From the Guidelines
Post-concussive headaches can last anywhere from a few days to several months, with most adults recovering within 3 to 12 months of their injury. According to the most recent and highest quality study, up to 34% to 44% of patients with concussion or mild traumatic brain injury (mTBI) experience symptoms at 3 to 6 months after injury, and between 5% and 20% experience symptoms at 12 months after injury 1. The duration of post-concussive headaches can vary significantly, and it is essential to note that approximately 10-15% of individuals may experience post-concussion syndrome, where headaches and other symptoms continue beyond three months.
Key Factors Influencing Duration
- The severity of the concussion or mTBI
- The presence of other symptoms, such as dizziness, blurred vision, sleep disturbance, neck pain, and fatigue
- The effectiveness of nonpharmacological interventions, such as early information and advice, graded physical exercise, vestibular rehabilitation, and psychological treatment 1
- The individual's overall health and medical history
Management and Treatment
- For immediate relief, acetaminophen (Tylenol) at 500-1000mg every 6 hours as needed is recommended, not exceeding 4000mg daily
- NSAIDs like ibuprofen (Advil, Motrin) should be avoided in the first 24-48 hours after injury as they may increase bleeding risk
- Rest, adequate hydration, and avoiding screens, bright lights, and loud noises can help manage symptoms
- If headaches worsen, are accompanied by vomiting, slurred speech, or increased confusion, immediate medical attention is necessary
Importance of Early Intervention
Early intervention and treatment can significantly impact the duration and severity of post-concussive headaches. A systematic review and meta-analysis found that nonpharmacological interventions, such as graded physical exercise and psychological treatment, can be effective in reducing symptoms and improving quality of life in individuals with persistent postconcussion symptoms 1.
From the Research
Duration of Post-Concussive Headaches
- The duration of post-concussive headaches can vary, with some studies suggesting that headaches can persist for several months after the initial injury 2.
- A study published in 2018 found that one week after treatment, 5/19 patients reported experiencing headaches "frequently" or "always" 3.
- Another study published in 2020 found that about 60% of patients continue to complain of headache at 3 months post injury, with higher levels of disability than those without headache 4.
- A 2022 study found that 51.4% of participants reported headache at 7 days post-concussion, with no association between acute administration of ibuprofen, acetaminophen, or both and presence of headache at 7 days 5.
Factors Influencing Headache Duration
- Risk factors have been identified for prolonged symptoms, including certain early interventions that may decrease persistent symptoms 2.
- A history of headache before a head injury occurs and female gender are possible risk factors for headache after TBI 6.
- Comorbid conditions should be considered when choosing an appropriate preventive therapy for post-traumatic headache (PTH) 6.
Treatment and Management
- Treatment of PTH may be acute or preventive, with recommendations for the use of migraine-specific acute therapy when indicated 6.
- Preventive therapy may be considered when PTH is frequent, disabling, or refractory to acute therapies 6.
- Clinicians need to be cautious with long-term medication overuse in those whose headache symptoms persist 5.