Post Traumatic Headaches: 5 Types

[Polly Prisms]

Have you ever researched and researched information on headaches, and never found anything that describes your post traumatic headaches?  Well, maybe that's because most articles are written for people who have not had a traumatic brain injury. Finally, I have found a wonderful article that describes our headaches perfectly!  Below, is an excerpt from that article. I hope it gives you some insight.

Post-traumatic Headaches: Subtypes and Behavioral Treatments (excerpt)
Thomas Bennett

Type 1:  Steady Pressure With Cap-like Distribution
Type 1 headaches are the most common and persistent variety of headaches that occur after head injury. Patients will often have this type of headache concurrently with one or more of the other types. As indicated, these headaches are described as a steady pressure, often with a cap-like distribution, but more commonly in a circumscribed area elsewhere than the site of the injury. There is usually a deep tenderness present in the neck or shoulder region, and headache can often be reproduced by manual pressure on these tender areas. The intensity of the associated pain is described as being from "mild to very severe". The attacks of pain can recur for many years. Occurring intermittently, the attacks can vary from several hours to as long as ten days duration (Dalessio, 1980).

Type 1 headaches are usually made worse by effort stress, coughing, stooping or turning the head. As a result the patient may be functionally incapacitated for engaging in physical activity related to work or recreation. During periods of severe headache of this sort, patients may experience spinning sensations, dizziness, and photophobia (Dalessio, 1980).

Finally, these headaches are associated with persistent and sustained muscle contraction in the head, neck, upper back, and shoulders. This can be easily demonstrated through electromyographic (EMG) studies that show excessive levels of muscle contraction in these patients. Medically, these headaches are treated with muscle relaxants, analgesics, amiltryptaline, heat, and massage. They often prove to be resistant to treatments.

Type 2:  Circumscribed Tenderness Around Impact Site
Most patients with Type 2 headaches suffer from Type 1 headaches as well. Type 2 patients have a circumscribed, relatively superficial tenderness of the scalp at the site of the original injury which is often, but not always, associated with a visible or palpable scar (Scherokman & Massey, 1983). In most patients who experience this type of pain,
there is spontaneous aching pain at the original site of impact; in some cases, headache pain only occurs when some pressure, such as a hat or a brush, is applied to the site (Dalessio, 1980). Typically, this type of posttraumatic headache pain is described as
being "moderate", and usually it resolves within a year after the original injury. It appears to be related to contusion and injury to the scalp vasculature.

Type 3:  Episodic Aching or Throbbing Pain, Usually Unilateral
Type 3 post-traumatic headaches are described as aching, often throbbing pain, usually unilateral in onset. They occur in attacks and are most commonly reported to occur in the temporal regions. They are also sometimes frontal, occipital, or post auricular. The attacks may be of short duration, and they may represent an intensification of symptoms for patients who also experience a background of Type 1 headache. Reported pain
associated with Type 3 headaches varies from "mild to severe". The intensity of the pain is increased by effort, coughing, bending, or lying down.

Post-traumatic headaches of the Type 3 variety, while usually unilateral often become generalized. They often begin in the morning or are present upon awakening, and they may continue all day. Nausea, vomiting, and anorexia may accompany them. Dalessio (1980) reports that these headaches are not relieved by massage or head but ice bags, cold compresses, and codeine will provide relief. Ergotamine tartrate eliminated this type of pain but did not diminish Type I components resulting from excessive muscle contraction.

Type 3 headaches are vascular in nature, and they are more commonly seen in patients with a migraine history, even if migraines have been rare or infrequent in the past. This type of headache disorder is related to recurrent painful distention of cranial arteries. For many patients, it represents the precipitation of a serious vascular headache (migraine) disorder in a person already at risk.

Type 4:  Episodic, Unilateral Frontotemporal Pain With Ipsilateral Mydriasis and
HyperhidrosisVijayan (1977) has described a type of headache syndrome associated with anterior neck injuries secondary to cervical whiplash (also see Khurana & Nirankari, 1986). In these patients, unilateral, frontotemporal vasodilating headaches are experienced episodically. What makes them unique is that they are accompanied by ipsilateral mydriasis
(excessive dilation of the pupil) and facial hyperhidrosis (excessive sweating). When the pain subsides, the patient is left with ipsilateral ptosis (drooping of the upper eyelid) and miosis (excessive constriction of the pupil). In Vijayan's series, patients experienced between two and 12 of these headaches per month.

Type 4 headaches are related to damage to the third-order sympathetic neuron in the neck; reflect localized sympathetic nervous system dysfunction. Patients with these headaches were helped when treated with the beta adrenergic blocking agent, propranolol, in doses of 20-60 mg per day (Vijayan, 1977); they did not respond to ergotamine.

Type 5:  Pain in Temple or Superior Temple Region
A fifth type of headache syndrome, which also typically is accompanied by Type 1 headaches, is an intermittent recurrent relatively steady pain in the region of the temples or just above. The pain may be unilateral or bilateral, and when it is bilateral, it may be described as a band extending from temple to temple. It is also typically accompanied by jaw popping during chewing, leaving no doubt that it is related to temporomandibular joint (TMJ) dysfunction or injury.

