by Kellie Pokrifka
Headache is the most common symptom following a brain injury. In those with moderate to severe brain injury, over half of the population will suffer from headache. Interestingly, rates are even higher in populations of those with mild TBI. Over 70% of those with concussion will experience post-traumatic headache.
However, determining the type of headache that occurs after a brain injury can be difficult. All of the subtypes of headache following TBI are considered post-traumatic headache (PTH, PTHA.) Know that PTH is simply a symptom, not a diagnosis. This term states that there is some sort of headache following brain injury, but the term fails to define what is causing the headache and what treatments will be appropriate.
Determining the actual cause of your headache will help guide you to the proper treatments. Common types of PTH involves issues with migraine, cervicogenic (neck), tension, neuritic (nerves), musculoskeletal (muscles), TMJD (jaw joint), and myofascial (soft tissue.) Headaches can also result from medications. Although extremely rare, the possibility of spinal leaks, aneurysms, and brain bleeds need to be considered as they can also result from brain injuries and present as headaches. Note that a patient can have multiple causes of headaches, and that each of them can exacerbate the others.
The mnemonic COLDER can be utilized to help determine the type of headache.
C– Character. What does the headache feel like? Dull and aching or sharp and stabbing?
O– Onset. What triggers the headache? Does it start during intense exercise or does it wake you up in the middle of your sleep?
L-Location. Where exactly does the headache start? Does it stay in one place, or does it continue to spread around your head?
D– Duration. How long does the headache last? Does it come in short bursts or can it last for hours or days?
E– Exacerbation. What makes your headache worse? Is it affected by bright lights? Does exercising cause even greater pain?
R– Relief. What helps your headache, even just slightly? Dark rooms? Caffeine? If your doctor has prescribed medication(s) for your headache, be able to explain the degree of relief and/or the side effects you experience while taking these medications.
While listing your COLDER description to your doctor, be as thorough as possible. Seemingly minor clues can be instrumental to receiving a proper diagnosis. Whether you get relief from a heating pad or from ice, or whether exercise helps ease or spike symptoms can provide your doctor with greater insight into the underlying problem.
We all know that brain injury recovery can be frustratingly complicated. Determining the cause of your headache can be just as much of an uphill battle as finding the proper treatments for your headache. Until we have more thorough research, trial and error is almost always essential to recovery. Be sure that your doctor(s) is truly willing to work with you through this process. Brain injury recovery is far less of a burden when our doctors work alongside us as teammates.
Kellie Pokritka is a TBI survivor and works as an intermediary between the experts and the patients with brain injuries.