Headaches after Concussion Part 2

Headaches after Concussion

Part II of II

How to Help Headaches After Concussion
One of the most important things to do after a concussion is to learn what to expect, so that the child and family are not surprised by typical symptoms and so they understand that most symptoms will get better within a week or two for most children. It is also very important to avoid getting another concussion because a second concussion can make symptoms much worse, especially if it happens soon after the first concussion. 
Any child with a concussion needs to be treated together with a medical provider to provide the best care for the child. Immediately following concussion the child should “rest”. This means no significant exercise, no texting, no driving, no video games, and limited school work, for at least a few days until symptoms improve. In the first few weeks following concussion, activities that worsen headaches or other post-concussion symptoms should be limited. Once headaches and other symptoms are gone, children may gradually increase their activity using a step-wise plan recommended by their doctor/care provider, but if headaches or other symptoms return with activity, then the child should return to the prior, lower level of activity. 
Families should discuss medications with their provider. Acetaminophen (Tylenol) can be helpful to treat severe headaches, and once it is clear that there is no bleeding, ibuprofen or naproxen can also be sued to help to reduce headache pain. Resting in a cool, dark, quiet place can lessen headaches and some people find that putting cold packs on the area that hurts can also help. To manage these headaches it is also very important to: 
  • Drink plenty of water
  • Get regular sleep
  • Eat regular meals
  • Decrease or manage stress
  • Avoid repeat head injury
Care providers may discuss using a “triptan” migraine medication like sumatriptan to treat a severe migraine-type headache that doesn’t respond to ibuprofen or acetaminophen for teenagers with a history of migraine headaches in the past or migraine type post-concussion headaches.
If the child with concussion is involved in sports, once the concussion symptoms are gone at rest, he/she needs to follow a gradual step-wise approach to returning to athletic activity, as outlined by a provider trained in concussion management. 
Chronic Headaches After Concussion
While most children recover completely back to normal within a short time after the concussion, some children have headaches and other post-concussive symptoms for a long time after the injury. When children have chronic headaches after concussion it is especially important to work with their medical care provider, concussion specialist and/or neurologist to develop a plan to help return them to health as soon as possible. This treatment plan should include regular meals, good hydration, stress management, and regular sleep. It may also include:
  1. Medications to treat “spikes” in headache such as acetaminophen, ibuprofen, naproxen or triptans
  2. Daily supplements such as magnesium, omega-3 fatty acids or riboflavin used to decrease headache frequency and severity
  3. Daily prescription preventive headache medications to decrease headache frequency and severity
  4. Complementary therapies such as physical therapy, massage, biofeedback therapy, or acupuncture
Once a child or teen has headaches lasting longer than a few weeks after concussion, with guidance from a medical provider, it may be reasonable to consider beginning low-impact aerobic exercise (“sub-threshold” exercise, such as walking, slow swimming, slow stationary biking) that does not make headache or other symptoms worse, as there is a concern that long periods of complete rest may eventually worsen rather than help symptoms (note this is NOT “return to play”). Fortunately, even if post-concussion headaches don’t get better in the first few weeks after concussion, most are better within 3 months and almost all are better within a year after injury. 
If a child has had multiple concussions, it is important to discuss the risks of future concussions with their care provider and weigh the benefits of continuing a particular sport vs. the risks of future concussion/s. Children with past concussions are more likely to have one in the future and the recovery time may be even longer after each subsequent concussion. 
Heidi Blume, MD, MPH, Assistant Professor, Division of Pediatric Neurology, Seattle Children's Hospital and Research Institute, Seattle, WA.
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