Management of Post-Fall Headaches and Return to Work
A gradual return to work once back to normal daily activities is the most appropriate approach for this 26-year-old woman with post-fall headaches and anxiety about returning to work.
Assessment of Current Situation
When evaluating a patient with post-fall head injury presenting with headaches and anxiety about returning to work, several factors must be considered:
- Severity and persistence of headaches
- Impact on daily functioning
- Psychological factors (anxiety about return to work)
- Physical readiness to resume occupational duties
Recommended Management Approach
1. Gradual Return to Work Strategy
The evidence strongly supports a phased rehabilitation approach focusing on work-specific tasks with scheduled progression of work activities 1. This approach balances recovery needs with the psychological benefits of returning to structured activity.
- Begin with mostly sedentary work
- Limit lifting to no more than 10 kg initially
- Gradually increase work responsibilities as symptoms improve
- Schedule specific progression of work activities
2. Timing Considerations
For mild head injuries (without significant neurological findings):
- Initial return to limited work duties can begin around 2-3 weeks post-injury
- Full return to work by 3-4 weeks depending on task requirements 2
3. Management of Anxiety
While anxiety about returning to work is present, starting sertraline is not the first-line approach for this situation. Instead:
- Address the emotional aspect of recovery 2
- Provide education about expected recovery trajectory
- Implement anxiety management strategies such as:
- Breathing techniques
- Grounding strategies
- Thought reframing 2
Only consider medication if anxiety persists despite these interventions and significantly impairs function.
4. Activity Restrictions
Complete activity restriction until headaches fully resolve is not recommended as:
- Immediate post-traumatic mobilization and functional treatment lead to shorter sick leave and faster return to work 2
- Prolonged inactivity can exacerbate anxiety and depression 2
- Work provides structure to the day and prevents social isolation 2
Important Considerations
Monitoring for Complications
During the return-to-work process, monitor for:
- Worsening headaches
- New neurological symptoms
- Increasing anxiety or depression
- Cognitive difficulties affecting work performance
Common Pitfalls to Avoid
- Excessive rest: Prolonged activity restriction can lead to deconditioning, increased anxiety, and delayed recovery
- Premature full return: Returning to full duties too quickly may exacerbate symptoms
- Ignoring anxiety: Untreated anxiety can become a major impediment to successful return to work 2
- Medication as first-line for anxiety: Starting sertraline without first trying non-pharmacological approaches may expose the patient to unnecessary side effects 3
When to Consider Additional Interventions
If the patient demonstrates:
- Persistent severe headaches despite appropriate management
- Significant cognitive impairment affecting work performance
- Severe anxiety that doesn't respond to non-pharmacological approaches
- Signs of post-traumatic stress disorder
Then consider:
- Neuropsychological assessment
- Referral to occupational therapy
- Consultation with a specialist in rehabilitation medicine
- Pharmacological treatment of anxiety if non-pharmacological approaches are insufficient
By following this approach, you can help this patient safely and effectively return to work while addressing both the physical and psychological aspects of her recovery.