The persistent impact of traumatic brain injuries

Despite how common and severe concussion is, this form of traumatic brain injury is widely misunderstood. These misconceptions prevent people from seeking appropriate care immediately after a head injury and from learning about post-traumatic headache, one of the most common and persistent effects of concussion. Here’s what you need to know about concussion and migraine.

Concussion’s Relation to Migraine and Post-Traumatic Headache

According to Dr. Bert Vargas, Director of the Sports Neurology and Concussion Program at UT Southwestern Medical Center, 95% of people with concussion will experience headache associated with that concussion. “Among those with headache, about two-thirds are going to have migraine features,” he said. Fortunately, that doesn’t mean that everyone will experience post-traumatic headache, a headache that develops within seven days of an injury or after regaining consciousness.

One of the biggest misconceptions about concussion is that you have to lose consciousness. That is simply not the case, says Dr. Amaal Starling, Assistant Professor of Neurology at the Mayo Clinic in Phoenix. In fact, she says, “less than 10% of individuals who have had a concussion actually lose consciousness.” Another common misconception is that you have to experience a direct blow to the head. “Any type of injury that causes the head to move forwards of backwards quickly can result in a whiplash injury to the head,” she says. Understanding these two common misconceptions of concussion is the first step to prevent post-traumatic headache. If you are injured, it is important to consult a health care provider immediately who can treat you and help prevent the onset of post-traumatic headache.

Some individuals have a higher risk of developing post-traumatic headache—in particular, those with a family history of migraine. Additionally, “A preexisting history of headache disorder—specifically migraine—may predispose an individual to develop post-traumatic headache after having an injury to the head,” Dr. Starling says. Research also suggests that the “female gender might actually play a role in the development of post-traumatic headache, and it may actually be a risk factor,” she adds.

Symptoms of Post-Traumatic Headache

While there are several subtle differences between migraine and post-traumatic headache, a large percentage of people with post-traumatic headache report experiencing symptoms similar to migraine—including headache, nausea, dizziness, insomnia, poor concentration, memory problems, and sensitivity to light and sound.

Dr. Lawrence Newman, Director of NYU Langone Health’s Headache Division, says that headache symptoms can last even years after the accident. “Thankfully, there are many opportunities for health care providers to prevent headache progression,” he said. “Identifying concussion early on and seeking professional help is essential.”

Preventing and Diagnosing Post-Traumatic Headache

Every concussion is different, so it’s vital to speak to a health care professional immediately after injury to determine an individualized treatment plan. Early treatment by a professional can reduce risk of further complications and help prevent persistent headache and other symptoms.

In the case of severe symptoms or complicated medical histories, it is recommended to consult a headache specialist. Dr. Vargas shared, “Headache specialists are expert at asking high-yield questions and identifying factors or underlying contributors to post-traumatic headache that maybe aren’t so obvious.” A headache specialist will also be able to suggest appropriate treatment options and unmask secondary causes for headache that might be separate from migraine.

Treatment for Post-Traumatic Headache

Health care providers currently treat post-traumatic headache like the headache it most resembles (commonly migraine or tension-type). This is because there are no treatments specifically designed and approved for post-traumatic headache. Dr. Vargas shared that case reports and his personal experience suggest that cognitive behavioral therapy and non-pharmacologic treatments work well for some patients as complements to other therapies, but hopes that research and concussion registries will expand understanding and treatment options for this unique population.

“Concussion awareness is key for health care providers and patients alike,” said Dr. Newman. “We can change the way concussion is treated and studied by exposing more neurology residents to concussion care, standardizing concussion response in hospitals and designating specialized concussion teams to evaluate and treat concussion.”

Recognizing a concussion and quickly seeking the appropriate treatment is important to alleviate symptoms and prevent potential long-term consequences, including prematurely returning to activity and the risk of re-injury. Use our Find a Doctor tool to find a health care professional near you.