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TBI Headaches: Types, Causes & Treatment Options

Image of Dr. Alina Fong, Ph.D.
Updated on 04 December, 2024
Medically Reviewed by

Dr. Mark Allen

TBI Headaches: Types, Causes & Treatment Options

Headaches are the most common symptom after a traumatic brain injury. The vast majority of people with TBI headaches experience symptom improvement within weeks; however, for some patients, headaches may persist for months or years. Alongside headaches, these patients may also experience a wide range of other persistent symptoms, such as brain fog, mood swings or “personality changes,” memory problems, and difficulty concentrating.

For TBI patients, the most common types of chronic headaches include tension-type headaches and migraine headaches. If you’re experiencing these types of headaches and your doctor prescribed analgesics to control the pain, you may have found that your headaches didn’t respond well to medication. We’ve written in detail about why medication is often not a good solution for patients with brain injuries. It includes a combination of factors, such as head trauma patients being more at risk for side effects and medications not being designed with the pathophysiology of TBI in mind.

For example, while patients with TBI headaches often use painkillers and/or antidepressants for their symptoms, SSRIs (a class of antidepressants) may increase or cause headaches, and pain medicine can cause rebound headaches. Treating TBI headaches is complicated and may require a multidisciplinary approach. Because of that, going to just one doctor (such as a neurology practitioner) may not be enough to resolve your symptoms.

In contrast, at Cognitive FX, we offer an alternative treatment that doesn’t rely on medication. We use a combination of exercise and multidisciplinary therapies to address the root cause of TBI headaches. Therapy improves headaches while also addressing many other common and persistent symptoms of head trauma.

In this article, we’ll look at:

If you’re experiencing persistent symptoms such as headaches, brain fog, fatigue, memory problems, vision changes, and more, months or years after a head injury, you’re not crazy. These are real symptoms caused by changes in the brain and autonomic system, and they can be helped. Over 90% of our patients experience significant recovery after treatment in our clinic. To determine if our program is right for you, please schedule a consultation with our team.

What Is a TBI Headache?

One of the most debilitating symptoms you can experience after a head injury is a headache. Curiously, headaches are more common after mild traumatic brain injuries (mTBI), also known as concussions, compared to moderate or severe ones. Up to 90% of patients experience this symptom for at least a few days after suffering a mTBI.

According to the International Classification of Headache Disorders (ICHD-3), TBI headaches are considered a secondary disorder, which means they develop as a consequence of another disorder. To be considered a TBI headache, they must develop within 7 days of the injury. However, some clinicians believe this time frame needs reassessment as some patients develop headaches weeks or even months after their injury.

Patients may experience acute or persistent headaches. Acute headaches typically resolve within three months after the incident, whereas persistent headaches last more than three months. More than half of all patients with headaches immediately after a concussion are still experiencing this symptom 12 months after the trauma.

Potential risk factors for developing persistent headaches after a TBI include:

  • Being female
  • Being elderly
  • Having a family history of headaches
  • Having pre-existing headaches, migraines, or migraine-like headaches
  • Developing a headache immediately after a concussion
  • Experiencing chronic pain other than headaches

If you already have a history of migraines before your head injury, you’re twice as likely to develop TBI headaches than a patient who doesn’t have a history of headaches. Patients with pre-existing tension-type headaches may also experience an increase in attack frequency. In contrast, severe headaches at the time of a head injury don’t necessarily mean that patients will develop persistent headaches.

Types of TBI Headaches

Types of Post-Concussion Headaches: Cluster, ANS, Sinus, Migraine, Ocular Migraine, Hypertension

Not every TBI headache feels the same. Patients often experience pain in the head at the point of impact after the injury, but headaches can develop afterward in different regions of the head. The most frequent headaches occur in the temple, followed by the forehead, neck, back of the head, and around the eyes.

Many different mechanisms can lead to TBI headaches (more on this below) and you may find that your headaches fit more than one type. Keeping a diary of your headaches, including location, cause, sensation, remedies, pain rating, and length, can be very helpful to show your doctor. Write down how you feel and what helps alleviate your headaches to understand how to better address your symptoms and help your doctor pinpoint what’s causing your persistent TBI headaches.

