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Headaches and Brain Injury - Fact Sheet
 Like memory issues,
headaches are very common physical complaints following a brain injury, and may
have an adverse impact upon your ability to follow a normal daily routine,
study or work.
A strange feature is that the persistence
of post traumatic headaches is not related to the severity of injury. Most
headaches following brain injury do not require surgical treatment. In some
cases, particularly severe brain injury, surgical intervention may be required
for conditions such as communicating  Hydrocephalus,
carotid
cavernous fistulas tension, pneumocephalus, brain abscesses and
subdural haematomas. Appropriate clinical examination and diagnostic tests are
needed to assess the form of treatment required.
Causes of Headaches
The brain itself is not a source of pain –
ironically, nerves themselves don’t feel anything. Headaches arise from
problems with a number of different structures both inside and outside the
head. Those inside the head can be the dura, the venous sinuses, blood vessels
and cranial nerves. Those outside the head can be the skin, muscles, nerves,
arteries, and joint capsules, cavities within the head, nerves and the
periosteum.
Should you be concerned?
When a headache first appears, how do you
know whether it is something to be concerned about, or simply something which
will go away with an over-the-counter pain killer, a glass of water and a lie
down?
If you have a brain injury you should be
concerned by novelty – any new or changed symptoms may be just part of life,
but they may instead signal a worsening or even improving of your situation.
See your doctor if you have any symptoms that are unusual, that unexpectedly
increase in severity or that have a serious negative effect upon quality of
life.
In addition to headaches that are caused by
a brain injury, you may be having a reaction to medication, you may have an
undiagnosed condition from the same event that resulted in the brain injury
(for example whiplash from a car crash) or you may even have a completely unrelated
medical condition.
The unfortunate truth is that some nerve
damage, particularly in the neck or back, can result in incurable pain
which must be treated with full-time medication. However there is nothing to be
gained by putting up with pain until you can't do it any longer or by taking
increasing amounts of over-the-counter medications until they are no longer
effective.
What your doctor should be
asking.
A post traumatic headache is only a Symptom
of an underlying disorder. Often a doctor may make this diagnosis and no
further investigation is made of the problems causing the pain. The headache
may be treated as neurovascular or Migraine headache when the great majority
are not primarily migraine type problems. There are different types of injuries
that may create the pain generators of headache. Ideally your doctor should ask
you questions about the injury.
Major types of headaches
The major types of headaches following
trauma include musculoskeletal headache, tension-type headache and neuralgic (i.e.
migraine) headache. Other rare causes of headache including Seizure disorders, pneumocephalus
(air in the head), cluster and paroxysmal hemicrania (severe and typically
one-sided).
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Musculoskeletal headache is the most
common type and also the most overlooked. There can be musculoskeletal pain
from the neck and structures in the head — a very common cause of this is whip
lash injuries. These headaches often worsen with stooping, bending or exertion
and may be associated with dizziness, sensitivity to light, sensitivity to
sound and even imbalance. Manipulative therapy can be effective to assist in
resetting bony structures. Other treatment may focus on strengthening weak
spinal musculature, improvement of posture, anti-inflammatory medications and
muscle relaxants, or the use of splints.
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Cervical Sympathetic Nerve Syndrome. Unfortunately,
there is one instance in which a headache resulting from whiplash cannot be
cured, and that is when the cervical spinal column – the length of spinal
column in the neck itself – is damaged. Symptoms can include, apart from a
headache, uncontrollable spasms over the body, painful pins and needles all
over the body, vertigo, facial pain, sinus congestion, fatigue, and more. This
condition has also been known as Barre-Lieou Syndrome, after the doctors who
independently discovered it. Although it is possible to treat this condition if
there is pressure upon the nerves but no actual damage, it is vital that
treatment be within 72 hours of the injury or permanent damage becomes almost
inevitable.
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Tension headaches are reported by most
people to feel like a diffuse vice-like pressure throughout the head. An attack
can last from 30 minutes to a week. Tension type headache may be chronic or
episodic depending on frequency. There appear to be two types - one with
migraine features fairly responsive to anti-migraine medications, the other
without such features.
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Neuralgic Pain Syndrome tends to occur
when large nerves in the scalp are injured following trauma. This type of pain
tends to be a shooting, stabbing type in the front and side of the head,
sometimes with pain around or behind the eye.
- Migraine headache can last from four
hours to three days. They have perhaps the clearest diagnosis of any of the
categories of headache, using the acronym POUNDing: Pulsating headache for
between 4 and 72 hOurs, Unilateral (one-sided), Nauseating and Disabling. Treatment
should include reduction of triggers such as stress, foods that may elicit an
allergic reaction, sleep inconsistency and other allergies. Hormonal fluxes can
also cause migraines, and hormone replacement therapy has been effective at
controlling migraines in many cases. The most effective control is often,
however, awareness – people who are susceptible to migraines often have an
“aura” that signals the approach of a migraine, and may be able to prevent it
by immediately stopping stressful activities and/or taking pain-killers.
Appropriate medication could include tryptamines,
ergotamine or corticosteroids. Relaxation training and biofeedback also should
be considered. Newer techniques including the use of botulinum toxin injection
into pericranial musculature should also be looked at.
There are many other types of headaches
which can be diagnosed with tests such as MRI scanning of the brain, X-rays and
magnetic resonance angiography.
Are headaches dangerous as
well as unpleasant?
A headache can interfere with your
judgement, cause fatigue and contribute to irritability or aggression as well
as impair your ability to work, socialize or even simply keep your life in
order. But is a headache directly dangerous?
Unfortunately, it seems that it is possible
for a migraine to itself cause a brain injury. Studies have previously shown
that migraine sufferers are at an increased risk of stroke and heart attacks
and a recent study has found that during a migraine, as well as during stroke
and head trauma, the brain can swell enough to restrict blood flow and starve
cells of oxygen, a process known as Cortical Spreading Depression (CSD).
Medication
Pain management in brain injury is often
difficult as medications may work against recovery. Many painkillers work
against the re-emergence of the person’s mental and physical systems. Later,
narcotics are a problem because of their potential for substance abuse and
their negative side effect on the ability to think clearly.
Anti-inflammatory agents are appropriate
for musculoskeletal pain, though doctors must stay alert for possible gastric
problems. Patients with brain injury and spinal cord injury tend to have high
acid content in the stomach and are susceptible to stomach ulcers which can be
increased by these agents.
Antidepressants can be effective in
controlling headache and nerve pain. These are not sedating except in high
doses, and don’t depress the respiratory cycle.
Coping with Limitations
Lack of awareness, reduced attention and
short-term memory and distrust can make it hard to help a person with a brain
injury in coping with pain. First, the individual must understand the source of
the pain. The pain should be explained in a manner that compensates for any
Cognitive deficits. Explanations should be provided in brief, concrete
sentences. An understanding is needed of the benefits of treatment and how the
treatment plan will help achieve these benefits.
Where to Get Help
There are support groups and medical
facilities set up to help people cope with chronic pain. Contact your local
doctor or Brain Injury Association to get the contact details in your state.
For more information on coping with chronic pain, see the Handling pain and brain injury fact sheet at www.braininjury.org.au
Further information
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Headaches and brain injury 
