Post traumatic headaches -how can physio help?
What is a post-traumatic headache?
It is a headache which can occur following any brain injury, and is one of the most common complaints following a mild traumatic brain injury. (Ref 1-4)
Often the headache will resolve quickly following the original injury, but in some clients the headache persists. If it continues beyond 3 months, it is termed chronic.
What types of post traumatic headaches are there?
There are many causes and types of headaches and it is important to have a reliable diagnosis, so that the appropriate treatment can be determined.
The Ontario Neurotrauma Foundation has identified four common types in adults following a mild traumatic brain injury:
1. Migraine without aura
2. Frequent episodic tension-type headache
3. Primary stabbing headache
4. Occipital neuralgia
Headaches may be made up of more than one of these types.
You can get more detailed information here: http://braininjuryguidelines.org/concussion/
It’s important to note that headaches can also be caused by medication over-use. These are called rebound headaches. Your doctor will assess whether medication is the possible cause and develop a plan with you to deal with the problem.
What can physio do to help?
Once an assessment has been completed, your physiotherapist can help by advising, guiding and treating the following areas:
1. Pain, by using modalities such as heat, ice, acupuncture, manual therapy or Integrative Manual Therapy as needed.
2. Head and neck posture.
3. Stretches for the neck and upper body.
4. Strengthening for the neck and upper body when appropriate.
5. Cardiorespiratory exercise. Some headaches are aggravated by exercise. Your physiotherapist will guide you to the most appropriate program for you.
6. All exercise must be performed in a graduated way so that there are minimal injuries, and you are successful in getting the benefits from your program.
R. Sian Owen PT
1.Gladstone J. From psychoneurosis to ICHD-2: an overview of the state of the art in post-traumatic headache. Headache. 2009;49(7):1097-1111.
2. Dikmen S, Machamer J, Fann JR, Temkin NR. Rates of symptom reporting following traumatic brain injury. J Int Neuropsychol Soc. 2010;16(3):401-411.
3. Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC. Characteristics and treatment of headache after traumatic brain injury: a focused review. Am J Phys Med Rehabil. 2006;85(7):619-627.
4. Lew HL, Poole JH, Guillory SB, Salerno RM, Leskin G, Sigford B. Persistent problems after traumatic brain injury: The need for long-term follow-up and coordinated care. J Rehabil Res Dev. 2006;43(2):vii-x.