Headaches are a common symptom following a concussion. Pain is real. It is a complex personal experience influenced by emotions, attitude and perception.
What can you do for your headaches?
- Determine what is causing your headaches
- Be prepared to participate actively in managing your headaches
- Become knowledgeable about your condition
- Be open to a variety of treatment options in addition to medications
- Follow the recommended treatment plan
- Recognize that psychological factors, such as stress, along with physiological factors play a role in persistent headache
Types of Headaches
There are other variations on the types of headaches that can develop, but after a concussion, you may have one (or more) of the following.
Local pain in the back of the head/neck/shoulder
Characteristics: This type of head pain is described as pain that starts at the base of the head / neck area. The pain is more often dull and steady rather than sharp or throbbing. It commonly gets worse as the day goes on and it may spread over the top of the head to the front part of the head.
Cause: This type of headache pain usually originates from the irritation of a muscle in the cervical region (neck) and its surrounding tissue but it may also result from irritation of the bony structure. Cervical symptoms are complicated by injury to multiple structures within the neck such as discs, muscles and ligaments. Compressed discs may press on nerves in the neck. Pressing on the nerve can make parts of the body numb or decrease strength in parts of the body.
Migraine - like headaches
Characteristics: Following a concussion, you can develop a headache that resembles a migraine headache. Pain tends to be in the front of the head area of your forehead or temple. It is commonly described as a ‘pounding’ or ‘throbbing’ pain. It is sometimes associated with nausea and sensitivity to light and noise.
Cause: Migraines are sometimes called vascular headaches because they are associated with a constriction (narrowing) and dilation (expansion) of blood vessels at the temple. However this is not the whole story. Migraines may be triggered by a number of factors. Emotional stress or intense concentration tends to bring on or make these headaches worse. The symptoms rather than the triggers should identify this type of headache.
Tension type headache
Characteristics: In this type of headache, a dull pain spreads across a larger area of the head and is typically felt on both sides. Many people describe it as a feeling like a tight band around the skull or like a cap on top of the head.
Cause: Chronic muscle tension may occur from a variety of causes such as poor posture, muscle strain or stress.
If you have one or more of these headaches, the best treatment and strategies will depend on:
- Description / history of the headaches
- Personal and family headache history
- Physical examination
- The most common way people deal with a headache is to go to sleep or lie down. Try to lie down early before the headache gets bad. When you lie down, find a dark and/or quiet place.
- It is very important to get a good night’s sleep in order to prevent headaches from developing or escalating; refer to the handout on sleep hygiene for some strategies on managing your sleep.
- While sleeping it is important to support your neck and position your arms to reduce the muscle tension that may contribute to pain or headaches. Also ensure that you do not have your head under the covers, as recycled air has less oxygen in it.
- After an accident, your doctor may send you to a physiotherapist. It is important to find a physiotherapist who is familiar with this problem. The first time a physio works on your neck, the pain may get much worse. Tell your physio that you hurt. It is expected that it may worsen before it gets better. Make sure you complete exercises/stretches that are prescribed to you.
- Sometimes headaches require medication. There are two medication approaches: a) controlling pain that already exists and b) preventing headaches from starting. It is also good to be aware of any side effects of pain medication. Make sure you do your research and speak with your doctor re: any concerns you may have.
- Sometimes certain types of light can cause headaches. Wear dark sunglasses, in general the cheaper and darker the sunglasses, the better.
- If you find that noise triggers headaches, limit your exposure to noise by turning the volume down, or going to a quiet place. Wearing earplugs can help, but constant use of these is not recommended as it can promote noise sensitivity.
- Make sure you drink plenty of water, avoid or limit caffeine intake and eat healthy meals.
- Regardless of what is causing your headaches, emotional distress increases muscle tension. Those with head or neck trauma already tend to have tension in their head, neck shoulders or upper back. Pain can also become a stressor in itself which in turn increases emotional stress. Hence a cycle can occur between pain and emotional distress.
- It is important to manage stress and deal with it in healthy ways during recovery. See the Stress Management section for more information on this.