sharing your feedback and experience www.cntw.nhs.uk/yourfeedback

    Patient Advice and Liaison Service (PALS)
    PALS provide confidential advice and support, helping you to sort out any concerns that you may have about any aspect of your or your loved ones care.

    We act independently when handling patient and family concerns, liaising with staff, managers and, where appropriate, relevant organisations, to negotiate prompt solutions. If necessary, we can also refer patients and families to specific local or national-based support agencies.

    North of Tyne
    Tel: 0800 032 0202
    Email: [email protected]

    South of Tyne
    Tel: 0800 328 4397
    Text: 07825 061 035
    Email: [email protected]
    Post: Patient Advice and Liaison Service, Garden Lodge, Hopewood Park, Ryhope, Sunderland, SR2 0NB

    9am – 4.30 pm, Monday to Friday
    An answerphone is available at all times for you to leave a message. A member of the PALS team will aim to return your call as soon as possible.

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    Published by the Patient Information Centre
    2024 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
    Ref, PIC/905/0324 March 2024 V1
    www.cntw.nhs.uk Tel: 0191 246 7288
    Review date 2027