Can concussions cause migraines?

Can Concussions Cause Migraines?

Yes, concussions directly cause migraines, with headache/migraine being the most common acute symptom following concussion in both adults and children, and migraine-type headaches can develop even in individuals with no prior headache history. 1

Evidence for Causation

The 2020 Neurosurgery guidelines establish headache/migraine as one of five primary concussion subtypes, not merely an associated symptom. 1 This classification is based on systematic review and meta-analysis showing that:

• Headache is the single most common postconcussive symptom reported in both adults and children within 3 days of injury 1
• Migraine-type headaches are characterized by prodrome/aura with nausea, vomiting, and sensitivity to light, sound, or smell following head injury 1
• Patients develop headaches that differ from their pre-existing history or show changes on validated headache scales 1

Clinical Patterns

New-Onset Migraine After Concussion

Concussions can trigger chronic migraine in individuals with no prior headache history:

• In a study of 35 adults with no prior headaches, 100% developed recurrent migraine attacks (common or classic migraine) following minor head or neck trauma 2
• The median age of onset was 38 years—older than typical idiopathic migraine 2
• Headaches began immediately or within the first few days after injury 2
• Post-traumatic migraines recurred several times per week and were often incapacitating 2

Exacerbation of Pre-Existing Migraine

Pre-existing migraine disorders place individuals at significantly greater risk for worse outcomes after concussion:

• Adolescents with pre-existing migraines endorsed greater symptom severity acutely after concussion (mean 26.0 vs 16.7 in controls) 3
• These patients reported higher rates of mental fogginess (49.2% vs 33.9%) and memory problems (39.0% vs 24.6%) 3
• They performed worse on verbal and visual memory testing in the first 72 hours post-injury 3

Migraine Features in Post-Concussion Headaches

Post-traumatic headaches are phenotypically consistent with migraine:

• In deployed military personnel, 98% reported headaches as the most frequent acute symptom following concussion 4
• Of those reporting pre-deployment headaches, 84% described migraine features and/or triggers 4
• Daily post-traumatic headaches occurred in 68% and were associated with typical migraine features and triggers 4
• 75% of patients treated with triptans showed positive treatment response, confirming the migraine phenotype 4

Impact on Clinical Course

History of mild traumatic brain injury significantly affects migraine characteristics:

• Patients with mTBI history are more likely to have chronic migraine (74.3% vs 65.8%) 5
• They experience greater headache-related vertigo (23.0% vs 15.9%) 5
• Headaches are more frequently triggered by lack of sleep (39.4% vs 32.6%) and reading (6.6% vs 3.0%) 5
• They have significantly greater allodynia scores, migraine disability scores, and symptoms of anxiety and depression 5

Critical Clinical Pitfalls

Do not dismiss post-traumatic headaches as compensation neurosis or psychological factors:

• The neurologic literature has historically overemphasized compensation neurosis in chronic headaches after minor trauma 2
• In litigation cases, 78% of patients improved with appropriate anti-migraine treatment (propranolol or amitriptyline), demonstrating organic etiology 2
• Most patients with litigation claims are not cured by a verdict—they have genuine complaints requiring medical treatment 6

Do not delay diagnosis:

• There is often a median delay of 4 months before post-traumatic migraine is suspected 2
• Early recognition and treatment with prophylactic anti-migraine medication results in dramatic reduction in frequency and severity in 70% of patients 2

Management Implications

Obtain comprehensive headache history at baseline and post-injury:

• Document pre-deployment/pre-injury headache features, frequency, and migraine characteristics 4
• Identify migraine features (photophobia, phonophobia, nausea, aura) in post-concussive headaches 1
• Use validated headache scales to track severity changes 1

Consider early migraine-specific treatment:

• Triptans are effective for acute post-traumatic migraine 4
• Prophylactic medications (propranolol, amitriptyline) reduce frequency and severity 2
• Treatment should not be delayed pending litigation resolution 2