Post-Traumatic Headache and Concussion: Q&A with Dr. Amaal Starling

Post-Traumatic Headache is a unique form of pain induced by an injury to the head, which can be mild to severe. Dr. Amaal Starling explains the link between injury-induced headache and concussions

Dr. Amaal Starling is a neurologist specializing in migraine, post-traumatic headache and medical education. She is an Assistant Professor of Neurology at the Mayo Clinic in Scottsdale, Ariz. Through her work, she hopes to clear up common misconceptions about concussion and post-traumatic headache and how the two interrelate. We sat down with Dr. Starling to talk about some of these misunderstandings, causes, and treatment.

What is Post-Traumatic Headache?

Post-Traumatic Headache is a new headache that starts after someone has had an injury to the head. The headache has to occur within seven days of someone having that traumatic injury. It can be mild to severe, infrequent to continuous, and it can become persistent. It commonly has migraine features like sensitivity to light and sound, nausea, or vomiting, but it may not have those features.

Who is most at risk for Post-Traumatic Headache?

Once someone has had an injury to the head, it is important to determine who is at highest risk of developing Post-Traumatic Headache. There are certain risk factors we’ve defined based on scientific evidence.

One is having a pre-existing history of a headache disorder, specifically having a pre-existing history of migraine. What’s even more interesting is that even if someone doesn’t have a prior history, but they have a family history of migraine, those individuals are still predisposed to developing Post-Traumatic Headache after having injury to the head.

Secondly, the female gender might actually play role in the development of Post-Traumatic Headache and may actually be a risk factor. Currently there are several hypothesis for this. It may be related to reduced neck muscle mass in women, or to hormones. It could be an estrogen-related phenomena. This is still an active area of research.

It is important to review potential risk factors with patients so they know whether they may be at a higher risk of developing a Post-Traumatic Headache after having an injury to the head.

Why are doctors obligated to treat Post-Traumatic Headache?

Number one, because it hurts. Our goal as healthcare providers is to relieve pain and suffering.

Number two, the majority of individuals who have Post-Traumatic Headache are also suffering from a concussion, which can manifest as a headache plus additional symptoms. So in the treatment and recovery process of a concussion, we recommend sub-threshold exercise, physical therapy and occupational therapy. If we do not treat the headache, it is difficult to participate in active rehabilitation.

Number three, if we as healthcare providers don’t provide direction for the treatment of Post-Traumatic Headache, patients are going to end up treating it themselves. Individuals are going to hurt, and they’re going to use over the counter medications and may end up using things like ibuprofen, naproxen, other medications that could include caffeine, on a very frequent and often daily basis to try to relieve their pain. Unfortunately, when you use those types of medications on a daily basis, it can actually result in more complications and headaches.

What is the one thing you wish everyone knew about Post-Traumatic Headache?

The main thing I wish everybody knew about Post-Traumatic Headache is that there are things that doctors can do to help. If you have an injury to the head, seek the help of a healthcare provider so you’re not stuck in a situation where you’re trying to treat yourself. That could result in a medication overuse headache, or the development of further complications.

In addition, if we can give you early treatment, it may prevent the development of more persistent headache and more persistent symptoms overall.

What are the main misconceptions people have about Post-Traumatic Headache and concussions?

It’s really important to talk about the myths and misconceptions that exist in both concussion and Post-Traumatic Headache.

With regards to concussion, one of the biggest myths that I feel is becoming part of my life mission, is to make sure that people understand that you do not have to lose consciousness to have a concussion. In fact, less than 10 percent of individuals who have had a concussion actually lose consciousness.

Myth number two is that you actually don’t have to hit your head to have a concussion. Any type of rapid acceleration or deceleration injury can result in a whiplash injury to the neck. That can result in the brain—which floats inside of spinal fluid—hitting the front and the back of the hard skull, resulting in a traumatic injury.

The other important misconception to try to demystify is that if you’ve seen one concussion, you’ve seen them all. Each individual is very different, so it’s unhelpful to compare symptoms to anyone else’s head injury. Patients need to be encouraged to seek the advice of a healthcare provider who can design an individualized treatment plan for both active rehabilitation and recovery for the concussion, as well as the active treatment for the posttraumatic headache.

You can see Dr. Starling’s publications here, or follow her on Twitter for more headache related advice at @AmaalStarling