Headaches Following Traumatic Brain Injury

Headaches are common following a head injury, especially if the child had headaches before the brain injury. If headaches are a problem, encourage the family to keep a headache journal to track frequency and intensity at baseline and after starting medications. This will help identify food or activity triggers and the response to treatment. Headaches can wear the patient down emotionally. Before trying medications, try modalities such as physical therapy or relaxation techniques. Encourage adequate sleep and the avoidance of stress and possible food triggers, such as caffeine, alcohol, and hard cheeses. Headaches caused by brain injury tend to lessen over time, but may still be present 6 to 12 months after injury. [Kirk: 2008]

Common Post-Traumatic Headache Types
  • Tension headaches start at the base of the head or neck, worsen as the day progresses, and may spread over the top of head.
  • Migraine-like headaches are associated with pounding or pulsing pain located in the front of the head, and they can be triggered by stress or intense concentration. These headaches usually require medication.
  • Stabbing headaches have a sudden, sharp pain that can last from a few seconds to 2 minutes. Due to the short duration, they often are not treated; some drugs (usually anti-seizure variety) can help. These are rarely described in children after brain injury.
Treatment Options
  • Physical therapy is especially helpful for the tension type of headache. Exercise, such as swimming in warm water, can help loosen the muscles that contribute to this type of headache.
  • Medication use involves a trial and error approach with patient feedback to find the right medication or combination of medicines. Making certain that patients follow instructions exactly is important. Medications may only reduce (not eliminate) the pain and are used with 2 approaches in mind:
    • Rescue meds are used to control infrequent headaches when they occur. Educate the family that it is easier to treat a headache early, before it gets to maximum strength. Rescue meds are often over-the-counter pain medications such as acetaminophen or ibuprofen. Analgesic rebound headache may occur if the patient is taking these medications more than 3 times per week, and infrequent headaches may become daily headaches. For severe headaches, Midrin or sumatriptan, both of which require prescriptions, may be needed. Children with headaches in school should have medication available to them when the headache starts; it will be up to the medical home to write school prescriptions for rescue medications if necessary.
    • Preventative meds are taken daily for several weeks to gradually decrease the number of headaches or help break up a cycle of frequent headaches. These medications are used when patients are experiencing frequent headaches that affect functioning, e.g., multiple school absences. Medication types include:
      • Anti-depressants (Amitriptyline) can be effective in preventing pain and, in some instances, may help normalize sleep.
      • Anti-epileptics - valproic acid is FDA-approved to treat migraines and effective in about 70% of head-injured patients in preventing headaches; it can cause nausea and weight gain. Topiramate is also FDA-approved to treat migraines; it can cause weight-loss, word-finding problems, or kidney stones.
  • Other considerations:
    • Lying down in a dark, quiet place can relieve a headache.
    • Avoid bright sunlight, especially when going from a relatively dark building into blinding sunlight. A child may need to wear very dark sunglasses.
    • Pay attention to diet, and see if any foods are triggering the headaches.
    • Manage stress - if the child must do something stressful, arrange to do it early in the day.
    • Do not sleep with covers over the face.
    • Do not sleep in a room that is too hot or too cold.
    • Avoid extremely cold foods, such as ice cream.
    • Take preventive medications at the same time every day.


Information & Support

For Professionals

The American Headache Society (AHS)
A professional society of healthcare providers dedicated to the study and treatment of headache and face pain. The Society's objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders.

For Parents and Patients


National Headache Foundation
A nonprofit with comprehensive information on headaches and migraines; focused on support and finding cures.


Information about Food Triggers (WebMD)
Answers to often asked questions about food triggers, migraines, and headaches.


Headache Diaries (ACHE)
Daily, weekly, and monthly formats; American Headache Society's Committee on Headache Education.

Headache Diary (National Headache Foundation)
Simple, printable headache recording form with instructions on its use.

Headache Log (Our Family Doctors) (PDF Document 28 KB)
Printable record with areas to note time of onset, activity prior to headache, location of headache, duration, pain scale, medication taken and its effectiveness, triggers, and associated symptoms.

Helpful Articles

Blume HK.
Headaches after Concussion in Pediatrics: a Review.
Curr Pain Headache Rep. 2015;19(9):516. PubMed abstract

Heyer GL, Young JA, Rose SC, McNally KA, Fischer AN.
Post-traumatic headaches correlate with migraine symptoms in youth with concussion.
Cephalalgia. 2015. PubMed abstract

Authors & Reviewers

Initial publication: November 2008; last update/revision: April 2016
Current Authors and Reviewers:
Authors: Teresa Such-Neibar, DO
Lynne M. Kerr, MD, PhD
Reviewers: Meghan Candee, MD
Gary Nelson, MD

Page Bibliography

Kirk C, Nagiub G, Abu-Arafeh I.
Chronic post-traumatic headache after head injury in children and adolescents.
Dev Med Child Neurol. 2008;50(6):422-5. PubMed abstract