What is the recommended treatment for a headache resulting from head trauma?

Treatment of Headache from Head Trauma

For headaches resulting from head trauma, nonopioid analgesics such as ibuprofen or acetaminophen should be offered as first-line treatment, with careful counseling about the risks of analgesic overuse and rebound headache. 1

Acute Management Algorithm

Initial Assessment and Imaging

• For severe or worsening headache after mild traumatic brain injury (mTBI), healthcare professionals should consider obtaining a head CT to evaluate for intracranial complications, especially when associated with other risk factors 1
• Children with acutely worsening headache symptoms during observation periods should undergo emergent neuroimaging 1
• For headaches related to remote trauma, MRI without contrast is the preferred imaging modality, particularly when neurologic signs/symptoms are present or headaches are increasing in frequency, duration, or severity 1

Pharmacological Management

• Provide nonopioid analgesia (ibuprofen or acetaminophen) for painful headaches after acute mTBI 1
• Avoid opioids for headache management as they are not generally recommended for headache therapy 1
• Do not administer 3% hypertonic saline for treatment of acute headache after mTBI outside of research settings 1
• For severe headaches unresponsive to acetaminophen, consider adjunctive therapy with metoclopramide 10 mg orally, administered 20-30 minutes before or with acetaminophen 2

Chronic Management

For Persistent Post-Traumatic Headaches

• Refer patients with chronic headache after mTBI for multidisciplinary evaluation and treatment 1
• Consider analgesic overuse as a potential contributory factor in chronic post-traumatic headaches 1
• Post-traumatic headaches often resemble migraine or tension-type headaches and should be treated according to their predominant characteristics 3, 4, 5

Additional Interventions

• For patients with persistent vestibulo-oculomotor dysfunction after mTBI, consider referral to a program of vestibular rehabilitation 1
• Provide guidance on proper sleep hygiene methods to facilitate recovery 1
• If sleep problems persist despite appropriate sleep hygiene measures, consider referral to a sleep disorder specialist 1

Important Considerations and Pitfalls

• Limit use of acute headache medications to avoid medication overuse headache, which can occur with frequent use (typically more than 2-3 days per week) 6
• Be vigilant for signs of worsening that may indicate more severe injury, including:
  • Severe or worsening headache 1
  • Headaches associated with vomiting 1
  • Neurological deficits 1
• Post-traumatic headache can be persistent, with up to 25% of patients experiencing chronic headaches as long-term residua 3
• The milder the traumatic brain injury, the more likely the development of headaches, which is a paradoxical relationship that clinicians should be aware of 3, 5

Non-Pharmacological Approaches

• Encourage adequate hydration and rest in a quiet, dark environment 2
• Apply cool compresses to the forehead for symptomatic relief 2
• Consider physical therapy interventions, especially for headaches with cervical components 3
• Cognitive behavioral approaches may be beneficial for managing chronic post-traumatic headaches 3