Headaches after Concussion

Part I & II

Headaches are one of the most common symptoms after concussion in both children and adults. Fortunately, the symptoms of a single simple concussion resolve in a week or less for most kids, but a few children and teenagers will have headaches and other symptoms related to concussion for weeks or even months after their injury.

Definitions

Concussion is a traumatic brain injury that changes the way the brain functions. Concussions can occur as a result of a direct hit to the head (by the ground or an object), or from violent shaking of the head and neck (like “whiplash” injury). Immediately after a head injury, a child can have symptoms that include headache, confusion, memory loss/amnesia for the time around the injury, foggy thinking, dizziness, double vision, slurred speech, problems with coordination, or loss of consciousness.

Sometimes kids may not realize they’ve had a concussion, so it is important for parents, coaches, and team members to watch for these signs after a fall or hit to the head. Any person suspected of having a concussion during a sporting event (episode with trauma to the head and/or neck from the ground, another player or an object) should stop playing and be evaluated by a trained professional. Anyone who has had a concussion (any symptoms of concussion listed below after a head injury) should not return to play that day no matter what. (For more information and materials see the CDC “Heads Up” website: www.cdc.gov/concussion/HeadsUp/youth.html)

Concussion symptoms

After a concussion, it is important for a child to be evaluated by a trained medical provider to make sure there are no signs of a dangerous problem like bleeding in the brain or brain swelling. However, these problems are very, very rare following a single simple concussion. 

If a child has prolonged confusion or loss of consciousness, continued vomiting or new symptoms of weakness or change in speech, or worsening of symptoms with time after a concussion they need to be evaluated emergently by a medical professional.

After critical and emergent problems have been ruled out (brain scans are NOT usually needed to do this), then headache and other symptoms that relate to the concussion can be addressed by the doctor, patient and family. Symptoms after concussion can include:

  • Headaches
  • Balance Problems
  • Dizziness
  • Sleep Problems, sleeping too much or too little
  • Mood changes, irritability
  • Nausea
  • Sensitivity to light and/or noise
  • Foggy thinking
  • Confusion
  • Fatigue
  • Problems with concentration or focus

If the child continues to have these symptoms for more than a week after the concussion, or if symptoms get worse with time instead of better, you should contact your medical provider again to make a plan for further evaluation and management.

Heidi Blume, MD, MPH, Assistant Professor, Division of Pediatric Neurology, Seattle Children’s Hospital and Research Institute, Seattle, WA.

How to Help Headaches After Concussion

One of the most important things to do after a concussion is to learn what to expect. This is important so that the child and family are not surprised by typical symptoms, and so they understand that most symptoms will get better within a week or two for most children. It is also very important to avoid getting another concussion because a second concussion can make symptoms much worse, especially if it happens soon after the first concussion.

Any child with a concussion needs to be treated together with a medical provider to provide the best care for the child. Immediately following concussion, the child should “rest.” This means no significant exercise, no texting, no driving, no video games, and limited school work, for at least a few days until symptoms improve.

In the first few weeks following concussion, activities that worsen headaches or other post-concussion symptoms should be limited. Once headaches and other symptoms are gone, children may gradually increase their activity using a step-wise plan recommended by their doctor/care provider. However, if headaches or other symptoms return with activity, then the child should return to the prior, lower level of activity.

Families should discuss medications with their provider. Acetaminophen (Tylenol) can be helpful to treat severe headaches, and once it is clear that there is no bleeding, ibuprofen or naproxen can also be used to help to reduce headache pain. Resting in a cool, dark, quiet place can lessen headaches and some people find that putting cold packs on the area that hurts can also help.

To manage these headaches it is also very important to:

  • Drink plenty of water
  • Get regular sleep
  • Eat regular meals
  • Decrease or manage stress
  • Avoid repeat head injury

Care providers may discuss using a “triptan” migraine medication like sumatriptan to treat a severe migraine-type headache that doesn’t respond to ibuprofen, or acetaminophen for teenagers with a history of migraine headaches, or migraine type post-concussion headaches.

If the child with concussion is involved in sports, once the concussion symptoms are gone at rest, he/she needs to follow a gradual step-wise approach to returning to athletic activity, as outlined by a provider trained in concussion management.

Chronic headaches after concussion

While most children recover completely within a short time after the concussion, some children have headaches and other post-concussive symptoms for a long time after the injury. When children have chronic headaches after concussion, it is especially important to work with their medical care provider, concussion specialist and/or neurologist to develop a plan to help return them to health as soon as possible.

This treatment plan should include regular meals, good hydration, stress management, and regular sleep. It may also include:

  • Medications to treat “spikes” in headache such as acetaminophen, ibuprofen, naproxen or triptans.
  • Daily supplements such as magnesium, omega-3 fatty acids, or riboflavin used to decrease headache frequency and severity.
  • Daily prescription preventive headache medications to decrease headache frequency and severity.
  • Complementary therapies such as physical therapy, massage, biofeedback therapy, or acupuncture.

ce a child or teen has headaches lasting longer than a few weeks after concussion, with guidance from a medical provider, it may be reasonable to consider beginning low-impact aerobic exercise (“sub-threshold” exercise, such as walking, slow swimming, slow stationary biking) that does not make headache or other symptoms worse, There is a concern that long periods of complete rest may eventually worsen rather than help symptoms (note this is NOT “return to play”).

Fortunately, even if post-concussion headaches don’t get better in the first few weeks after concussion, most are better within 3 months and almost all are better within a year after injury.

If a child has had multiple concussions, it is important to discuss the risks of future concussions with their care provider, and weigh the benefits of continuing a particular sport vs. the risks of future concussion(s). Children with past concussions are more likely to have one in the future, and the recovery time may be even longer after each subsequent concussion.

Heidi Blume, MD, MPH, Assistant Professor, Division of Pediatric Neurology, Seattle Children’s Hospital and Research Institute, Seattle, WA.