Posttraumatic Headache

A variety of nonspecific symptoms may follow closed head injury, regardless of whether consciousness is lost. Headache is often a conspicuous feature. Some authorities believe that psychological factors may be important because there is no correlation of severity of the injury with neurologic signs.
The headache itself usually appears within a day or so following injury, may worsen over the ensuing weeks, and then gradually subsides. It is usually a constant dull ache, with superimposed throbbing that may be localized, lateralized, or generalized. It is sometimes accompanied by nausea, vomiting, or scintillating scotomas.
Disequilibrium, sometimes with a rotatory component, may also occur and is often enhanced by postural change or head movement. Impaired memory, poor concentration, emotional instability, and increased irritability are other common complaints and occasionally are the sole manifestations of the syndrome. The duration of symptoms relates in part to the severity of the original injury, but even trivial injuries are sometimes followed by symptoms that persist for months.
Special investigations are usually not helpful. The electroencephalogram may show minor nonspecific changes, while the electronystagmogram sometimes suggests either peripheral or central vestibulopathy. CT scans or MRI of the head usually show no abnormal findings.
Treatment is difficult, but optimistic encouragement and graduated rehabilitation, depending on the occupational circumstances, are advised. Headaches often respond to simple analgesics, but severe headaches may necessitate treatment with amitriptyline, propranolol, or ergot derivatives.