The most common types of TBI headaches include headaches that are similar to:

  • Tension-type headaches
  • Migraines
  • Cervicogenic headaches
  • Cluster headaches
  • Rebound headaches


TBI Headaches Similar to Tension-Type Headaches

TBI headaches similar to tension-type headaches are one of the most common types in patients with a brain injury, both immediately after a concussion or in PCS patients. About 20% to 40% of patients experience this type of headache during the first year after a concussion.

These headaches occur if the muscles and soft tissues in the back of the head and neck are injured, causing muscle tension and muscle spasms. Patients can experience pain in the neck, shoulders, back of the head, and sometimes at the top of the head.

Patients usually experience some of the following features:

  • Tight squeezing or pressing sensation around the entire head
  • Mild to moderate pain
  • Occur later in the day
  • Concurrent with neck pain (especially if patients suffered whiplash)
  • Lasts a few minutes to a few hours
  • Increases gradually in intensity
  • Often aggravated by stress
  • Include sensitivity to light and sound
  • Worsens with stress
  • Worsens with neck movements
  • Can be continuous or come and go

Tension-type headaches also include headaches caused by dysfunction of the autonomic nervous system (ANS). Patients experiencing this type of headache often report pain starting from the jaw and moving across the face over the top of the head or affecting the sinus area, with pain around the cheekbones.

TBI Headaches Similar to Migraines

Migraines are the other common type of persistent post-traumatic headaches, affecting almost half of patients. This type of headache is more common in patients with mild TBIs compared to patients with moderate or severe TBIs.

Migraines occur when one or more areas in the brain become hypersensitive and trigger a pain signal that quickly spreads to other parts of the brain. Patients who have migraines or have a family history of migraines are more likely to develop TBI migraines, but most patients improve over time regardless of TBI injury severity.

Patients with this type of headache often experience:

  • A dull, throbbing sensation, typically on one side of the head (sometimes both)
  • Moderate to severe intensity
  • Pain worsens with physical activity
  • Sensitivity to light, sound, and smell
  • Nausea and vomiting
  • Dizziness
  • Worsening pain with physical activity
  • An aura (this is often a warning signal that the migraine is coming on, such as seeing spots or bright lights, smelling a strange smell without cause, or feeling tingling in the hands)

Some patients experience a type of migraine called a vestibular migraine. This type of migraine comes with a wide range of other symptoms, such as vertigo, dizziness, lightheadedness, and/or motion-induced sickness. These headaches can persist for months or even years after the injury.

Patients may also experience ocular migraines, which may be accompanied by loss of vision in one or both eyes. These headaches are also called visual migraines, ophthalmic migraines, or monocular migraines, and tend to affect one side of the head with a throb or pulsating sensation which worsens when moving around. It can also cause nausea, vomiting, sensitivity to light, and blind spots or colored halos in vision.

TBI Headaches Similar to Cervicogenic Headaches

Cervicogenic headaches often occur as a result of a neck injury, affecting the muscles and soft tissues in the neck and the back of the head. These headaches are caused by problems with the cervical spine (vertebrae in the neck region) and muscles in the neck and shoulders and are common after whiplash. Neck movements and pressure or stress can trigger this type of headache and worsen symptoms.

Common features of cervicogenic headaches often include:

  • Headaches that start where the occipital bone meets the neck, shoulders, and back of the head but can travel over the top of the head
  • Dizziness and balance issues
  • Pain that ranges from mild to severe
  • A dull (non-throbbing) “pulling” feeling around the neck (sometimes patients describe it as like something is pulling around the neck)
  • Reduced range of motion in the neck
  • Gradually worsening symptoms

TBI Headaches Similar to Cluster Headaches

Cluster headaches are rare after a head injury but can be extremely painful. Patients with cluster headaches experience pain behind one eye that can occur in cyclical patterns or clusters. Typically, attacks last a few weeks or months, followed by a period of remission.

