Concussion, Migraine and Post-Traumatic Headache

Bert Vargas, MD, discusses the similarities between migraine and post-traumatic headache

One of the most debilitating symptoms a person can experience following a concussion is post-traumatic headache, says Bert Vargas, MD, an associate professor of neurology and the director of the Sports Neurology and Concussion Program at UT Southwestern Medical Center in Dallas.

Post-traumatic headache occurs within seven days of concussion or regaining consciousness after concussion. Although the headache can present in many ways, it often resembles migraine in both its symptoms and duration.

“This is relevant for headache providers because the majority of those post-traumatic headaches are going to be very migraine-like in their appearance,” Dr. Vargas says. “And in many cases, they can become very chronic. A large proportion of patients who have concussion with headache will still have headache at one month, three months, six months and then further on down the line.”

In fact, one study followed people with traumatic brain injury for five years after a concussion, and discovered that 35 percent were still experiencing post-traumatic headache, Dr. Vargas says.

Similar Presentation to Migraine

Following concussion, 95 percent of people are likely to experience headache, and among those with headache, roughly two-thirds will have migraine-like symptoms, Dr. Vargas says.

Symptoms of post-traumatic headache can include sensitivity to light and noise, nausea, dizziness, vomiting, insomnia, poor concentration, fatigue and personality changes like depression or nervousness. The headache might also have a pulsating quality that worsens with activity.

“When you look at a symptom severity checklist for concussion, it reads very much like criteria for migraine,” Dr. Vargas says. “You see headache, you see light sensitivity, you see sound sensitivity, you see nausea, you see vomiting.”

Treatment of Post-Traumatic Headache

Treating post-traumatic headache can be difficult, Dr. Vargas says, because there are currently no specific, evidence-based medications for it. “At this particular moment in time, we’re really left with the medications that we use for the headache it most closely resembles,” Dr. Vargas says.

Unfortunately, he says experts are still unsure whether this is the correct approach. “It’s unclear whether or not post-traumatic headache is really representative of migraine,” he says. “Is it the same pathophysiology? Does it have the same therapeutic targets? We don’t actually know that yet.”

In addition, Dr. Vargas says it’s also unclear whether cognitive behavioral therapy (CBT) and other non-pharmacological treatments can help patients with post-traumatic headache. Some case reports have indicated that CBT can help, but more research is needed to determine its efficacy.

“We haven’t really put post-traumatic headache up to the same degree of rigorous study that we have with migraine,” Dr. Vargas says. “I suspect that if we did study it, we would find that cognitive behavioral therapy is a very important piece of the puzzle in treatment for post-traumatic headache.”

Dr. Vargas believes that once post-traumatic headache is properly studied, better treatment options will become available.

What Health Care Providers Should Know

The most important thing health care providers can do when determining if a patient has post-traumatic headache is ask the right questions. Ask patients about the characteristics of their headache: Do they have nausea, vomiting, light sensitivity or sound sensitivity? In addition, be on the lookout for red flags that might indicate someone isn’t experiencing migraine or post-traumatic headache, but another form of headache. One red flag, Dr. Vargas says, could be a positional quality to the headache, which could indicate a low-pressure headache due to a cerebrospinal fluid (CSF) leak that can occur in the setting of head trauma. “Once you feel like you have a pretty firm grip on what type of headache you’re dealing with, then follow the treatment algorithms that we currently accept for those subsets of headache,” Dr. Vargas says.

Bert Vargas, MD, FAHS, is a member of the American Headache Society, a professional society for doctors and other health care workers who specialize in studying and treating headache and migraine. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders, and to share and advance the work of its members. Learn more about the American Headache Society’s work and find out how you canbecome a member today.