Headache After Head Injury

The International Classification of Headache Disorders 3rd edition (ICHD-3) beta definition for HAIH is that the headache starts within 7 days of injury or regaining consciousness.¹ Persistent HAIH lasts at least three months, but long-term follow up of HAIH is challenging. Do individuals hospitalized with head injury have new headaches or exacerbations of pre-existing headaches more often than others?

Data from 2 large epidemiological surveys conducted over 11 years in Norway were used in a population-based cohort study. Nordhaugh and colleagues² examined patient responses from 2 HUNT surveys taken 11 years apart: 294 adults hospitalized with a head injury who had a history of headache: 11.9% minimal, 71.8% mild, 10.9% moderate, no severe head injuries; and 25,662 controls.

Mild head injury significantly linked to: 74% increased risk of new onset headache; 70% increased risk of persistent headache; 93% increased risk of exacerbation of preexisting headache. Results were adjusted for age, sex, anxiety, depression, education, smoking, and alcohol use. No significant differences were seen between women and men.

Individuals with new headache or exacerbation of pre-existing headache for ≥ 3 months after head injury should seek medical advice. These patients may need improved follow up: standardized tools to assess post-traumatic headache are needed as are guidelines. Better head injury prevention strategies may help prevent HAIH. (Note: few individuals with moderate and severe head injury were included in the study; results are uncertain for these groups.)

Medical attention is warranted in patients who experience symptoms of increased intracranial pressure (eg, dizziness, headache, tinnitus, double vision) while on fluoroquinolones or tetracyclines.