Features of cluster headaches often include:

  • Excruciating head pain behind or around one eye that radiates to other areas of the face
  • Redness of the eye
  • A stuffy or runny nose
  • Pale skin or flushing on the affected side
  • Drooping eyelid on the affected side
  • Sensitivity to light and sound

Rebound Headaches from Medication

Patients with TBI headaches often resort to painkillers as a short-term solution to manage their headaches. The problem is that excessive or prolonged use of these medications can cause a type of secondary headache, called rebound headaches. This applies to both over-the-counter products as well as prescribed medications. These headaches can affect about 40% of patients who overuse painkillers. Luckily, most patients improve once they stop taking these medications, but some are difficult to stop and may cause side effects if stopped too quickly.

Often, these headaches resemble the underlying type of headache that the patient is already experiencing, which means it’s virtually impossible to distinguish between the headache caused by the concussion and the headache caused by medication. If you feel that you may be experiencing rebound headaches, contact your healthcare provider.

Features of these headaches include the following:

  • Caused by long-term use of painkillers
  • Improved by stopping painkillers
  • Often mistaken for the primary headache the patient is already experiencing
  • Often accompanied by neck pain and consequently mistaken for cervicogenic headaches
  • Most commonly experienced in the morning
  • Associated with poor sleep

What Causes TBI Headaches

Although TBI headaches are extremely common, the mechanism behind these is still a mystery. Not all headaches are caused by the same process. The most common causes include:

  • Dysfunction of the autonomic nervous system (ANS)
  • Neurovascular coupling dysfunction
  • Vision problems
  • Vestibular problems
  • Sleep disturbances

Autonomic Nervous System (ANS) Dysfunction

Headaches can develop if patients experience disruption of the autonomic nervous system (ANS).

The ANS controls many bodily functions, including breathing rates, heart rate, and blood pressure. The ANS includes two subsections: the sympathetic nervous system (SNS), which regulates the “fight or flight” response, and the parasympathetic nervous system (PNS), which controls the “rest and digest” process. In a healthy person, these two sections work in harmony, allowing the body to respond quickly to what happens in your environment.

However, head injuries disrupt this equilibrium. For most patients, the SNS tries to stay in control all the time, forcing the body to be in a constant state of high alert. This leads to various symptoms, including fatigue, sleep disturbances, memory problems, and headaches.

Some patients describe these ANS headaches as feeling like their head is blowing up like a balloon or like there’s a clamp tightening around their head. Others report that the pain starts in the neck and moves up around the back of the head to the temples. If your symptoms get worse after physical exercise, then it is likely that your headaches are caused by ANS dysfunction. Despite this, it’s very important to engage in regular exercise to help with your recovery. There are steps you can take to exercise safely after a head injury.

Autonomic dysfunction may also cause tension-type headaches. In this case, patients complain that the pain starts on the jaw and then moves across the face and over the top of the head. ANS headaches may also feel like pressure on the sinus area, with pain around the cheekbones which spread to the rest of the head.

Further reading: Dysautonomia after a head injury

Neurovascular Coupling (NVC) Dysfunction

Nerve cells can request what they need to function — oxygen and nutrients — from a network of blood vessels in the brain. In turn, these blood vessels deliver these resources to the right place at the right time. This dynamic relationship is called neurovascular coupling (NVC).

After a TBI, however, this connection is often disrupted. If this happens, the brain struggles to complete normal functions and patients are likely to experience headaches. If you notice that your headaches get worse when you’re doing cognitive tasks, you might be experiencing headaches caused by NVC dysfunction. It’s common for the effects of NVC dysfunction to develop alongside ANS dysfunction, further aggravating the symptoms.

Vision Problems

It’s common for TBIs to trigger vision problems, which in turn may cause headaches. After a head trauma, areas of the brain involved in processing visual information may struggle to function properly and often compensate by working overtime. This puts an extra strain on the brain and causes headaches that are typically worse when patients are in a visually busy environment, using the computer, or trying to read.

The most common form of visual problem that can trigger headaches is binocular vision dysfunction (BVD). This happens when the eyes are misaligned and don’t focus together in the same direction. Other conditions that cause headaches include convergence insufficiency and accommodative dysfunction. If you think your headache is caused by visual issues, you need to be assessed by a neuro-optometrist.

