Headache

In speaking to a group of brain injury professionals, I asked for a list of the most common symptoms of brain injury. The one that I wasn't looking for, but which came up first and most often, was headache. The literature agrees that headache is probably the most common symptom after brain injury. Yet, from a forensic standpoint, it is an aspect of the case that is least fascinating, being one that there is virtually no way to quantify, show a footprint of or to clearly pinpoint the cause.

In the research and thought that went into this page, I realized that at least as far as this symptom is concerned, we attorneys have made the same mistake that far too many doctors make.

One reason that we attorneys have little fascination with headache, is that it is the symptom which most often disappears after the acute stage of the injury. Yet, when it does persist into the sub-acute and chronic stage, it not only can have significantly disabling consequences, it can point to serious other problems. Like its soul mate, depression, it often does not correlate to either the severity of the initial diagnosis or the expected time frame for recovery from concussion.

"It has been repeatedly demonstrated that post traumatic headache is most common and indeed often most severe in patients with the least injury." Marc E. Hines, in Varney and Roberts, The Evaluation and Treatment of Mild Brain Injury, ©1999, Lawrence Erlbaum and Associates, at page 375 and 376.

The problem with headache after brain injury is not one of diagnosing the headache, but ascertaining its cause and type. Headache is so common a complaint, its existence too often is not even factored into the overall diagnosis of the patients problems. Also complicating the headache picture, is that by the nature of the biomechanics, most of those who suffer a concussion can be expected to have non-brain injury headaches, as some injury to either the neck or scalp is almost a prerequisite to the type of acceleration / deceleration forces which cause diffuse axonal injury. Both neck and scalp injuries will cause headaches, that are not directly related to injury to the brain.

A sad irony is that headache is one symptom for which effective treatment often exists. And the proper treatment can often relieve the severity of other cognitive complaints. In one study of 129 patients involved with legal claims, only 30 of such patients got treatment for headaches. Of the patients who got no treatment for headache, only 14% returned to work in a reasonable period of time. In contrast, in those who got treatment for headaches, 83% returned to work in a reasonable time, substantially before the settlement of their claims. See The Evaluation and Treatment of Mild Brain Injury beginning at page 382-383, citing studies done by Kelley, R.E.

As a result of the complexity of identifying the cause and ascertaining the type of headache, headaches are most accurately called "post traumatic headaches" as opposed to brain injury headaches. Hines, in his excellent discussion of post traumatic headaches in The Evaluation and Treatment of Mild Brain Injury beginning at page 375, classifies headaches into complex, multiple types. Hines' work is beyond the scope of our treatment here but it is highly recommended to any doctor charged with treating those with post concussion problems. His premise that the physician who listens and "treats whatever is treatable" is one that we must insist all physicians follow.

Yet in what Hines calls this "complex montage of interacting factors", the post-traumatic migraine screams for a specific treatment here.

It is not necessary to have a loss of consciousness to suffer permanent brain injury.

Source: Definition of Mild Traumatic Brain Injury Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87

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