Ohio Clinic Improving The Treatment of Concussion and Post-Traumatic Headache

“A tight band around my head.” “Piercing pain behind my eyes.” “Pulsating pressure like my head might explode.”

Do any of these sound like you? These are comments we hear every day from patients with post-traumatic headaches (headaches resulting from concussion, motor vehicle accidents, or other forms of head impact trauma). Many patients report their post-traumatic headaches “just feel different” from a normal headache. This is because the cause and presentation of post-traumatic headaches are noticeably different from other headaches. 

At The BRAIN Center, we treat post-traumatic headaches every day, and our patients have many of the same questions you may be asking. Routinely, our patients have already seen more than 10 other physicians prior to visiting our clinic without notable improvement. 

If you’re experiencing these post-concussion symptoms six weeks after injury, it is highly unlikely the headaches will resolve without treatment.

Brain-Based Neuroplasticity Therapy

With post-traumatic headaches, it’s important to address the source of the issues, not just the symptoms. We provide our patients with therapy designed to promote neuroplasticity (the brain’s ability to change and to heal itself and the body) in the affected regions of the brain. At The BRAIN Center, patients are put through intensive therapy designed to kick-start neuroplasticity. 

At our concussion treatment center, we work with patients whose symptoms didn’t go away with rest and time. Neuroplasticity is at the center of their recovery journeys. The brain’s ability to heal with physical and cognitive therapy brings hope to our patients and to anyone else who has sustained a brain injury. Even those without injury or trauma can find improved quality of life through neuroplasticity. 

Cervicogenic and Autonomic Nervous System (ANS) Headaches

Cervicogenic and Autonomic Nervous System (ANS) headaches are some of the most distinctly reported headaches after a head injury. While they can sometimes be separate in cause (aka, someone with isolated issues in their cervical spine may experience headaches as a result), they can cause similar headache “types” after concussion or brain injury. Many of our patients experience both.

Cervicogenic headaches are often associated with neck tension, neck pain, and a pulling feeling along the neck. They are related to the cervical spine (the neck bones and discs) and the musculature in the neck and shoulders. These can commonly be related to whiplash-associated injuries, but may also be subsequent to ANS dysfunction.

How are the cervical spine and ANS related with regard to headaches? We will explain, starting with ANS headaches. 

Headaches related to autonomic nervous system dysfunction caused by a mild traumatic brain injury (mTBI) are complex due to the control the ANS has over our entire bodies (heart rate, breathing, blood pressure, temperature, the list goes on…). ANS headaches, as we will call them, are caused by vascular (i.e., blood vessel) or cerebral blood flow (i.e., occurring in your head) problems and can often be associated with feelings of pressure, as though there were a clamp or a band on your head. Cervicogenic and ANS headaches are closely connected, and many patients have both, so we assess and treat each patient’s headaches on a case-by-case basis. 

What is the Autonomic Nervous System (ANS) 

The autonomic nervous system controls heart rate, respiration rate, vascular constriction and dilation, and many of the other bodily functions we don’t think about that keep us alive. After a concussion, the autonomic nervous system may become dysregulated, leading to a variety of common symptoms.

It is a bodily nervous system that conducts “automatic” body processes. It has two parts, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). These regulate your “fight or flight” and “rest and digest” processes, respectively. Normally, these two are balanced like a set of scales so that we can respond to our environment appropriately. After head injury, however, the fight or flight system (SNS) may tend to dominate.

For example, you may initially be startled when you hear a loud sound, but you recover and rebalance when you realize it was a dish dropped on the floor. When the autonomous nervous system is dysregulated due to a concussion, the SNS can more easily dominate the PNS and prevent your body from returning to a ‘normal’ resting state as quickly as it should. In other words, the sound of a dish falling may cause your “fight or flight” reaction to linger.

Why does this matter? It has lasting effects on your stress levels, your blood pressure, and other functions regulated by the ANS — including post-traumatic headaches.