Common symptoms in patients with visual dysfunction include:

  • Frontal headache in the brow area
  • Sensitivity to light
  • Headache pain that impedes daily functioning or memory
  • Dizziness
  • Dull, stabbing, or throbbing pain around the eyes and forehead
  • Double or blurry vision
  • Headaches that get worse in a busy environment or when using the computer
  • Poor hand-eye coordination and balance

Further reading: Vision problems after a concussion

Vestibular Dysfunction

Vestibular dysfunction is another issue that may cause headaches. Located in your inner ears, the vestibular system sends messages to the brain regarding how the body is moving. The brain then combines information coming from the inner ears, eyes, and body to figure out the position of the head relative to the rest of the body. The brain can identify whether you’re moving or at rest, whether your environment is moving, and so forth.

The problem is that, after a TBI, the brain may start receiving contradicting signals about the position and movement of the body coming from the vestibular and visual systems. When this happens, the brain relies more on visual inputs to stabilize the head than it normally would. Using the eyes almost exclusively to keep the balance leads to headaches, fatigue, nausea, balance issues, and difficulty performing routine daily activities.

In the long term, relying too much on vision to keep balance causes the brain to become visually dependent. This means that, even after patients heal from the head injury, the brain will continue to use information from the eyes and ignore vestibular input. This may explain why you struggle to perform tasks in low light, and experience dizziness and headaches.

Headaches caused by vestibular problems create the following symptoms:

  • Migraines
  • Severe, throbbing headaches
  • Pain, usually on one side of the head
  • Nausea and vomiting
  • Dizziness and loss of balance
  • Sensitivity to light, smell, and noise

Further reading: Vestibular therapy after a concussion

Poor Sleep and Other Sleep Disturbances

After a TBI, many patients complain of poor sleep, which in turn triggers headaches, including migraines, tension-type headaches, and cluster headaches. Again, these seem to be more frequent among patients with mild TBSIs rather than those with moderate or severe TBIs.

Researchers believe this happens because the hypothalamus is responsible for both regulating sleep and modulating pain. If this area is damaged after a head trauma, it dysregulates sleep patterns and triggers headaches. Another possible mechanism involves the pineal gland, which is involved in regulating sleep. This gland produces melatonin, a hormone that makes you feel sleepy in the evening. If this area is affected by the head injury, low levels of melatonin disrupt normal sleep cycles and cause headaches.

Further reading: Sleep disturbances after a head injury

Untreated Whiplash

As described earlier, cervicogenic headaches are common after a whiplash injury. If they’ve suffered whiplash, patients can experience pain radiating from the neck and upper shoulders to the forehead and back or sides of the head. These headaches can flare up right after the injury or in the days and weeks afterward.

For some patients, whiplash symptoms persist for months and need specialized treatment to resolve. In addition to headaches, patients may experience weakness, difficulty talking, confusion, dizziness, nausea, and excessive tiredness.

Further reading: Untreated whiplash symptoms & treatment

Psychological Difficulties

Depression, anxiety, and other emotional problems are common after a brain injury. About half of patients are affected by mental health problems within the first year after injury.

Headaches triggered by depression and other mood disorders are often described as dull and throbbing, with the pain worse in the morning but getting better as the day goes on. These headaches are likely caused by changes in the brain that occur with depression, but the exact mechanism is still a mystery. Patients with pre-existing psychological conditions are more likely to experience headaches caused by depression, but it can happen to anyone.

Depression headaches are usually accompanied by:

  • Fatigue
  • Tension in your neck and shoulders
  • Lightheadedness or dizziness
  • Difficulty concentrating
  • Muscle aches
  • Sleep problems
  • Jaw pain

Further reading: Post-concussion depression

Treating TBI Headaches

Treating TBI headaches can be challenging. As described in this article, patients can experience different types of headaches caused by different mechanisms. A one-size-fits-all approach cannot help every patient.

