Post Traumatic Headaches - Life After the Car Accident

Many times after a car accident people will have initial neck pain, are seen in the emergency room and treated. If the injuries are not life threatening they are sent home with some medication and told to rest. Unfortunately, many will start to have headaches, even if they have never had headaches before. Those with a history of headaches will find their headaches are getting worse. Most of the time the headache will dissipate over a week or two and everything will be fine.

But what if the headaches don't go away? What happens and what do people do if the headache gets worse? Post traumatic headaches that get better in four to six weeks are considered acute headaches, but those that stay at the same pain level, start to get worse, or go beyond six weeks are more concerning. The headaches may be all over the head and moderate in pain with breakthrough stabbing, throbbing pain on one side. This more severe form of headache is associated with migraine symptoms and indeed is a migraine.

At this point most people will reach for the over the counter medications such as Excedrin or Tylenol. Failing that, they may try the medication the doctor in the emergency room gave them and most of the time these treatments are quite successful. However, there is a certain percentage of people who will not respond to this treatment and as a result will start taking more and more medication. The headaches will begin to get worse for two reasons.

First of all, the medication will start enhancing the headaches and cause a condition known as analgesic rebound headache syndrome. In this case, the headache pain goes up and the person grabs the Excedrin which brings the headache down a bit. But, as the medication wears off, the headache starts getting bad again. More medication, more bouncing up and down in pain levels. Eventually, the medication stops working but the person still keeps taking it in desperation because they don't know what else to do. They might got to their doctor and get stronger drugs, such as Lortab but this only makes the situation worse.

Secondly, the medication used at this point is all wrong. Post traumatic headaches respond best to low doses of tri-cyclic anti-depressants such as Elavil or Pamelor. Elavil is generally accepted as being the best medication, but most doctors make the mistake of using migraine doses (10-50mg). Unfortunately, post-traumatic headaches do not respond to this dose but most people do respond when the dose is slowly titrated up to 75-150 mg. Fortunately, this medication is also excellent for any associated neck pain and spasms!

The breakthrough migraines are treated just like that..like migraines. A small dose of an anti-seizure drug may also be necessary with triptans (Imitrex or Maxalt) for when the pain is bad.

Don't forget, like all other headache syndromes, lifestyle is very important. Regular sleep cycles, good diet and exercise as tolerated will all help the headaches get better. In this particular case, however, the vitamins and herbs used to successfully treat migraines do not have much of an effect on post traumatic headaches. None the less, many people do want to try them to help the migraine component.

The key to post traumatic headache syndrome is to find a headache specialist and be patient. If the headaches are severe, chances are that it will take several months for any one treatment to have an effect. Most people are not aware of this fact in headache treatment, so they tend to start and stop treatments after a few days or weeks and become discouraged. The longer the brain has the treatments on board, the greater the chance it will heal.

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How Your Dentist Can Fix Your Headaches

Anyone who has ever seen an Excedrin commercial knows about tension headaches. And it's true that tension causes most headaches. But where does the tension come from?

Stress is commonly blamed for tension headaches. The fact is that stress is a contributing factor but jaw posture is the main culprit. All the muscles that are tense are the same muscles that work your jaw. Throughout our lives, we don't have much choice about our jaw posture because the way our teeth fit together dictates our jaw posture. Even when your jaw is "resting," it "rests" near your habitual bite. But what if your bite is posturing your jaw in a position that puts constant tension on the muscles in your head and neck? That's where the tension headaches come from.

What can be done to get rid of the tension headaches--or at least make them less intense and less frequent? A number of specially trained "neuromuscular" dentists are trained to help patients find the most comfortable posture for the jaw, which relaxes the muscles in the head and neck. Special computer equipment is used to measure jaw muscle activity, just as a cardiologist measures heart activity with an EKG. Once this relaxed posture is established, headache tension melts away.

Improved jaw posture can be established with a properly made bite plate, called an orthotic. Sometimes a simple bite adjustment on a filling can improve the jaw posture--the jaw muscles can be as sensitive as The Princess and the Pea. If there is a significant difference between the habitual bite and the ideal bite, porcelain bonding or orthodontics can be used to permanently correct the jaw posture, giving lasting relief to a lifetime of headache problems.

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Headaches - Type of Headaches and Their Management

Headaches are one the most common afflictions in life, with up to 90% of people reporting having suffered from headaches at some point in their lives. Most headaches, other than being painful and bothersome, do not signify anything more serious. However, some type of headaches are signals of more serious conditions and require immediate medical attention.

