From the Guidelines
The recommended treatment for post-traumatic headaches two weeks after hitting your head on cement typically includes over-the-counter pain relievers such as acetaminophen (Tylenol) at 500-1000mg every 6 hours (not exceeding 4000mg daily) or ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours with food. Rest, stress reduction, and avoiding triggers like bright lights, loud noises, and screens can help manage symptoms. Apply cold packs to the injury site for 15-20 minutes several times daily to reduce inflammation. Stay hydrated and maintain regular sleep patterns. If headaches are severe, persistent, or accompanied by concerning symptoms like vomiting, vision changes, confusion, or worsening pain, seek immediate medical attention as these could indicate a more serious condition like a concussion or intracranial bleeding. A healthcare provider might prescribe stronger medications like triptans for migraine-like symptoms or recommend physical therapy for neck-related pain. Post-traumatic headaches typically resolve within 3-6 months, but proper medical evaluation is essential to rule out complications and develop an appropriate treatment plan 1.
Some key considerations for treatment include:
- Using the appropriate dosage of over-the-counter pain relievers and not exceeding the recommended maximum daily dose 1
- Considering the addition of a triptan to an NSAID or acetaminophen if patients do not achieve sufficient pain relief 1
- Avoiding the use of opioids or butalbital for the treatment of acute episodic migraine 1
- Counseling patients on lifestyle modifications, such as staying well hydrated, maintaining regular meals, and managing stress 1
- Being aware of medication overuse headache, which is a potential complication of migraine treatment 1
It's essential to prioritize medical evaluation to rule out complications and develop an appropriate treatment plan, as post-traumatic headaches can have varying causes and severity levels 1.
From the Research
Treatment for Post-Traumatic Headaches
- The recommended treatment for post-traumatic headaches after hitting your head on cement two weeks ago is not clearly established, as current evidence does not support a specific treatment 2.
- However, amitriptyline has been studied as a potential treatment for headache after traumatic brain injury, with some studies suggesting its efficacy in reducing headache frequency and severity 2, 3.
- A study published in 2020 found that amitriptyline did not show a significant benefit in reducing headache frequency, but the sample had significantly lower headache severity compared to a prior study 2.
- Another study published in 2011 found that amitriptyline was superior to placebo in migraine prophylaxis at 8 weeks, but the benefit was not sustained at subsequent time points due to a robust placebo response 3.
- A retrospective cohort study published in 2016 found that low doses of amitriptyline were effective and well-tolerated in treating chronic headache disorders, with approximately 3/4 of patients experiencing improvement 4.
Diagnostic Considerations
- It is essential to evaluate the findings of computed tomography (CT) and Magnetic Resonance Imaging (MRI) among patients presented with the chief complaint of headache to determine those that require neuroimaging due to a likely secondary cause 5.
- Red flags and Clinical warning criterion (CWC) can act as a screening tool to help identify patients who may benefit from neuroimaging 5.
- A study published in 2016 found that CT/MRI in patients without red flag or CWC signs yields a very low percentage of clinically significant positive findings in neuroimaging, suggesting limited value in terms of cost-effectiveness 5.
Alternative Treatments
- Mirtazapine has been compared to amitriptyline in the treatment of chronic tension-type headache, with both drugs showing similar efficacy but mirtazapine having fewer side effects 6.
- A study published in 2003 found that mirtazapine was as efficient as amitriptyline in the treatment of chronic tension-type headache, but with significantly fewer side effects 6.