If it’s difficult for you to go to work or school with a headache, your doctor may suggest medication. Typically, these range from over-the-counter painkillers (such as acetaminophen or ibuprofen) for occasional headaches to specific prescription drugs to treat migraines (such as triptans) for more severe or constant cases. This may help with some symptoms but should only be considered as a short-term option.

We strongly discourage long-term treatment of TBI headaches with medication because:

  • It’s not FDA-approved: At the moment, there are no FDA-approved drugs to treat chronic TBI headaches.

  • It’s not backed by science: Researchers still don’t fully understand what causes these headaches and, as such, there isn’t enough evidence to support the use of medication to treat long-term TBI headaches. One of the few studies available found that, although most participants reported short-term improvements after taking painkillers, about one-third started experiencing headaches again a week later. This explains why treating TBI headaches with medication often results in poor treatment responses.

  • It’s not suitable: The main issue with medications is that they were not designed to treat TBI headaches. For example, doctors often prescribe triptans to treat migraines and cluster headaches. The problem is that these drugs work by limiting blood flow in the brain. If your headache is caused by neurovascular coupling or autonomic nervous system dysfunction, limiting blood flow is likely to make the problem worse.

  • It’s not safe: Long-term use of painkillers is not always safe for patients. In addition to rebound headaches described above, medication can cause renal failure or gastrointestinal complications, such as acute gastritis and gastric ulcers.

  • It’s not a complete treatment: Pharmacological interventions also fail to address all the needs of patients with TBI headaches. Painkillers may alleviate headache symptoms in the short term, but they do not address other physical, cognitive, and emotional symptoms that occur after a TBI. Relying on just painkillers as the only treatment can lead to a delay in recovery and lower the patient’s quality of life.

Treating TBI Headaches Without Medication

EPIC Treatment exercise with headphones [V1]

At Cognitive FX, we specialize in treating patients with lingering symptoms from brain injury, including patients with post-concussion syndrome (PCS), as well as other causes of head trauma, such as bacterial and viral brain infections, carbon monoxide poisoning, “chemo” brain, transient ischemic attack, and COVID-19.

We use a multidisciplinary therapy approach that is much more effective than a single therapy. Furthermore, we go beyond just trying to improve headache symptoms. Instead, we seek to help the brain heal from the injury causing your symptoms.

Our treatment process begins with a detailed examination. Our team will go through your medical history, review the symptoms that you’re experiencing, and conduct a series of physical exams that help us understand how your brain and body were affected by the concussion. Most importantly, we use an imaging technique called functional neurocognitive imaging (fNCI) to zero in on which of your brain regions were affected by your injury and how well they’re communicating with other brain regions.

fmri-brain-scans-duke-study-implications-2

The next step is to combine all this information and design a treatment plan tailor-made for you. Ultimately, our treatment aims to restore normal neurovascular coupling and ANS function in the areas highlighted as dysfunctional by our evaluation. We also use specific methods that can help relieve your head pain, including breathing exercises, neuromuscular massage, and BrainWave.

EPIC Treatment exercise

During treatment week, patients go through an intense regime of exercise and therapy. Sessions start with aerobic exercise to improve blood flow in the brain, followed by different therapies to help your brain heal. Therapies used include:

epic-treatment-exercises-22

At the end of treatment, patients undergo a second scan to see how the brain is adapting to therapy. For some patients, the changes are significant, while for others, the brain takes longer to respond and change. Nevertheless, 90% of our patients experience improvements in their symptoms during treatment. Most of these patients go on to continue improving at home.

After treatment, our team also meets up with you to review your scan and other test results and give you “homework.” Your homework will include some combination of aerobic exercise, cognitive games, and cognitive rest to continue your recovery journey.

You may find it helpful to read the recovery stories some of our other patients have shared. Here are a few links to get you started:

  • Myrthe van Boon is a mother of two who struggled with debilitating post-concussion symptoms for years before finding Cognitive FX.

  • Olivia Seitz is a former figure skater who found symptom relief after more than a decade of chronic illness.

  • Sam Pembleton was an adolescent hit by a soccer ball in the head; she tried treatment methods for five years before finding Cognitive FX.

  • These patients all completed video testimonials about their initial injury and their experience at Cognitive FX.