Many people in our society clench their teeth at night (bruxism) in response to stress. An automobile accident that results in a person striking the windshield or dashboard can easily exacerbate ongoing temporomandibular joint degeneration or significantly displace or injure a healthy joint. High resolution computerized tomography has been shown to be vastly superior to conventional radiography in detecting TMJ degeneration in post-traumatic headache patients (Tilds, Miller, & Guidice, 1986). The increasing
availability of magnetic resonance imaging will enhance the detection of these difficulties further.

Treatment of TMJ syndrome, whether posttraumatic or not, may require a multidisciplinary approach including orthodontic and surgical treatments, splint therapy, physical therapy, and biofeedback.


To read the complete article, go to this website:  http://www.neuropsychonline.com/loni/jcrarchives/vol06/v6i2%28benne...

[Polly Prisms]

Aww, Arthur, I do understand that these five types are not the only types of post-traumatic headaches. In fact, I have experienced very severe headaches of a completely different type than these described, myself.  Yes, these are some of the most common ones, but, nonetheless, many neurologists, general practitioners, and others don't seem to have a clue about them. From my experience, they are usually labeled as migraines, cluster headaches, tension headaches, etc. But most of the headaches we experience are really unlike any of them.

This article will not help everyone, but I am hoping that it will help give some relief to some people who are trying to find answers or get the message to those that matter.

[Polly Prisms]

Hi Arthur! Thanks for the compliment about my dog, Apollo. I'll have to get back to you on your post, though. I can only read for short periods of time. :-)  Thanks, again. Polly

Arthur Levine said:

    Hey Polly

    I meant to say, but forgot all about it, that that is a very pretty dog...... My wife goes out of town Sunday evening and comes back Wednesday night.

    Since I would much rather talk about dogs than anything even remotely TBI related..... and as I absolutely love having and being around dogs,  even more than I hate having a TBI......

   Monday morning I am going to look at some Great Pyrenees X Anatolian Sheppard puppies.  I still miss my precious Sasha, my 185 lb 36" tall at her withers and almost 8' tall standing on her hind legs with her paws on my shoulders, and could walk with me for hours GP X AS..... Biggest (but by far not near the heaviest) dog in the county according to all the Sheriffs deputies....

    I have had one of the bigger Malamutes anywhere, but, I have been spoiled by the personality and gentleness and outright responsiveness and train-ability of the Anatolians and Pyrenees.
   Please... DO NOT consider that statement as any sort of suggestion or endorsement that any such giant size dog, especially a Malamute or any kind of LGD is anything that you or anyone else you know have any business even thinking about getting ... IT IS NOT!!! No matter who you are here, neither you, nor most likely anyone you know has any business what-so-ever ever even having any such thoughts.....

   Cyndi says if I ever get another dog that big she is going to kill me, and "kill you dead this time" ..... so if figure if I get a puppy I have somewhere around 1.5 to 2 years left..... though maybe less as they tell me the pups are 10 weeks old and already close to 25 pounds....

    It takes a strange sort of moron, one who has absolutely no fear of any dog anywhere, that can and even stranger, wants to, raise and train a giant dog to be as gentle and easily handled as a smaller Golden Retriever.            

    Apparently one of those morons would be me...

[Polly Prisms]

Arthur, it is so heart-warming to hear you speak about your favorite dog.  Sounds like a GP X AS would be a great companion dog for you. . .maybe not so much for your wife, though. ;-)  My husband used to raise Shetland sheepdogs and collies, and we are definitely dog people, too. Have fun looking at the pups!

Arthur Levine said:

    Hey Polly

    I meant to say, but forgot all about it, that that is a very pretty dog...... My wife goes out of town Sunday evening and comes back Wednesday night.

    Since I would much rather talk about dogs than anything even remotely TBI related..... and as I absolutely love having and being around dogs,  even more than I hate having a TBI......

   Monday morning I am going to look at some Great Pyrenees X Anatolian Sheppard puppies.  I still miss my precious Sasha, my 185 lb 36" tall at her withers and almost 8' tall standing on her hind legs with her paws on my shoulders, and could walk with me for hours GP X AS..... Biggest (but by far not near the heaviest) dog in the county according to all the Sheriffs deputies....

    I have had one of the bigger Malamutes anywhere, but, I have been spoiled by the personality and gentleness and outright responsiveness and train-ability of the Anatolians and Pyrenees.
   Please... DO NOT consider that statement as any sort of suggestion or endorsement that any such giant size dog, especially a Malamute or any kind of LGD is anything that you or anyone else you know have any business even thinking about getting ... IT IS NOT!!! No matter who you are here, neither you, nor most likely anyone you know has any business what-so-ever ever even having any such thoughts.....

   Cyndi says if I ever get another dog that big she is going to kill me, and "kill you dead this time" ..... so if figure if I get a puppy I have somewhere around 1.5 to 2 years left..... though maybe less as they tell me the pups are 10 weeks old and already close to 25 pounds....

    It takes a strange sort of moron, one who has absolutely no fear of any dog anywhere, that can and even stranger, wants to, raise and train a giant dog to be as gentle and easily handled as a smaller Golden Retriever.            

    Apparently one of those morons would be me...

[DENISE ALDRICH]

What an awesome article and vast of information, thanks so much for sharing. I'm printing and sharing with my therapist and case manager. Thanks so much again.

[Polly Prisms]

I'm so glad this article is helpful to you, Denise. I am also going to print it out and take it to my physician.

Best regards,

Polly