THE SITUATION · AFTER A HEAD INJURY
Post-traumatic headache is headache that follows a head injury. It usually looks like migraine or tension-type headache. Most improves over weeks to a few months. Past three months, it is treated as a headache disorder in its own right, not as an injury still healing.
Headache is the most common symptom after a head injury. It is also the most common reason people are told to wait. Most does settle. What is worth knowing is which signs mean you should not wait. And when the waiting has gone on too long.
IN THE FIRST HOURS AND DAYS
- A headache that is getting steadily worse instead of easing.
- Repeated vomiting, growing drowsiness, confusion, or trouble waking.
- Seizure, weakness, numbness, slurred speech, or unsteadiness.
- Clear fluid from the nose or ear, or bruising behind the ear or around both eyes.
- Any head injury while taking anticoagulants (blood thinners), or with a bleeding disorder.
- These belong in an emergency department. Age matters at both ends. Over 65 and under 2 both call for a lower bar.
Bleeding under the skull can show up days or weeks later, with little memory of the injury. This is most true in older people and those on blood thinners. A new or worsening headache in that window gets assessed, not watched.
How long does post-traumatic headache last?
Post-traumatic headache most often looks like migraine or tension-type headache. Most improve over weeks to a few months. Once it lasts beyond three months, it is treated as a headache disorder in its own right. It is no longer treated as an injury still healing.
An unhelpful pattern is common here. People are told again and again that it takes time. By the time anyone treats it actively, a year has passed. A medication overuse layer has formed on top. That layer is often the largest single driver by then.
Why won’t my headache go away after a head injury?
Three things, and only one is the original injury. The neck (cervical) structures are very often hurt at the same time and never examined. So a treatable cervicogenic part, coming from the neck, hangs on with no end in sight. Sleep is disrupted after head injury in a high share of people. That raises pain sensitivity every day that follows. The third depends on your situation. Less activity, time off work, and not knowing when it will end all turn up the sensitization the injury started. Sensitization means the nervous system has become more reactive to pain.
That third factor is why a step-by-step return to activity beats long rest for most people past the first few days. It is also why an open-ended “take it easy” is poor advice after the acute (early) window.
Frequently asked questions
How long should a headache last after a head injury?
Most improve over weeks to a few months. Beyond three months, it is treated as a headache disorder, not as ongoing recovery.
When is a headache after a head injury an emergency?
When it is getting worse instead of easing. When there is repeated vomiting, drowsiness, confusion, or any neurological sign. Or any injury on blood thinners. See the box above.
Why has nobody examined my neck?
It is the most common gap in this situation. Neck structures are hurt in the same event. They cause a headache that will not settle on its own.
Should I rest completely?
Only briefly. Past the first few days, a step-by-step return to activity generally does better than long rest.
Can a headache start days after hitting your head?
Yes, and that delay matters. Bleeding under the skull can show up days or even weeks after an injury. Sometimes the person barely remembers the injury at all. This is most likely in older people and in anyone on blood thinners. A new or worsening headache in that window gets checked, not watched. Any head injury on blood thinners is an emergency department visit.
What does a post-traumatic headache feel like?
Most often it looks like migraine or tension-type headache. Those are the same headache types people get without an injury. What marks it as post-traumatic is the timing: it follows a head injury. Most improve over weeks to a few months. When it lasts past three months, it is treated as a headache disorder in its own right. It is no longer an injury that is still healing.
Can pain medicine make a headache after a head injury worse?
Yes. When people are told again and again to give it time, a year can pass before anyone treats the headache actively. By then, a medication overuse layer has often formed on top of the original headache. That layer is often the largest single driver of the pain. Taking it apart is part of treating a headache that has lasted this long.
Related
Sensory symptoms alongside headache have their own short differential.
Past three months, it is a headache disorder, not a recovery
That reframing is usually what unlocks active treatment, and it is often a year overdue.
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Sources
- Ashina H et al. Post-traumatic headache attributed to traumatic brain injury: classification, clinical characteristics, and treatment. The Lancet. Neurology, 2021. PubMed 34022171
- Mavroudis I et al. Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies. Journal of clinical medicine, 2023. PubMed 37445267
- Barlow KM. Post-traumatic headache: An unmet medical need. Headache, 2021. PubMed 34928511
- Rau JC et al. Imaging Post-Traumatic Headache. Current pain and headache reports, 2018. PubMed 30062548