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Ask the Expert: Headache Causing Disability Probably Not Tension

Q. I am under the care of my doctor for headaches. After reading about tension-type headaches, I feel like these are what I have been having. I have mild-to-moderate headaches for two weeks at a time. No over-the-counter (OTC) medicine helps. My doctor gave me a sample of migraine medications, but they didn’t help. I don’t know what to do from here or how to get treatment. Exactly what should I tell my doctor so that he can help me? Do you have any advice to help prevent the headaches? I work full time and I’m a wife and mother to two kids. I can’t continue having these headaches.

A. Unfortunately, headaches are a common symptom following head injury. The headaches may occur regardless of whether the head injury was mild or severe. Headaches that persist for greater than three months following the head injury are called chronic post-traumatic headaches. Although these headaches may occur in isolation, they are often part of the post-traumatic syndrome, which consists of headaches, personality changes and difficulty with concentration, nervousness and sleeping.

The diagnosis of post-traumatic headache is made by considering the timing with which the headache began in relation to the head injury. With severe head injury, diagnostic tests such as MRI of the brain may be abnormal. Often, however, diagnostic tests are normal, especially if the head injury was mild. Recent research has suggested that injury caused by mild traumatic brain injury cannot be seen by typical diagnostic tests in many cases. Tests used in research studies can sometimes detect changes in brain structure that are very small in size, as well as abnormalities in brain function.

The treatment of chronic post-traumatic headaches is often difficult. The best approach includes a combination of therapies involving medications, physical therapy, biobehavioral therapy and cognitive therapy.

Todd Schwedt, M.D.
Washington University Headache Center, St. Louis, MO

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