Headaches are the most common acute symptom of a sports-related concussion, and factors, both before and after the concussion, can help identify the best treatment selection. A review of options to facilitate recovery is published in Current Pain and Headache Reports.
Headaches post-concussion can impact doctors’ ability to assess the injury and may complicate the treatment process. Pre-concussion factors that affect a post-concussion headache are sex differences, medical history of headaches and mood disorders, and prior concussion history. Females report more headaches before and after concussions, which can confound severity and recovery time. A history of migraines, personal or family, can increase the likelihood of headaches post-concussion. A history of depression or anxiety can also increase the risk for headaches post-concussion, but this increase could be related to mood disorders and not directly to the injury. A history of a prior concussion tends to increase overall symptom severity, including headaches.
Concussion factors that can impact headache severity include migraine cluster presentation and cervicogenic or physiological dysfunction. Patients with cluster migraine-like headaches experience increased severity of initial symptoms and report poor balance and neurocognitive scores. Cervicogenic dysfunction could explain headaches, reduced coordination, and postural instability. Physiological dysfunction, mainly cerebral blood flow modifications, could also explain headaches and worsening symptoms.
Treatment of headaches, regardless of the different impacting factors, remains similar. Patients need a tailored treatment plan that includes proper sleep, modified rehabilitation and physical activity, potential vision therapy, and, if warranted, medication use. Sleep hygiene includes proper sleeping conditions and a sleep routine. Rehabilitation to the cervical spine can lead to reductions in headache pain. For concussions involving the vision system, therapy from a neuro-optometrist can provide marked improvements. The outcome of medication use is unclear, but there have been some promising results from early studies involving triptan and prophylactic medication.
In conclusion, many factors play a role in the severity and duration of headaches after a concussion. A complete evaluation and tailored treatment plan need to be created for each patient, taking these factors and injury situations into consideration.
Register-Mihalik JK, Vegt CBV, Cools M, Carnerio K. Factors associated with sport-related post-concussion headache and opportunities for treatment. Curr Pain Headache Rep. 2018; 22(11):75.