Head Trauma and Headaches

Once upon a time, cartoon characters saw stars. Boxers got punch drunk. Football players had their bells rung. And soldiers were shell shocked. Today we know these innocent-sounding terms describe serious injuries that doctors call concussions, mild traumatic brain injuries or closed head injuries. We also know these injuries are nothing to laugh about.

Doctors often see brain trauma in people who’ve been involved in accidents and falls, but less recognized causes have also captured media attention in recent years. Stories began appearing about former pro-football players dealing with the long-term effects of multiple concussions in the early 1990s. Concerns also began to rise in the mid-2000s as health officials became aware of returning U.S. soldiers who appeared unscathed, but were suffering from the effects of brain trauma caused by powerful blast waves sent out by improvised explosive devices. Studies show that about 20 percent of returning soldiers experienced one or more concussions while serving in Iraq or Afghanistan. 

“With a concussion, there may be no visible signs of injury,” says Shawn Kile, M.D., a Sutter Medical Foundation neurologist who specializes in treating patients with concussions. “And in the case of blast injuries, there might be no direct impact.” 

Concussions are not isolated to activities where trauma is common. According to the Centers for Disease Control and Prevention, approximately 1.6 million to 3.8 million sports- and recreation-related traumatic brain injuries occur in the United States each year. Most of these are mild traumatic brain injuries that are not treated in a hospital or emergency room.

“All contact sports—football, soccer, lacrosse and others—put kids at risk of concussion,” says Sarah Cheyette, M.D., a Palo Alto Medical Foundation neurologist who specializes in children’s headaches, “but without a doubt, I see more concussions in girls who play soccer than I see in both male and female athletes in all other sports combined.”

In his adult patients, Dr. Kile sees a variety of causes, including “a number of patients who suffered concussions from falls, especially tree trimmers and horseback riders.” He adds, “It’s also not unusual to see someone who experienced a concussion after a seemingly minor incident, such as tripping or slipping and falling. The severity of the accident doesn’t always relate to the intensity of the concussion symptoms.”

Post-Concussion Symptoms

While the causes vary, the effects are similar enough to be grouped in a condition that doctors call “post-concussion syndrome.” 

“Headaches are the most common symptom of post-concussion syndrome, but they’re rarely the only symptom,” says Dr. Kile. “Other symptoms can include dizziness, inability to concentrate, memory issues, sleep problems, irritability, anxiety and others. People may have bits and pieces of all of these in varying degrees. But they almost always have headaches.”

 “Post-concussion headaches are often debilitating,” Dr. Kile says. “They’re very intense and typically throb, like a migraine headache. They can include nausea and sensitivity to light and sound, and visual disturbances—all classic migraine symptoms. People with a personal or family history of migraine may have them, but even people with no migraine history get these migraine-like headaches.” 

Treating Post-Concussion Syndrome

These severe headaches are often what bring patients to Dr. Kile’s concussion clinic. “The headaches are the first things we go after when treating post-concussion syndrome,” Dr. Kile says. “Getting the pain under control allows people to sleep better, which is critical to helping the brain recover. Eliminating the headache pain often improves concentration and other symptoms, as well.”

Doctors may also run blood tests to check for deficiencies. “We look for conditions and deficiencies that might hinder brain recovery,” Dr. Kile says, “such as checking thyroid hormone levels and finding deficiencies in B12 or vitamin D. We also encourage patients to eat a healthy diet, which may help recovery.”

Cognitive rehabilitation is another type of therapy sometimes used to treat patients with post-concussion syndrome. Through cognitive training, people strengthen mental skills weakened by the injury. When an injury prevents a person from recovering skills, cognitive therapy helps the brain learn new skills to replace those lost.

Any injury takes time to mend. That’s especially true of brain injuries. Dr. Kile states, “Most people recover within six to 12 months, but about 10 percent of people continue to experience symptoms for years.” 

The recognition of how common concussions are, especially among soldiers and athletes, has spurred research into treatments. “We’re always looking for ways to promote brain healing. For example, a couple of recent studies show that certain amino acids may help optimize neural repair,” Dr. Kile says. “But the most important message people with post-concussion syndrome need to hear is that, with the right care, it’s possible to get symptom relief and promote brain healing.”