From the Guidelines
For a patient experiencing post-traumatic headaches one month after a motor vehicle accident, I strongly recommend a trial of aspirin-acetaminophen-caffeine for acute treatment, given its statistically significant improvement in pain freedom and relief at 2 hours, as evidenced by a recent study 1. The patient's symptoms should be thoroughly evaluated by a healthcare provider to determine the cause and appropriate treatment.
- Over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) may also be considered for pain management.
- Additionally, rest, stress reduction techniques, and gentle neck stretches can provide relief.
- The patient should maintain a headache diary to track triggers, pain intensity, and medication effectiveness.
- These headaches may be post-traumatic headaches resulting from concussion, whiplash, or other injuries sustained during the accident.
- If symptoms persist or worsen, the healthcare provider might consider prescription medications like amitriptyline (10-25mg at bedtime) or physical therapy, which has been shown to be beneficial in reducing headache frequency and intensity 1.
- Red flag symptoms requiring immediate medical attention include severe pain, confusion, weakness, vision changes, or vomiting.
- Proper hydration, regular sleep patterns, and avoiding alcohol and caffeine can support recovery.
- It is essential to note that there is insufficient evidence to recommend for or against any specific medication over another for the short-term treatment of migraine or the prevention of migraine headache, tension headache, or cluster headache 1.
- However, aspirin-acetaminophen-caffeine is a strong recommendation for acute migraine treatment, with a number needed to treat of 9 for pain freedom at 2 hours and 4 for pain relief at 2 hours, and no serious adverse events reported 1.
From the Research
Patient Evaluation
- The patient had a motor vehicle accident (MVA) a month ago and is still experiencing post-traumatic headaches, which suggests a possible secondary headache disorder 2.
- A thorough history and physical examination are necessary to determine the cause of the headaches, including evaluation for red flags such as recent head or neck injury, new or worsening headache, and neurologic findings 2, 3, 4.
Diagnostic Testing
- Diagnostic testing, such as neuroimaging, cerebrospinal fluid (CSF) examination, and blood tests, may be indicated depending on the patient's history and findings 2.
- Computed tomography (CT) of the brain or magnetic resonance imaging (MRI) brain scan may be necessary to rule out underlying conditions such as subarachnoid bleeding or intracranial pressure/volume causes 2, 4.
- CSF examination may be useful in diagnosing subarachnoid bleeding, infection, and high and low CSF pressure syndromes, including cerebrospinal fluid hypovolemia syndrome 2, 5.
Treatment Options
- Acute treatment of headache may include acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 4.
- Migraine-specific treatments, such as triptans, gepants, and lasmiditan, may be considered for patients with migraine headaches, but should be used with caution in patients with cardiovascular risk factors 4.
- Preventive treatments, such as antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, may be necessary for frequent headaches 4.
- Epidural blood patch therapy may be effective for patients with cerebrospinal fluid hypovolemia syndrome 5.