How does this specifically come into play for post-traumatic headaches? There can be many physiological sources. Autonomic nervous system dysregulation leads to increased muscle tone and tension in the neck (along with many other places, but for headaches, we will focus on the neck). In addition, concussions can lead to disruption in the regulation of the head’s blood flow as a result of your ANS being out of balance. As a result, patients experience tension and pressure in the head.

Autonomous nervous system headaches can present in a few different ways. They often are described as starting in the back of the neck and spreading up around the back of the head to the temples like a crown. This sensation is caused by the gradual blood flow buildup and the muscle tension from neck muscles. 

Jaw tension-type headaches can also be related to autonomic nervous system dysregulation. It often begins around the back of the jaw and can move across the face and over the top of the head. You, your family, or even friends may note increased jaw musculature or teeth grinding associated with jaw-related head pain. 

ANS headaches can also feel like sinus pressure headaches, with pressure or pain present around the nose and near the bridge of your nose and cheekbones (where the sinuses are located), then spreading through the head. Unlike allergy sinus headaches, the pain is almost constant; it does not change based on the time of day or exposure to allergens. Congestion may or may not be present.

In some less common occasions, they can also be accompanied by soft spots bump(s) on the head due to excess fluid pooling in a single location — also called “edema.”

Finally, post-traumatic headaches are usually not the sole cause for the “headache” experience. Vision issues, genetic and environmental risk factors, and a multitude of other variables can make every person’s experience very different. After a concussion, people may have one, several, or all of these factors influencing their headaches.

Often, people will describe a “moving headache” which incorporates many of the described locations and profiles a headaches here. However, this doesn’t mean your headache is untreatable! It just means that treatment will need to approach every aspect of the causal factors of your specific headache profile. 

Migraine Headaches

Another commonly reported type of post-traumatic headache is a “migrainous” headache. These typically present as an extreme, stabbing pain on one side of the head (or the other), generally near the top of the head. However, the term “migraine” can be thrown around and used to describe the feeling of any extreme headache. Just know that migrainous, severe, unilateral (i.e., on one side) headaches caused by a concussion often occur in individuals who have a predisposition to or family history of migraines. That said, they can also occur in individuals who do not have any history of migraines.

If you’ve ever experienced an “aura” before your headache, it’s probably migrainous. About 30% of people who suffer from migraine experience an aura (a sensory change or disturbance) right before the migraine manifests.

For example, an aura could show up as black or white spots in your vision, a strange smell, or tingling hands. An aura can be a good warning for some people to take their migraine pills or move to a safe area. These sensory disturbances may make a person extremely sensitive to light, touch, or smell.

Although the exact cause of migraines is unknown, the neurovascular components of a migraine and a concussion are quite similar. For this reason, it is understandable that the physiological effects of a concussion can increase the frequency or intensity of migraines, especially for someone who is already predisposed to them.

In addition, the similarities between migraine and ANS headaches makes it VERY difficult to discern what a patient has. In some cases, it takes years of testing and experimentation with medication to determine what a patient has. And it is very possible a patient has both chronic migraines and ANS headaches.

But that doesn’t mean it’s not working with your doctor to determine if your headaches are migrainous or not. Family history of migraines, the effectiveness of migraine medication on your severe headaches, initiating factors, and aura will help your doctor understand what you might have. 

Concussion, Vision, and Headaches

In addition to ANS headaches and migraine headaches, patients can experience a few other types of post-traumatic headaches.

One main type is related to vision. These headaches are common if you experience vision problems after a concussion (things like light sensitivity, peripheral vision problems, difficulty focusing). The strain created by trying to overcompensate for any new vision issues leads to tough, pulsing headaches. These headaches generally involve the area around the eyes and your eyes may feel like they are inflamed or pained. Often, we’ve found vision therapy after concussion may make vision-associated symptoms worse — or simply not solve vision issues and vision-related headaches after brain injury.