Keywords: TBI, headaches
Focus Keyword: Headaches
The Doctor-Patient Headache Paradigm – What does it mean? Headache is one of the most common persisting symptoms after Traumatic Brain Injury (TBI) [1]. Headaches are prevalent over the first year post-TBI, with people with a previous history of headaches and females being more likely to experience them. However, headache incidence is not related to TBI severity [1].
When should patients worry about their headaches?
Most headaches are not dangerous, but patients must keep in mind that they should see a doctor if, in the first days after a brain injury, they experience:
- worsen headache
- nausea or vomiting
- weakness or speaking difficulties
- sleepiness [2].
What tests are needed in order to diagnose a headache, and what treatments are used for post-traumatic headaches?
A Computerized Tomography (CT) scan of the brain is carried out for most patients in the first few days after a brain injury to ensure that there is no bleeding in the brain. Usually, there is no need for further testing besides the initial CT scan.
The healthcare providers rely on the patient’s symptoms and history to diagnose the type of headache they are suffering from.
The treatment for the patient depends on the type of headache they are diagnosed with. They should always keep in touch with their doctor and report the results of the treatment, as well as possible side effects. A headache diary is recommended, as it can help monitor the symptoms [2].
What lifestyle changes can be made to prevent headaches?
Lifestyle changes represent a significant part of treatment because, in the beginning, doctors are reluctant to start directly with medication in order to relieve the pain. Usually, patients can improve their symptoms just by making a few upgrades in their lifestyle, as seen in Figure 1.
In addition, there are many different therapies that patients can benefit from if needed.
Other suggestions include wearing dark glasses in the case of bright light-triggered headaches, avoiding food or beverages that seem to trigger the onset of headaches, using relaxation techniques (e.g., listening to music, meditation, deep breathing), setting a sleep schedule, getting daily exercises, avoiding tobacco alcohol or caffeine [3].
What are the treatment options for different types of headaches?
The treatment prescribed for occasional headaches includes:
- stretching
- heat or ice packs
- self-massage
- over-the-counter pain medication like ibuprofen or acetaminophen
- headache medication that needs a doctor’s prescription (for example, sumatriptan for migraine) [2].
Recurrent headaches (appearing more than twice a week) usually require therapy, a prescription from a doctor, or a procedure. The following therapies could help:
- acupuncture
- therapeutic massage
- local injections to muscles, nerves, and joints of the cervical spine (steroids or numbing medication)
- physical therapy for the upper back or neck
- nerve stimulators such as Cefaly devices (transcutaneous electrical nerve stimulation devices)
- Cognitive Behavioural Therapy [2–4].
Medications that could help in decreasing the pain or prevent headaches after a TBI are presented in Figure 2 below:
Headaches after a TBI represent a challenge for healthcare providers worldwide as they affect the patients and their day-to-day living, making it difficult to manage activities or maintain a social life. Fortunately, nowadays, there is a multitude of treatments and therapies available used to prevent headaches from becoming a chronic problem. Therefore, patients should feel comfortable talking with their doctor or healthcare provider about choosing the best treatment strategy for them and their lifestyle. Integrating the biopsychosocial model (Figure 3) in the management of post-TBI headaches could be of significant importance. The integration of complex and multidisciplinary approaches, including exercise, physical rehabilitation, and psychosocial interventions, aims at increasing the overall quality of life for patients who suffered a TBI [5].
References
- Hoffman JM, Lucas S, Dikmen S, Braden CA et al. Natural history of headache after traumatic brain injury. J Neurotrauma. 2011; 28(9):1719-25. doi: 10.1089/neu.2011.1914.
- Headaches after Traumatic Brain Injury.https://msktc.org/tbi/factsheets/headaches-after-traumatic-brain-injury
- Managing Post-Traumatic Headaches After Brain Injury. Available at: https://www.brainline.org/article/managing-post-traumatic-headaches-after-brain-injury
- Silverberg ND. Behavioral treatment for post-traumatic headache after mild traumatic brain injury: Rationale and case series. NeuroRehabilitation. 2019;44(4):523-530. doi: 10.3233/NRE-192708.
- Register-Mihalik JK, DeFreese JD, Callahan CE, Carneiro K. Utilizing the Biopsychosocial Model in Concussion Treatment: Post-Traumatic Headache and beyond. Curr Pain Headache Rep. 2020;24(8):44. doi: 10.1007/s11916-020-00870-y.