A large community based study of headaches in Singapore (Ho KH, Ong BK. A community based study of headache diagnosis and prevalence in Singapore. Cephalalgia 2003 Feb;23(1):6-13) found that the overall lifetime prevalence of headaches in Singapore was 82.7%, and this did not vary between racial groups. The types of headaches were classified into: migraines (9.3%), episodic tension type headaches (39.9%), chronic tension type headaches (2.4%) and unclassified headaches(31.2%).

PATHOPHYSIOLOGY

Because the brain itself does not have any pain receptors, the pain in headache is actually from several structures in the head and neck region. These include the scalp and neck muscles, meninges (brain lining), extra-cranial arteries, large veins, cranial and spinal nerves. Pain from sinuses, eyes and temporomandibular joint can also radiate to the head to cause headaches.

TYPES OF HEADACHES

Causes of headaches may be classified as being Primary (where it is not caused by an underlying condition) or Secondary (where an underlying condition exists).
A. PRIMARY HEADACHES

Tension Type Headaches

Tension headaches are the most common types of headaches experienced. The pain is described as being a mild to moderate constricting, pressing or tight pain on both sides of the head. It is generally not made worse by routine physical activity, such as walking, and there is usually no significant associated nausea or vomiting.

Tension headaches are thought to be caused by muscle tension origination in the neck, shoulders, forehead and skull. These muscles tighten due to poor posture, stress, eye strain or fatigue, resulting in a headache.

Tension type headaches respond well to simple pain killers, such as paracetamol or NSAIDS (non-steriodal anti-inflammatory drugs). Caffeine has also been shown to help. Patients with chronic tension-type headaches may occasionally need to consider prophylactic treatment.

Migraine Headaches

Migraines usually begin more frequently in the young, and are characterized by severe, throbbing pain, typically on one side of the head. There is usually associated nausea and vomiting, and increased sensitivity of light and sound. The pain on migraine is generally made better by resting in a darkened room.

Acute migraine attacks may be treated with oral pain-killers and migraine-specific medication (ergotamine and triptans). If vomiting is significant, injections may be required for pain relief and nausea control. For patients who get frequent migraine attacks, there is a role for prophylactic treatment which your doctor may recommend.

Cluster Headaches

Cluster headaches are the least common type of primary headaches and occur almost exclusively in males. They are usually extremely painful and have a pattern of occurring in "clusters", usually at the same time of the day for several weeks. They are usually described as constant, deep and excruciating, always located on one side of the head. There may be associated symptoms such as a runny or blocked nose, nausea or droopy, red, teary eye.

Cluster headache sufferers often feel compelled to pace up and down the room or rock in a chair. This is unlike the migraine sufferer who usually wants to curl up in bed and be still.

B. SECONDARY HEADACHES

Secondary headaches are the symptom of an underlying condition and it is thus important for them to be recognized and not dismissed. Conditions which may cause secondary headaches include infections of the brain and meninges (lining of the brain), strokes, tumours, bleeding in the brain from some form of trauma, sleep apnoea, very high blood pressure, acute glaucoma and rhino-sinusitis.

DIAGNOSIS

Your doctor will make an assessment of your headache by conducting a clinical interview, followed by a thorough neurological examination. If there are symptoms or physical signs suggestive of a more serious secondary cause, your doctor may recommend a referral to the Emergency Department or imaging investigations in an outpatient setting.

SIMPLE MEASURES FOR HEADACHES

Most primary headaches respond to simple measures.

Pain-killers: Pain killers such as paracetamol and NSAIDS (non-steriodal anti-inflammatory drugs) are often sufficient to control most headaches. For migraine and cluster headaches, specific medication such as ergotamine and triptans may be used.

Sleep: Having insufficient good quality sleep can contribute to headaches. Make sure that you get a good nights rest to enjoy more headache-free days.

Cold Therapy: An ice pack or cold pack placed over the painful area during an acute headache attack, can temporarily provide some relief by numbing the soreness and reducing tension.

Adequate Rest and Reduction of Anxiety: Tension and migraine type headaches are often precipitated by stress. Stress management methods, exercise, meditation etc, can all help reduce and possibly prevent such headaches.

Healthy Eye Care: Eye strain from prolonged reading or computer work can trigger headaches. Ensure that you have properly prescribed glasses to correct for any vision problems, as short or long sightedness can aggravate eye strain.

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