If you’re experiencing persistent symptoms such as headaches, brain fog, fatigue, memory problems, vision changes, and more, months or years after a concussion, you’re not crazy. These are real symptoms caused by changes in the brain and autonomic system, and they can be helped. Over 90% of our patients experience significant recovery after treatment in our clinic. To determine if our program is right for you, please schedule a consultation with our team.

Other Alternative Treatments for TBI Headaches

As health care providers become more aware that prescription drugs are not the best option to treat patients with TBI headaches, more non-pharmacological interventions are being used to treat TBI headaches.

Some of the current options include:

  • Cognitive Rehabilitation Therapy: This therapy helps patients learn ways to avoid stress and understand what triggers their headaches. Studies show that it can reduce headaches, dizziness, and nausea.

  • Progressive muscle relaxation techniques: Patients learn several exercises to tense and relax particular muscle groups in the body. Recent research shows that engaging in muscle relaxation exercises a few times per week can improve headaches.

  • Cognitive Behavioral Therapy (CBT): CBT is becoming increasingly popular to treat TBI headaches, especially if emotional or behavioral symptoms accompany it. A study found that CBT for military veterans with headaches and post-traumatic stress disorder (PTSD) reduced symptoms and improved their quality of life.

  • Acupuncture: There is evidence to support that this technique can reduce headaches and improve the quality of life in patients with a TBI injury regardless of the severity of the injury.

  • Physical Therapy: This therapy can help patients engage in several exercises to reduce inflammation and pain. Exercise may also help relieve migraines and cervicogenic headaches by improving the range of motion in the neck and shoulders.

  • Nutraceuticals: Patients can use different food supplements to help with headaches and migraines, including vitamin D, riboflavin (vitamin B2), coenzyme Q, magnesium, and melatonin.

  • Osteopathic treatments: There is some evidence suggesting that osteopathic manipulations, such as craniosacral therapy and neck massage, can help headaches. If you want to try this, make sure you find a certified therapist.

  • Lifestyle changes: Lifestyle changes after a brain injury can alleviate headache symptoms and improve quality of life. Recommendations include keeping hydrated, reducing stress, engaging in regular exercise, and following a healthy sleep pattern.

How to Deal with TBI Headaches at Home

Headaches can affect your daily life and make it harder to go to work or attend school. Here are some techniques to cope with headaches at home when they arise:

  • Follow a consistent sleep pattern: Sleep disturbances can aggravate headache symptoms. To avoid this, go to bed and get up at the same time every day, even on weekends and holidays. If you need to take a nap during the day, restrict it to 20–30 minutes. Avoid the use of mobile phones before going to bed.

  • Find ways to reduce stress in your life: Find what causes you stress and triggers headaches. For example, if you struggle with busy and noisy places, go shopping at off-peak hours.

  • Stay in touch with your friends: Isolation is not the solution for your headaches. Stay in touch with family and friends, get involved in your community, or look for a support group for patients with chronic pain.

  • Avoid stimulants such as alcohol and caffeine: These may give some temporary relief, but in the long term, they aggravate your condition and delay recovery.

  • Practice mindfulness and breathing exercises: Learn mindfulness or breathing techniques to relax at home. This helps to dampen the overactive sympathetic nervous system and improve blood flow to the brain.

  • Exercise regularly: Exercise can worsen your headache at first, but in the long term, regular exercise alleviates headaches and improves cardiovascular health. Start with short bursts of exercise followed by controlled breathing to calm down. Gradually work your way up.

  • Eat a balanced diet: Choose food that helps your brain recover from injury, take supplements and vitamins as needed, and avoid processed, fatty, or sugary foods.

  • Consult your physician: If you suspect that you suffered whiplash, speak with your doctor to confirm that there is no structural damage in your neck. As described earlier, untreated whiplash can cause headache and other symptoms indefinitely.

  • Try massage therapy: Tension in the neck and shoulders aggravates headache pain. You can work with a physical therapist to learn stretching exercises that can help.

  • Try our headache relief masterclass: We put together a class specifically to help with post-traumatic headache pain relief.


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